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Meta-Analysis
. 2019 Apr 1;14(4):e0214684.
doi: 10.1371/journal.pone.0214684. eCollection 2019.

The role of primary intraocular lens implantation in the risk of secondary glaucoma following congenital cataract surgery: A systematic review and meta-analysis

Shuo Zhang  1   2 , Jiaxing Wang  3 , Ying Li  3 , Ye Liu  4 , Li He  5 , Xiaobo Xia  1   2
Affiliations
Meta-Analysis

The role of primary intraocular lens implantation in the risk of secondary glaucoma following congenital cataract surgery: A systematic review and meta-analysis

Shuo Zhang et al. PLoS One. .

Abstract

Objective: This meta-analysis aims to evaluate the incidence of secondary glaucoma in patients under the age of 2 years who underwent congenital cataract surgery with or without primary intraocular lens (IOL) implantation.

Methods: An electronic literature search was performed in Medline, EMBASE, and Web of Science databases to retrieve studies between January 2011 and November 2018. Patients with congenital cataract who did primary IOL implantation, aphakia, or secondary IOL implantation followed by receiving extraction surgery were included in this study. Relevant studies meeting defined eligibility criteria were selected and reviewed systematically by meta-analysis. Long-term incidences of secondary glaucoma, which developed at least one year after cataract surgery, were considered and discussed as clinical outcomes in each cohort. The pooled data were analyzed according to a random effects model.

Results: Eight publications involving 892 eyes were included in the current meta-analysis. In the general population of eyes with congenital cataract, the long-term incidence of secondary glaucoma was lower (P = 0.06) in eyes with primary IOL (9.5%) than in eyes without primary IOL (15.1%), including aphakia and secondary IOL. The pooled risk ratio (RR) favors primary IOL implantation in all patients (RR = 0.63). For bilateral congenital cataract, the incidence was 6.7% in eyes with primary IOL implantation, which is significantly lower than the 16.7% in eyes with aphakia and secondary IOL implantation (P<0.05, RR = 0.44). However, for unilateral congenital cataract surgery, the incidence was very similar in eyes with and without primary IOL (12.4% vs 12.0%, P = 0.61, RR = 0.87).

Conclusions: In patients under 2 years of age, primary IOL implantation for bilateral congenital cataract surgery is associated with a lower risk of secondary glaucoma.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart of the literature search and the study selection process for the meta-analysis.
Fig 2
Fig 2. Forest plots describing the treatment effects in all congenital cataract cases.
A. Development of secondary glaucoma after primary IOL implantation versus aphakia. B. Primary IOL implantation versus aphakia and secondary IOL implantation regarding the development of secondary glaucoma.
Fig 3
Fig 3. Forest plots describing the effects of treatments in patients with bilateral congenital cataract.
A. Primary IOL implantation versus aphakia alone regarding the development of secondary glaucoma. B. Development of secondary glaucoma in primary IOL implantation versus aphakia and secondary IOL implantation.
Fig 4
Fig 4. Forest plots describing the treatment effects in subpopulations with unilateral congenital cataract.
A. Development of secondary glaucoma in primary IOL implantation versus aphakia alone. B. Primary IOL implantation versus aphakia and secondary IOL implantation regarding the development of secondary glaucoma.
See this image and copyright information in PMC

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