Management of Childhood Glaucoma Following Cataract Surgery

Abstract

Glaucoma remains a frequent serious complication following cataract surgery in children. The optimal approach to management for 'glaucoma following cataract surgery' (GFCS), one of the paediatric glaucoma subtypes, is an ongoing debate. This review evaluates the various management options available and aims to propose a clinical management strategy for GFCS cases. A literature search was conducted in four large databases (Cochrane, PubMed, Embase, and Web of Science), from 1995 up to December 2021. Thirty-nine studies-presenting (1) eyes with GFCS; a disease entity as defined by the Childhood Glaucoma Research Network Classification, (2) data on treatment outcomes, and (3) follow-up data of at least 6 months-were included. Included papers report on GFCS treated with angle surgery, trabeculectomy, glaucoma drainage device implantation (GDD), and cyclodestructive procedures. Medical therapy is the first-line treatment in GFCS, possibly to bridge time to surgery. Multiple surgical procedures are often required to adequately control GFCS. Angle surgery (360 degree) may be considered before proceeding to GDD implantation, since this technique offers good results and is less invasive. Literature suggests that GDD implantation gives the best chance for long-term IOP control in childhood GFCS and some studies put this technique forward as a good choice for primary surgery. Cyclodestruction seems to be effective in some cases with uncontrolled IOP. Trabeculectomy should be avoided, especially in children under the age of one year and children that are left aphakic. The authors provide a flowchart to guide the management of individual GFCS cases.

Keywords: aphakia; cataract surgery; childhood glaucoma; cyclodestruction; glaucoma drainage device; lensectomy; management (or therapy); pseudophakia; trabeculectomy; trabeculotomy.

Figure 1

Glaucoma Following Cataract Surgery based on Childhood Glaucoma Research Network classification algorithm. Childhood: based on national criteria, <18 years old (USA); <16 years old (UK, Europe, UNICEF) (reproduced with permission from Grajewski, World Glaucoma Association Consensus Series 9: Childhood glaucoma, Kugler publications 2013 [5]). Abbreviations: IOP = Intra-Ocular Pressure.

Figure 2

Literature search: PRISMA Consort flow diagram. According to THE PRISMA Statement 2009 [19]. Abbreviations: PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses; n = amount of articles.

Figure 3

Suggested flowchart for the management of childhood GFCS with open-angle configuration (adapted with permission from Grigg, World Glaucoma Association Consensus Series 9: Childhood glaucoma, Kugler publications 2013 [16]). Abbreviations: IOP = Intra-Ocular Pressure; MMC = Mitomycin C; y = years; GDD = Glaucoma drainage device; PAS = peripheral anterior synechiae.