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. 2023 Apr 1;141(4):324-331.
doi: 10.1001/jamaophthalmol.2022.6413.

Incidence of Glaucoma-Related Adverse Events in the First 5 Years After Pediatric Lensectomy

Erick D Bothun  1 , Michael X Repka  2 , Raymond T Kraker  3 , Rui Wu  3 , David A Leske  1 , Sarah R Hatt  1 , Zhuokai Li  3 , Sharon F Freedman  4 , William F Astle  5 , Susan A Cotter  6 , Jonathan M Holmes  7 ; Pediatric Eye Disease Investigator Group
Collaborators, Affiliations

Incidence of Glaucoma-Related Adverse Events in the First 5 Years After Pediatric Lensectomy

Erick D Bothun et al. JAMA Ophthalmol. .

Abstract

Importance: Glaucoma can develop following cataract removal in children.

Objective: To assess the cumulative incidence of glaucoma-related adverse events (defined as glaucoma or glaucoma suspect) and factors associated with risk of these adverse events in the first 5 years after lensectomy prior to 13 years of age.

Design, setting, and participants: This cohort study used longitudinal registry data collected at enrollment and annually for 5 years from 45 institutional and 16 community sites. Participants were children aged 12 years or younger with at least 1 office visit after lensectomy from June 2012 to July 2015. Data were analyzed from February through December 2022.

Exposures: Usual clinical care after lensectomy.

Main outcomes and measures: The main outcomes were cumulative incidence of glaucoma-related adverse events and baseline factors associated with risk of these adverse events.

Results: The study included 810 children (1049 eyes); 443 eyes of 321 children (55% female; mean [SD] age, 0.89 [1.97] years) were aphakic after lensectomy, and 606 eyes of 489 children (53% male; mean [SD] age, 5.65 [3.32] years) were pseudophakic. The 5-year cumulative incidence of glaucoma-related adverse events was 29% (95% CI, 25%-34%) in 443 eyes with aphakia and 7% (95% CI, 5%-9%) in 606 eyes with pseudophakia; 7% (95% CI, 5%-10%) of aphakic eyes and 3% (95% CI, 2%-5%) of pseudophakic eyes were diagnosed as glaucoma suspect. Among aphakic eyes, a higher risk for glaucoma-related adverse events was associated with 4 of 8 factors, including age less than 3 months (vs ≥3 months: adjusted hazard ratio [aHR], 2.88; 99% CI, 1.57-5.23), abnormal anterior segment (vs normal: aHR, 2.88; 99% CI, 1.56-5.30), intraoperative complications at time of lensectomy (vs none; aHR, 2.25; 99% CI, 1.04-4.87), and bilaterality (vs unilaterality: aHR, 1.88; 99% CI, 1.02-3.48). Neither of the 2 factors evaluated for pseudophakic eyes, laterality and anterior vitrectomy, were associated with risk of glaucoma-related adverse events.

Conclusions and relevance: In this cohort study, glaucoma-related adverse events were common after cataract surgery in children; age less than 3 months at surgery was associated with elevated risk of the adverse events in aphakic eyes. Children with pseudophakia, who were older at surgery, less frequently developed a glaucoma-related adverse event within 5 years of lensectomy. The findings suggest that ongoing monitoring for the development of glaucoma is needed after lensectomy at any age.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Repka reported receiving grants from the National Eye Institute (NEI) and served as a scientific consultant to Alcon during the conduct of the study. Mr Kraker reported receiving grants from the NEI during the conduct of the study. Mr Wu reported receiving grants from the Jaeb Center for Health Research during the conduct of the study. Mr Leske reported receiving grants from the NEI and the Mayo Foundation for Medical Research during the conduct of the study. Dr Li reported receiving grants from the NEI during the conduct of the study. Dr Freedman reported being a scientific consultant for Qlaris Bio, Inc and a scientific investigator for the Pediatric Eye Disease Investigator Group outside the submitted work. Dr Cotter reported receiving grants from the NEI during the conduct of the study. Dr Holmes reported receiving grants from National Institutes of Health during the conduct of the study and outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Cumulative Incidence of Glaucoma-Related Adverse Events in Aphakic vs Pseudophakic Eyes
Shaded areas indicate 95% CIs.
Figure 2.
Figure 2.. Development of Glaucoma-Related Adverse Events (AEs) According to Characteristics at Time of Lensectomy Among Children With Aphakic Eyes
A Cox proportional hazards regression model was used to estimate the 5-year cumulative incidence of glaucoma-related AEs. The robust sandwich variance estimator was used to adjust for the correlation between eyes of participants who contributed data from both eyes to the analysis. The date of the glaucoma-related AE was not collected, so the date of the most recent office visit at which the complication was reported was used to estimate the cumulative incidence. Office visits were included in the analysis if reported up to 5.5 years following lensectomy to estimate the cumulative incidence (referred to as 5-year incidence). Hazard ratios (HRs) are adjusted estimates from a Cox proportional hazards regression model including all factors listed as categorical covariates. P ≤ .01 was considered significant. Observations with missing or unknown values in any of the subgroup factors were not included in the model.
Figure 3.
Figure 3.. Development of Glaucoma-Related Adverse Events (AEs) According to Characteristics at Time of Lensectomy Among Children With Pseudophakic Eyes
A Cox proportional hazards regression model was used to estimate the 5-year cumulative incidence of glaucoma-related AEs. The robust sandwich variance estimator was used to adjust for the correlation between eyes of participants who contributed data from both eyes to the analysis. The date of the glaucoma-related AE was not collected, so the date of the most recent office visit at which the complication was reported was used to estimate the cumulative incidence. Office visits were included in the analysis if reported up to 5.5 years following lensectomy to estimate the cumulative incidence (referred to as 5-year incidence). Hazard ratios (HRs) are adjusted estimates from a Cox proportional hazards regression model. The model was limited to 3 factors as categorical (laterality, anterior vitrectomy, and both). If the factor of interest was laterality or anterior vitrectomy, only 2 factors were included in the model. P ≤ .01 was considered significant. Observations with missing or unknown values in any of the subgroup factors were not included in the model.
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