Cataract Surgery in Children Commonly Led to Glaucoma-Related Adverse Events

Cataract surgery led to glaucoma-related adverse events (AEs) in children, according to study findings published in JAMA Ophthalmology, and among patients younger than 3 months, there was an elevated risk of AEs in aphakic eyes after cataract surgery.

The Pediatric Eye Disease Investigator Group collected data on children who had lensectomy prior to age 13 years in a 5-year span. This study assessed the 5-year cumulative incidence for glaucoma-related AEs that were associated with risk of glaucoma-related AEs within 5 years of a cataract surgery.

The study was designed as a clinical research registry, and medical record review at enrollment was used to collect medical and ophthalmic data. Both eyes were included if a lensectomy was performed on both eligible eyes. Children who were 12 years or younger and had a lensectomy in the previous 45 days between June 2012 and July 2015 were enrolled in the registry.

All participants were identified as having a unilateral or bilateral lensectomy. Glaucoma was defined as having an intraocular pressure (IOP) that was greater than 21 mm Hg and having one of the following: abnormal corneal enlargement, increased optic nerve cupping, use of medication to reduce IOP, or glaucoma surgery. Glaucoma suspect was defined as a participant having an IOP greater than 21 mm Hg, "in the absence of a criterion for glaucoma," the study investigators noted.

There were 810 children and 1049 eyes that were included in this study. There were 443 eyes (55% female; mean [SD] age, 0.89 [1.97] years) that were aphakic after lensectomy and 606 eyes (47% female; mean age, 5.65 [3.32] years) that were pseudophakic. The median age at first lens surgery was 0.21 (range, 0.04-12.40) years in aphakic eyes and 5.32 (range, 0.13-12.98) years in pseudophakic eyes.

Seventy-four percent of aphakic eyes were from children who were younger than 6 months when they had their lensectomy. Anterior segment abnormalities were reported twice as often in children with aphakia vs pseudophakia (14% vs 7%). Nearly every aphakic eye had anterior vitrectomy at the lens surgery vs pseudophakic eyes (97% vs 59%).

Glaucoma-related AEs incidence rate in a 5-year period was 29% (95% CI, 25%-35%) in 443 eyes with aphakia and 7% (95% CI, 5%-9%) in 606 eyes with pseudophakia. There were 7% of aphakic eyes and 3% of pseudophakic eyes that were glaucoma suspect; 11% of children with glaucoma-related AEs after bilateral surgery had AEs in 1 eye and 77% had reported AEs in both.

Children younger than 3 months had a higher risk of glaucoma-related AEs within 5 years (adjusted HR [aHR], 2.88; 99% CI, 1.57-5.23), abnormal anterior segment (aHR, 2.8; 99% CI, 1.56-5.30), intraoperative complications at time of lensectomy (aHR, 2.25; 99% CI, 1.04-4.87), and bilaterality (aHR, 1.88; 99% CI, 1.02-3.48).

Infants younger than 6 weeks at lensectomy had the highest rates of glaucoma-related AEs (44%; 95% CI, 35%-53%), and infants 6 weeks to less than 3 months had the next highest (35%, 95% CI, 28%-44%). Fewer children with pseudophakic eyes developed a glaucoma-related AE within 5 years (5%).

A lack of overlap in age between the cohorts, the definition of glaucoma used in this study being different than the Childhood Glaucoma Consensus and other studies, and a substantial loss of completion for a full 5 years of follow-up were cited as limitations on generalizability of these study findings

The researchers concluded that aphakic eyes more commonly had glaucoma-related AEs within 5 years of lensectomy, with children younger than 3 months having an elevated risk of glaucoma-related AEs.

Reference

Bothun ED, Repka MX, Kraker RT, et al. Incidence of glaucoma-related adverse events in the first 5 years after pediatric lensectomy. JAMA Ophthalmol. Published online February 16, 2023. doi:10.1001/jamaophthalmol.2022.6413