alexa Glaucoma following congenital cataract surgery--the role of early surgery and posterior capsulotomy.


Optometry: Open Access

Author(s): Michaelides M, Bunce C, Adams GG, Michaelides M, Bunce C, Adams GG

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Abstract BACKGROUND: To determine the rate of glaucoma following congenital cataract surgery at Moorfields Eye Hospital (MEH), and to investigate potential risk factors for glaucoma in our case series. METHODS: A retrospective case notes review was undertaken of all congenital cataract lensectomies performed at MEH between 1994 and 2000. The following parameters were ascertained: age at surgery, unilateral or bilateral cataract, whether a posterior capsulotomy (PC) was performed at the time of surgery, whether an intraocular lens (IOL) was inserted, duration of follow-up, and if aphakic glaucoma (AG) developed. All lensectomies were performed through a limbal incision by a single consultant surgeon. RESULTS: A total of 47 subjects were identified - 40 patients with bilateral cataracts and 7 with unilateral. Of the 40 bilateral cataract patients, 76 eyes had lensectomies; with 37 of these patients (71 lensectomies) having at least 5 year follow-up. Based on patient count, the 5 year risk of AG in at least one eye following surgery was 21.6\%. Based on eye count, the 5 year risk of AG after lensectomy was 15.5\%. The average age at surgery of patients who did not develop AG, and had at least 5 years follow-up, was 28.7 months (range 2 weeks to 6 years), with 20\% having surgery within the first month of life. In comparison, the average age at surgery of patients with at least 5 years follow-up, who developed AG was 1.6 months (range 2 weeks to 7 months), with 60\% having surgery within the first month of life. In subjects with at least 5 years follow-up, a PC rate of 100\% was identified in the eyes that developed AG, compared to 61\% in eyes that did not develop AG. An IOL was inserted in O\% of eyes with AG, compared to 57\% in eyes that did not develop AG. Onset of AG ranged from one month post surgery to 7 years, with an average yearly incidence of 5.3\%. CONCLUSION: Early surgery in patients with bilateral cataracts is associated with a marked increase in risk of AG. Our data suggest that an intact posterior capsule may be associated with a lower rate of AG.
This article was published in BMC Ophthalmol and referenced in Optometry: Open Access

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