Postoperative glaucoma is perhaps the most feared complication after paediatric cataract surgery, as it is difficult to control. Paediatric glaucoma is also challenging to diagnose, and different definitions of glaucoma have led to a rather big range of reported incidences of this disease. It can occur soon after surgery, in which case it is usually closed-angle glaucoma, or it can have a late onset, even more than a decade after surgery, and its aetiopathogenesis remains unclear to this day. There is significant controversy as to what the risk factors are for developing it, especially regarding intraocular lens implantation. The vast majority of studies show that an earlier age at surgery confers a higher risk. Medical and surgical treatment of aphakic/pseudophakic glaucoma can be successful; however, management often requires repeated procedures with or without multiple medications, and the prognosis is guarded. The visual outcome depends on sufficient intraocular pressure control and management of concurrent amblyopia.
Chen et al . (Ophthalmic Surg Lasers Imaging2005;36(1):6-13) reported that aphakic glaucoma (AG) was the most common postoperative complication (20.2%) of lensectomy in pediatric cataracts.
Vishwanath et al . (Br J Ophthalmol. 2004;88(7):905-10) reported that bilateral lensectomy during the first month of life is associated with a higher risk of subsequent glaucoma than surgery performed later. They suggested that it may be prudent, in bilateral cases, to consider delaying surgery until the infant is 4 weeks old.
Trivedi et al . (JAAPOS 2006;10(2):117-23) concluded that patients undergoing cataract surgery with or without IOL implantation at an early age are at high risk for development of glaucoma.
Swamy et al . (Br J Ophthalmol.2007;91(12):1627-30) reported secondary glaucoma as an important sequela following surgery for congenital cataracts. They concluded that these patients should have lifelong surveillance, as glaucoma can occur years after surgery.
Michaelides et al . (BMC Ophthalmol. 2007;7:13) also reported that early surgery in patients with bilateral cataracts is associated with a marked increase in risk of AG. They suggested that an intact posterior capsule may be associated with a lower rate of AG.
Khan et al . (JAAPOS 2009;13(2):166-9) noted that the lowest relative risk for later AG in their cohort was for surgery performed at 3-4 months of age.
Kirwan et al . (Acta Ophthalmol. 2010;88(1):53-9) noted that surgery for congenital cataract at an early age increases the risk of glaucoma development, regardless of whether the eye is aphakic or pseudophakic.
Tatham et al . (Eye 2010 Apr 23 [Epub ahead of print]), in a 20-year retrospective study, noted that factors other than age at surgery are important risk factors for glaucoma in these eyes.
Sinha, Rajesh, et al. “Management of congenital cataract: A review.” Indian Journal of Ophthalmology, vol. 58, no. 6, Nov.-Dec. 2010, p. 563. Gale Academic OneFile, https://link-gale-com.i.ezproxy.nypl.org/apps/doc/A241320149/AONE?u=nypl&sid=AONE&xid=80b30689. Accessed 22 Mar. 2020.
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