Timing of diagnosis and treatment of glaucoma following infantile cataract surgery

PURPOSE:To report timing of diagnosis and treatment of glaucoma following cataract surgery (GFCS) in a large cohort of infants undergoing cataract surgery at a tertiary care center. STUDY DESIGN:Cross-sectional study PARTICIPANTS: All consecutive infants that underwent cataract surgery over a 30-year period from January1991 to December 2021 were included if they had at least one year follow-up. METHODS:The data collection included age at time of cataract surgery, presence of associated ocular or systemic conditions, age at diagnosis of GFCS, and treatment required to control GFCS. Glaucoma diagnosis required intraocular pressure (IOP) > 21 mm Hg on more than 2 visits with glaucomatous optic nerve head changes and/or visual field changes, or in young children, other anatomic changes such as corneal enlargement or haze or accelerated axial elongation and myopic shift. OUTCOME MEASURES:The incidence of GFCS was calculated. Linear regression was performed to assess the effect of age at time of cataract surgery. Analysis of risk factors and treatment modalities was performed using univariate and multivariate analysis. RESULTS:383 eyes (260 patients) were analyzed. Median age at surgery was 52 days and median follow-up, 8 years. GFCS was noted in 27% (104/383 eyes; median age at surgery, 45 days; median follow-up, 13 years.) Young age at surgery (< 3 months) was the greatest risk factor (p=0.001) but the incidence was similar for infants operated in the first, second, or third month of life (25%, 36%, 40%, respectively, p=0.4). Microcornea (41%, p<0.0001), poorly dilating pupils (25%, p=0.001), persistent fetal vasculature (PFV, 13%, p=0.8), or anterior segment dysgenesis (3%, p=0.02) were considered as additional risk factors. Surgical intervention was needed for 73% (24/33) eyes with early onset GFCS compared to 14% (10/71) eyes with later onset GFCS (p=0.0001). Medical treatment was effective in 86% with later onset GFCS (p=0.006). CONCLUSION:The incidence of GFCS was 27%, and timing of diagnosis occurred in a bimodal fashion. Early onset GFCS usually requires surgical intervention; medical treatment is effective for later onset GFCS. Cataract surgery within the first 3 months of life, microcornea and poor dilating pupils were major risk factors.