Study Links Pediatric Cataract Surgery to Glaucoma-Related Adverse Events

A recent study published in JAMA Ophthalmology revealed that cataract surgery in children can result in glaucoma-related adverse events (AEs). The study also found that patients below 3 months of age are at a higher risk of developing AEs in aphakic eyes following cataract surgery.

Between June 2012 and July 2015, the Pediatric Eye Disease Investigator Group conducted a study on children who had undergone lensectomy prior to the age of 13 years. The study aimed to assess the 5-year cumulative incidence of glaucoma-related adverse events (AEs) following cataract surgery and the associated risk of developing such AEs within 5 years.

The study was designed as a clinical research registry, and data were collected through medical record review at enrollment, including medical and ophthalmic data. Both eyes were included in the study if lensectomy was performed on both eligible eyes, and only children aged 12 years or younger who had undergone lensectomy within the previous 45 days were enrolled in the registry.

The study participants were categorized based on whether they had undergone unilateral or bilateral lensectomy. Glaucoma was defined as an intraocular pressure (IOP) higher than 21 mm Hg and the presence of one of the following: abnormal corneal enlargement, increased optic nerve cupping, use of medication to lower IOP, or previous glaucoma surgery. The study investigators also defined glaucoma suspect as a participant with an IOP greater than 21 mm Hg but without any criterion for glaucoma.

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%).

Although the study findings indicated a higher risk of glaucoma-related adverse events (AEs) in aphakic eyes within 5 years of lensectomy, the researchers noted limitations that could affect generalizability.

These limitations include the lack of age overlap between the cohorts, a different definition of glaucoma than the Childhood Glaucoma Consensus and other studies, and a significant loss of completion for a full 5 years of follow-up. Additionally, the study found that children younger than 3 months had an increased risk of glaucoma-related AEs.

Reference

Erick D. Bothun et al, Incidence of Glaucoma-Related Adverse Events in the First 5 Years After Pediatric Lensectomy, JAMA Ophthalmology (2023). DOI: 10.1001/jamaophthalmol.2022.6413

Eric Crouch, Glaucoma Considerations in Pediatric Cataract Surgery, JAMA Ophthalmology (2023). DOI: 10.1001/jamaophthalmol.2023.0001