Incidence of Glaucoma or Suspected Glaucoma Within the First Year Post-Lensectomy in Children and Treatment Approach to These Patients

Evaluated Data and Patient Population

The study processed data from an international clinical registry containing information on 994 children (1361 eyes) who underwent unilateral or bilateral lens removal at one of 61 centers located in the United States (n = 57), Canada (n = 3), and the United Kingdom (n = 1) between June 2012 and July 2015. Patients met the inclusion criteria if their data were entered into the registry within 45 days after lensectomy and they underwent at least one clinical examination between the 6th and 18th months post-operation. Glaucoma or suspected glaucoma was diagnosed using standard criteria. Statistical analysis was conducted between June 2017 and August 2019.

Out of 702 patients included in this cohort study, 353 (50.3%) were boys, and 427 (60.8%) were white. The average age at the time of lens removal was 3.4 years (range 0.04−12.9 years).

Findings

Glaucoma was diagnosed in 54 out of 970 eyes, with suspected glaucoma present in an additional 14 eyes. The average age at the time of lensectomy for these 66 eyes was 1.9 years (range 0.07−11.2 years). Anti-glaucoma surgery was performed in 23 out of 66 eyes (34.8%) at a median of 3.3 months (range 0.9−14.8 months) post-lensectomy.

The risk of developing glaucoma or suspected glaucoma was 15.7% in the case of 256 eyes of children who were ≤ 3 months old at the time of lensectomy. For 714 eyes of children older than 3 months at the time of surgery, this risk was only 3.4%.

When divided into aphakic and pseudophakic eyes, the risk of developing glaucoma or suspected glaucoma in the group of 438 aphakic eyes was 11.2% versus 2.6% in 532 pseudophakic eyes.

No correlation between the risk of developing glaucoma or suspected glaucoma was observed for any of the following variables: gender, race/ethnic group, laterality of lensectomy, performing anterior vitrectomy, presence of anterior segment abnormalities, or complications during surgery.

Conclusion

The study demonstrated that glaucoma or suspected glaucoma develops in a small number of eyes within the first year post-lensectomy and that in cases of its occurrence, there is likely a correlation with aphakia and younger age at the time of lens removal. Frequent check-ups and targeted monitoring for potential signs of glaucoma are advisable after lensectomy, especially in children who underwent surgery within the first 3 months of life or in children without intraocular lens implantation.

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Source: Freedman S. F., Kraker R. T., Repka M. X. et al. Incidence and management of glaucoma or glaucoma suspect in the first year after pediatric lensectomy. JAMA Ophthalmol 2019 Nov 21, doi: 10.1001/jamaophthalmol.2019.4571 [Epub ahead of print].