Regional EuroTimes
Date Posted 14/09/2009
Congenital cataract surgery at very young age does not increase risk of glaucoma
Congenital cataract surgery in very young patients does not appear to increase the incidence of glaucoma compared to surgery performed later in life, according to a retrospective study reported by Andrew J Tatham MB, ChB, MRCOphth, Leicester Royal Infirmary, UK at the first World Congress of Paediatric Ophthalmology and Strabismus, which took place at the XXVII Congress of the ESCRS.
The case-note review study included data from 90 children who underwent surgery for congenital cataracts at an age of 14 years or less over a 20-year period from 1987 to 2007.
It showed that only two eyes of one patient developed glaucoma over 5.3 years of follow-up and that there was no significant difference in the incidence of the condition, whether the surgery was performed at age 50 days or less, 51 days to one year, or at age one to 14 years.
That is, among 18 eyes of 13 children who underwent surgery at less than 50 days of age none had developed glaucoma after a mean follow-up period of 7.5 years. Among 28 children aged 51 days to one year at time of surgery, one patient developed glaucoma in both eyes and among those one to 14 years old none developed glaucoma.
“The incidence of glaucoma in our series was lower than in previous reports, 44 were operated on during the first year and just two eyes developed glaucoma as we know with aphakic glaucoma it often has poor prognosis and our child was no exception. He had bilateral lens extraction at five months and developed glaucoma at age 12 despite regular outpatient visits, IOP checks, disc examinations,” Dr Tatham said.
Dr Tatham noted that in 11 recent series of aphakic glaucoma the incidence ranged from 3.7 per cent to over 50 per cent. The reason for such a large variation in the studies remains unclear.
He pointed out that the follow-up in his study compared favourably with others and that apart from four patients lost to follow-up, all were examined for possible glaucoma. A possible factor may have been the surgical technique used, which aimed to remove as much lens material as possible thereby reducing postoperative inflammation.
“It seems that factors other than the age at time of surgery determines whether they will develop glaucoma or not. We don’t understand the mechanism very well perhaps when we understand the mechanism better we will understand the risk factors better,” Dr Tatham concluded.
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