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Long-term outcome of pediatric aphakic glaucoma
Rahul Bhola1, Ronald V Keech, Richard J Olson
1Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52246, USA.
Insights
Pediatric aphakic glaucoma patients can achieve good vision long-term, but often require multiple medications and surgeries for intraocular pressure control. This study tracked outcomes for these complex cases.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Glaucoma Research
Background:
- Aphakic glaucoma, a serious complication following pediatric cataract surgery, presents unique management challenges.
- Long-term visual outcomes and treatment requirements in this specific patient population are not well-defined.
Purpose of the Study:
- To evaluate the long-term visual acuity and treatment outcomes in pediatric patients diagnosed with aphakic glaucoma.
- To identify the frequency of medication adjustments and surgical interventions needed for managing intraocular pressure.
Main Methods:
- Retrospective analysis of 36 pediatric patients (55 eyes) with aphakic glaucoma, diagnosed between 1969 and 2004.
- Inclusion criteria excluded patients with other ocular conditions, syndromes, or inadequate follow-up (minimum 1 year).
- Outcome measures included visual acuity, medication changes, maximum medication use, and surgical interventions over a mean follow-up of 18.7 years.
Main Results:
- At final follow-up, 54.5% of patients achieved visual acuity of 20/40 or better.
- A significant proportion required multiple medication adjustments (66% needed 3+ changes) and sustained high medication use (64% required 3+ medications).
- Twenty-seven percent of eyes (15/55) underwent surgical intervention, with 40% requiring 1 surgery and 53% needing 2-3 surgeries.
Conclusions:
- Pediatric aphakic glaucoma can have favorable long-term visual outcomes.
- Effective management frequently necessitates aggressive medical therapy with multiple medications and may require repeated surgical interventions to control intraocular pressure.
Purpose:
To determine the long-term outcome in pediatric patients with aphakic glaucoma.
Methods:
A retrospective analysis of 130 patients diagnosed with aphakic glaucoma between 1969 and 2004 was performed. A total of 36 patients (55 eyes) were included in this study after excluding those who had cataract extraction after age 10 and those patients with other ocular conditions, systemic syndromes, traumatic cataracts, congenital glaucoma, or inadequate follow-up (less than 1 year). Outcome variables studied included visual acuity, number of medication changes required over the course of the follow-up, maximum number of medications used at a time for more than 6 months to control intraocular pressures, and surgical interventions required. Mean follow-up period was 18.7 years (range, 6.9-35 years).
Results:
At the time of last follow-up, 54.5% of the patients had visual acuity 20/40 or better, 34.5% had 20/50 to 20/200, and 11% had acuity worse than 20/200. During the course of follow-up, 34% required 1 to 2 medication changes for controlling glaucoma, 33% required 3 to 5 medication changes, and 33% required 6 or more medication changes. Thirty-six percent of the eyes required a maximum of 1 to 2 medications for more than 6 months during the course of follow-up, 33% required 3, and 31% required 4 or more medications for controlling intraocular pressure. Of the 55 eyes, 15 eyes (27%) required surgical intervention. Six of the 15 eyes (40%) required 1 surgery, 8 eyes (53%) required 2 to 3 surgeries, and 1 eye (7%) required 4 to 6 surgeries.
Conclusion:
Patients with glaucoma after pediatric cataract surgery can have a good visual outcome although multiple medications and surgical interventions may be required to control the glaucoma.
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