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Glaucoma-related adverse events in the Infant Aphakia Treatment Study: 1-year results
Allen D Beck1, Sharon F Freedman, Michael J Lynn
1Emory Eye Center, Atlanta, GA 30322, USA. abeck@emory.edu
Insights
Congenital cataract surgery in infants increases glaucoma risk, especially in younger patients or those with persistent fetal vasculature. Vigilance for glaucoma is crucial in the first year post-surgery.
Area of Science:
- Ophthalmology
- Pediatric Surgery
Background:
- The Infant Aphakia Treatment Study (IATS) investigated outcomes of congenital cataract surgery.
- Congenital cataracts require early surgical intervention, often in infancy.
Purpose of the Study:
- To determine the incidence of glaucoma and glaucoma suspects in the IATS.
- To identify risk factors for glaucoma-related adverse events after congenital cataract surgery in infants.
Main Methods:
- 114 infants (1-6 months) with unilateral congenital cataracts underwent surgery with or without intraocular lens (IOL) implantation.
- Standardized definitions for glaucoma and glaucoma suspect were applied.
- Follow-up data was collected for the first year post-surgery.
Main Results:
- 12% of patients developed a glaucoma-related adverse event within the first year.
- The incidence was 9% with lensectomy/vitrectomy and 16% with IOL implantation.
- Risk factors included persistent fetal vasculature (3.1x higher odds) and younger age at surgery (1.6x higher odds per month).
Conclusions:
- Congenital cataract surgery, with or without IOLs, does not eliminate the risk of early glaucoma development.
- Infants undergoing surgery at a younger age or with persistent fetal vasculature face a higher risk.
- Close monitoring for glaucoma is essential after congenital cataract surgery, particularly in high-risk infants.
Objectives:
To report the incidence of glaucoma and glaucoma suspects in the IATS, and to evaluate risk factors for the development of a glaucoma-related adverse event in patients in the IATS in the first year of follow-up.
Methods:
A total of 114 infants between 1 and 6 months of age with a unilateral congenital cataract were assigned to undergo cataract surgery either with or without an intraocular lens implant. Standardized definitions of glaucoma and glaucoma suspect were created and used in the IATS.
Results:
Of these 114 patients, 10 (9%) developed glaucoma and 4 (4%) had glaucoma suspect, for a total of 14 patients (12%) with a glaucoma-related adverse event in the treated eye through the first year of follow-up. Of the 57 patients who underwent lensectomy and anterior vitrectomy, 5 (9%) developed a glaucoma-related adverse event; of the 57 patients who underwent an intraocular lens implant, 9 (16%) developed a glaucoma-related adverse event. The odds of developing a glaucoma-related adverse event were 3.1 times higher for a child with persistent fetal vasculature and 1.6 times higher for each month of age younger at cataract surgery.
Conclusions:
Modern surgical techniques do not eliminate the early development of glaucoma following congenital cataract surgery with or without an intraocular lens implant. Younger patients with or without persistent fetal vasculature seem more likely to develop a glaucoma-related adverse event in the first year of follow-up. Vigilance for the early development of glaucoma is needed following congenital cataract surgery, especially when surgery is performed during early infancy or for a child with persistent fetal vasculature. Five-year follow-up data for the IATS will likely reveal more glaucoma-related adverse events.
Trial Registration:
clinicaltrials.gov Identifier: NCT00212134.
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