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Management of Childhood Glaucoma Following Cataract Surgery

Anne-Sophie Simons1,2, Ingele Casteels1,2, John Grigg3

  • 1Department of Ophthalmology, University Hospitals UZ Leuven, Herestraat 49, 3000 Leuven, Belgium.

Journal of Clinical Medicine
|February 25, 2022
PubMed

Insights

Glaucoma following cataract surgery (GFCS) in children requires careful management. Glaucoma drainage device implantation offers the best long-term intraocular pressure control, while trabeculectomy should be avoided in young or aphakic children.

Area of Science:

  • Ophthalmology
  • Pediatric Surgery
  • Glaucoma Research

Background:

  • Glaucoma following cataract surgery (GFCS) is a significant complication in pediatric patients.
  • Optimal management strategies for GFCS remain a subject of ongoing debate within the medical community.

Purpose of the Study:

  • To review current management options for GFCS.
  • To propose a clinical management strategy for pediatric GFCS cases.

Main Methods:

  • A comprehensive literature search was conducted across four major databases (Cochrane, PubMed, Embase, Web of Science) from 1995 to December 2021.
  • Included studies focused on pediatric eyes with GFCS, treatment outcomes, and a minimum 6-month follow-up.
  • Thirty-nine studies reporting on angle surgery, trabeculectomy, glaucoma drainage device (GDD) implantation, and cyclodestructive procedures were analyzed.

Main Results:

  • Medical therapy is often used as a first-line treatment to temporize before surgical intervention.
  • Multiple surgical procedures may be necessary for adequate GFCS control.
  • Angle surgery (360 degrees) is a less invasive option that can precede GDD implantation.
  • Glaucoma drainage device (GDD) implantation demonstrates the highest efficacy for long-term intraocular pressure control in childhood GFCS, with some advocating for its use as primary surgery.
  • Cyclodestructive procedures can be effective for refractory cases.
  • Trabeculectomy is contraindicated, particularly in children under one year of age and those who are aphakic.

Conclusions:

  • A structured clinical management strategy, including a decision-making flowchart, is proposed for GFCS.
  • Glaucoma drainage device implantation is recommended as a primary or subsequent surgical option for achieving sustained intraocular pressure control in pediatric GFCS.
  • Avoidance of trabeculectomy in specific pediatric populations is crucial.

Keywords:
aphakiacataract surgerychildhood glaucomacyclodestructionglaucoma drainage devicelensectomymanagement (or therapy)pseudophakiatrabeculectomytrabeculotomy

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