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Incidence of Glaucoma-Related Adverse Events in the First 5 Years After Pediatric Lensectomy
Erick D Bothun1, Michael X Repka2, Raymond T Kraker3
1Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
Insights
Glaucoma complications are common after pediatric cataract surgery. Aphakic eyes face higher risks, especially when surgery occurs before 3 months of age, necessitating vigilant monitoring.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Glaucoma Research
Background:
- Cataract removal (lensectomy) in children can lead to glaucoma development.
- Early detection and risk factor assessment are crucial for managing post-lensectomy glaucoma.
Purpose of the Study:
- To determine the incidence of glaucoma-related adverse events within 5 years after pediatric lensectomy.
- To identify risk factors associated with these events in children younger than 13 years.
Main Methods:
- A 5-year longitudinal cohort study involving 810 children undergoing lensectomy.
- Registry data analysis from institutional and community sites, comparing aphakic and pseudophakic eyes.
- Statistical analysis of baseline factors and their association with glaucoma-related events.
Main Results:
- The 5-year cumulative incidence of glaucoma-related adverse events was 29% in aphakic eyes versus 7% in pseudophakic eyes.
- In aphakic eyes, younger age at surgery ( < 3 months), abnormal anterior segment, intraoperative complications, and bilaterality increased risk.
- No significant risk factors were identified for pseudophakic eyes within the evaluated parameters.
Conclusions:
- Glaucoma-related adverse events are a significant concern following pediatric lensectomy.
- Aphakia and early surgical age are key risk factors for developing glaucoma.
- Continuous ophthalmological monitoring is essential for children post-lensectomy to detect glaucoma early.
Importance:
Glaucoma can develop following cataract removal in children.
Objective:
To assess the cumulative incidence of glaucoma-related adverse events (defined as glaucoma or glaucoma suspect) and factors associated with risk of these adverse events in the first 5 years after lensectomy prior to 13 years of age.
Design, Setting, And Participants:
This cohort study used longitudinal registry data collected at enrollment and annually for 5 years from 45 institutional and 16 community sites. Participants were children aged 12 years or younger with at least 1 office visit after lensectomy from June 2012 to July 2015. Data were analyzed from February through December 2022.
Exposures:
Usual clinical care after lensectomy.
Main Outcomes And Measures:
The main outcomes were cumulative incidence of glaucoma-related adverse events and baseline factors associated with risk of these adverse events.
Results:
The study included 810 children (1049 eyes); 443 eyes of 321 children (55% female; mean [SD] age, 0.89 [1.97] years) were aphakic after lensectomy, and 606 eyes of 489 children (53% male; mean [SD] age, 5.65 [3.32] years) were pseudophakic. The 5-year cumulative incidence of glaucoma-related adverse events was 29% (95% CI, 25%-34%) in 443 eyes with aphakia and 7% (95% CI, 5%-9%) in 606 eyes with pseudophakia; 7% (95% CI, 5%-10%) of aphakic eyes and 3% (95% CI, 2%-5%) of pseudophakic eyes were diagnosed as glaucoma suspect. Among aphakic eyes, a higher risk for glaucoma-related adverse events was associated with 4 of 8 factors, including age less than 3 months (vs ≥3 months: adjusted hazard ratio [aHR], 2.88; 99% CI, 1.57-5.23), abnormal anterior segment (vs normal: aHR, 2.88; 99% CI, 1.56-5.30), intraoperative complications at time of lensectomy (vs none; aHR, 2.25; 99% CI, 1.04-4.87), and bilaterality (vs unilaterality: aHR, 1.88; 99% CI, 1.02-3.48). Neither of the 2 factors evaluated for pseudophakic eyes, laterality and anterior vitrectomy, were associated with risk of glaucoma-related adverse events.
Conclusions And Relevance:
In this cohort study, glaucoma-related adverse events were common after cataract surgery in children; age less than 3 months at surgery was associated with elevated risk of the adverse events in aphakic eyes. Children with pseudophakia, who were older at surgery, less frequently developed a glaucoma-related adverse event within 5 years of lensectomy. The findings suggest that ongoing monitoring for the development of glaucoma is needed after lensectomy at any age.
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