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Glaucoma after cataract extraction and posterior chamber lens implantation in children
K M Brady1, C S Atkinson, L A Kilty
1Department of Ophthalmology Children's Hospital of Pittsburgh, Pennsylvania, USA.
Insights
Pediatric cataract surgery with intraocular lens (IOL) implantation had a low glaucoma incidence, particularly in developmental cases. Careful surgical techniques and follow-up are crucial for managing potential complications like angle recession glaucoma.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Glaucoma Research
Background:
- Pediatric cataract extraction with intraocular lens (IOL) implantation is a common procedure.
- Postoperative glaucoma is a potential complication following pediatric cataract surgery.
- Understanding the incidence and risk factors for glaucoma is crucial for optimal patient outcomes.
Purpose of the Study:
- To determine the incidence of postoperative glaucoma in children undergoing cataract extraction and posterior chamber IOL implantation.
- To identify potential risk factors and preventive measures for glaucoma in this patient population.
Main Methods:
- A retrospective evaluation of 45 eyes from 37 pediatric patients (aged 1-18 years) who underwent cataract extraction and IOL implantation between 1991 and 1994.
- Patients with specific exclusion criteria (microcornea, preoperative glaucoma, poor pupil dilation) were selected.
- Surgical techniques included continuous curvilinear anterior capsulorhexis, extracapsular aspiration or phacoemulsification, and posterior capsule retention. Peripheral iridectomy was performed in some cases.
- Postoperative medications included corticosteroids and antibiotics.
Main Results:
- Three patients with traumatic cataracts developed postoperative glaucoma.
- One case of pseudophakic pupillary block was successfully managed with a peripheral iridectomy.
- Two patients developed late-onset glaucoma secondary to angle recession and peripheral anterior synechias, respectively.
- No patients with developmental cataracts developed glaucoma.
Conclusions:
- Careful patient selection, atraumatic surgical techniques (e.g., continuous curvilinear capsulorhexis, in-the-bag IOL placement), and appropriate postoperative management (atropine, corticosteroids) can minimize the risk of pseudophakic pupillary block and glaucoma.
- Lifelong follow-up is essential for detecting chronic open-angle and traumatic angle-recession glaucoma in pediatric patients after cataract surgery.
Purpose:
To evaluate the incidence of postoperative glaucoma in children who have cataract extraction and posterior chamber intraocular lens (IOL) implantation.
Setting:
Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Methods:
The incidence of glaucoma of all etiologies was evaluated in 45 eyes of 37 selected consecutive patients aged 1 to 18 years who had cataract extraction and posterior chamber IOL implantation from 1991 to 1994. Mean follow-up was 23 months (range 6 to 38 months). Nineteen patients had traumatic and 18 had developmental cataract. Exclusion criteria were microcornea smaller than 9.0 mm in diameter, preoperative glaucoma, or poor pupil dilation. The surgical technique comprised a continuous curvilinear anterior capsulorhexis in most cases, extracapsular aspiration by Ocutome or phacoemulsification, and retention of the posterior capsule. A peripheral iridectomy was done in 7 eyes (16%). Postoperative medications included topical atropine combined with topical, subconjunctival, and systemic corticosteroids and antibiotics.
Results:
Three patients with traumatic cataract developed postoperative glaucoma during the follow-up. One developed pseudophakic pupillary block; however, a peripheral iridectomy prevented glaucoma. Two other patients developed late-onset glaucoma: one secondary to angle recession and the other to peripheral anterior synechias. No patient with developmental cataract developed glaucoma.
Conclusion:
Careful patient selection, atraumatic surgical technique, continuous curvilinear capsulorhexis, in-the-bag IOL placement, postoperative atropine, and topical and systemic corticosteroids significantly lower the incidence of pseudophakic pupillary block and glaucoma. Although no patient developed glaucoma, lifelong follow-up is mandatory to detect chronic open-angle and traumatic angle-recession glaucoma.