Incidence and Risk Factors of Glaucoma Following Pediatric Cataract Surgery with Primary Implantation

Abstract Purpose To determine the incidence and risk factors for glaucoma after pediatric cataract surgery with intraocular lens (IOL) implantation. Design Retrospective, consecutive case series. Methods . Setting Institutional, monocentric. Study population One hundred and thirty-six children (199 eyes) that underwent pediatric cataract surgery before one year of age with a minimum of one-year follow-up. Intervention Pediatric cataract surgery with IOL implantation. Main Outcome Measures Presence or absence of secondary glaucoma. Results Mean age at surgery was 148±93 days (range:30-359) with a mean follow-up of 6.3±3.6 years (range:1.1-12.8). Glaucoma developed in 31 eyes (16%) with a 5 and 10-year incidence of 12% and 28% respectively. The incidence of glaucoma seemed to be bimodal with a first peak occurring after a mean delay of 2.5 months (range:1.6-4.1 months) and a second peak occurring after a mean delay of 5.7 years (range:2.6-11.7 years). Younger age at surgery, shorter axial length, longer follow-up, use of trypan blue, reintervention and bilateral surgery were associatied with higher incidence of glaucoma. Multivariate analysis including the aforementioned variables indentified longer follow-up (odds ratio [OR] 1.3; 95% confidence interval [CI], 1.1-1.6; P=0.001), reintervention (odds ratio [OR] 4.1; 95% confidence interval [CI], 1.2-13.4; P=0.02) and use of trypan blue (odds ratio [OR] 4.1; 95% confidence interval [CI], 1.3-13.1; P=0.02) as predictors for the development of glaucoma. Conclusion Glaucoma is a common complication following pediatric cataract surgery. It seemed to have a bi-modal incidence. Risk factors for glaucoma development were reintervention, use of trypan blue and long follow-up.