Postoperative Glaucoma Following Infantile Cataract Surgery: An Individual Patient Data Meta-analysis

Importance Infantile cataract surgery bears a significant risk for postoperative glaucoma, and no consensus exists on factors that may reduce this risk. Objective To assess the effect of primary intraocular lens implantation and timing of surgery on the incidence of postoperative glaucoma. Data Sources We searched multiple databases to July 14, 2013, to identify studies with eligible patients, including PubMed, MEDLINE, EMBASE, ISI Web of Science, Scopus, Central, Google Scholar, Intute, and Tripdata. We also searched abstracts of ophthalmology society meetings. Study Selection We included studies reporting on postoperative glaucoma in infants undergoing cataract surgery with regular follow-up for at least 1 year. Infants with concurrent ocular anomalies were excluded. Data Extraction and Synthesis Authors of eligible studies were invited to contribute individual patient data on infants who met the inclusion criteria. We also performed an aggregate data meta-analysis of published studies that did not contribute to the individual patient data. Data were pooled using a random-effects model. Main Outcomes and Measures Time to glaucoma with the effect of primary implantation, additional postoperative intraocular procedures, and age at surgery. Results Seven centers contributed individual patient data on 470 infants with a median age at surgery of 3.0 months and median follow-up of 6.0 years. Eighty patients (17.0%) developed glaucoma at a median follow-up of 4.3 years. Only 2 of these patients had a pseudophakic eye. The risk for postoperative glaucoma appeared to be lower after primary implantation (hazard ratio [HR], 0.10 [95% CI, 0.01-0.70]; P  = .02; I 2  = 34%), higher after surgery at 4 weeks or younger (HR, 2.10 [95% CI, 1.14-3.84]; P  = .02; I 2  = 0%), and higher after additional procedures (HR, 2.52 [95% CI, 1.11-5.72]; P  = .03; I 2  = 32%). In multivariable analysis, additional procedures independently increased the risk for glaucoma (HR, 2.25 [95% CI, 1.20-4.21]; P  = .01), and primary implantation independently reduced it (HR, 0.10 [95% CI, 0.01-0.76]; P  = .03). Results were similar in the aggregate data meta-analysis that included data from 10 published articles. Conclusions and Relevance Although confounding factors such as size of the eye and surgeon experience are not accounted for in this meta-analysis, the risk for postoperative glaucoma after infantile cataract surgery appears to be influenced by the timing of surgery, primary implantation, and additional intraocular surgery.