Aphakia, Age Tied to Increased Glaucoma Risk After Pediatric Lensectomy

Tuesday, December 3, 2019
By Marilynn Larkin (Reuters Health)

Glaucoma or glaucoma suspect may develop in the first year after pediatric lensectomy, and infants three months or younger and those with post-procedure aphakia are especially at risk, a multicenter registry study revealed.

"We found that glaucoma does occur (after cataract removal) and the age effect seems to be more dominant than expected," Dr. Sharon Freedman of Duke University School of Medicine in Durham told Reuters Health by email. "It may be that very young age at surgery is the main driver behind the increased risk for later becoming a glaucoma suspect or developing glaucoma, and we suggest these children need lifelong monitoring for glaucoma."

The multicenter study included 702 children from the U.S. and Canada. About half were boys; 61% were white, and the mean age at lensectomy was 3.4 years, according to the JAMA Ophthalmology report, online November 21.

After lensectomy, glaucoma was diagnosed in 52 of 970 eyes and glaucoma suspect, in 14 (adjusted overall incidence risk, 6.3%). Among the affected children (61% girls), the mean age at lensectomy was 1.9 years.

Glaucoma surgery was performed in 34.8% of affected eyes at a median of 3.3 months after lensectomy. The incidence risk of glaucoma or glaucoma suspect was 15.7% for 256 eyes of infants 3 months or younger at lensectomy versus 3.4% for 714 eyes of infants older than 3 months (relative risk, 4.57).

Similarly, the incidence risk was 11.2% for 438 aphakic eyes versus 2.6% for 532 pseudophakic eyes (relative risk, 4.29).

No association was seen between the risk of developing glaucoma or glaucoma suspect and variables including sex, race/ethnicity, laterality of lensectomy, performance of anterior vitrectomy, prelensectomy presence of anterior segment abnormality, or intraoperative complications.

Dr. Teresa C. Chen, a surgeon in the Glaucoma Service at Massachusetts Eye and Ear in Boston, told Reuters Health that frequent monitoring, as suggested by the study authors, "is critical, because irreversible vision loss from glaucoma can be prevented or minimized with early detection."

Further, she said by email, "Although the authors suggest that children who have had lensectomy at three months of age or younger or who are aphakic after surgery need more frequent screening for glaucoma, it is important to remember that all children who have had lensectomy surgery need frequent monitoring for glaucoma."

"Other studies have suggested that lensectomy surgery within the first year of life increases the risk of glaucoma, because the angle is still developing during this period," she said. "Microcornea is another important risk factor for glaucoma after lensectomy surgery."

"Glaucoma after pediatric lensectomy surgery classically occurs years after initial lensectomy surgery, and the incidence of glaucoma increases over time," she noted. Therefore, in keeping with Dr. Freedman's comment, she said, "lifelong glaucoma screening is essential for any pediatric lensectomy patient."

Adapted from Reuters Health article