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Secondary glaucoma after paediatric cataract surgery
  1. Brighu Narayan Swamy (brighu{at}eye.usyd.edu.au),
  2. Frank Billson (fbillson{at}bigpond.net.au),
  3. Frank Martin (frank.martin{at}bigpond.com),
  4. Craig Donaldson (craigdonaldson{at}msn.com.au),
  5. Stephen Hing (stephenw{at}chw.edu.au),
  6. James EH Smith (jehsmith{at}bigpond.com),
  7. Robyn Jamieson (robynj{at}bigpond.net.au),
  8. John Grigg (johng{at}eye.usyd.edu.au)
  1. Save Sight Institute, Sydney, Australia, Australia
  2. 1. Save Sight Institute, University of Sydney. 2 The Children's Hospital at Westmead, Sydney, Australia
  3. The Children's Hospital at Westmead, Sydney, Australia, Australia
  4. The Children's Hospital at Westmead, Sydney, Australia, Australia
  5. The Children's Hospital at Westmead, Sydney, Australia, Australia
  6. 1 The Children's Hospital at Westmead, Sydney. 2 Royal North Shore Hospital, Sydney, Australia, Australia
  7. 1. Save Sight Institute, University of Sydney. 2 The Children's Hospital at Westmead, Sydney, Australia
  8. 1. Save Sight Institute, University of Sydney. 2 The Children's Hospital at Westmead, Sydney, Australia

    Abstract

    Purpose: To determine the prevalence and risk factors associated with secondary glaucoma post congenital cataract surgery.

    Methods: All children diagnosed with congenital cataracts in a major children's hospital between 1985 and 2005 were included in a retrospective case series. Medical records of 423 eyes among 283 patients who underwent cataract surgery with or without intraocular lens implantation at age =< 16 for congenital cataract were reviewed. The main outcome measure was presence or absence of secondary glaucoma and time to glaucoma post surgery. The following risk factors were evaluated; age at cataract surgery, presence of systemic anomalies, microcornea, persistent hyperplastic primary vitreous (PHPV), primary capsulotomy/anterior vitrectomy, primary IOL implantation, secondary membrane surgery and duration of post operative observation.

    Results: The statistical methods were the use of Kaplan-Meir survival analysis and Multivariate Cox hazards regression analysis. Mean follow up was 6.3 +/- 5.0 years (median 4.6 years; range 0.5 - 20.3 years). Glaucoma developed in 36 of 234 patients (15.4%). Multivariate Cox proportional hazards regression analysis identified age less than 9 months at time of surgery (RR 2.9, 95% CI 1.3-7.7; p=0.03), microcornea (RR 3.7, 95% CI 2.0-7.0; p<0.001), and follow up time as important predictors of glaucoma. PHPV (RR 1.4, 95% CI 0.7-2.7; p=0.41) and primary posterior capsulotomy/anterior vitrectomy (RR 2.2, 95% CI 0.9-5.5; p=0.17) were not significantly associated with secondary glaucoma in the multivariate model. Mean time to glaucoma after congenital cataract surgery was 4.9 years (range 2 weeks to 16.8 years).

    Conclusion: Secondary glaucoma is an important sequelae in patients who undergo surgery for congenital cataracts. It is imperative that these patients get life long surveillance as glaucoma can occur years after initial operation.

    • Congenital cataract
    • aphakia
    • aphakic glaucoma
    • paediatric glaucoma
    • secondary glaucoma

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