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Glaucoma following cataract surgery in the first 2 years of life: frequency, risk factors and outcomes from IoLunder2
  1. Ameenat Lola Solebo1,2,3,4,
  2. Jugnoo S Rahi1,2,3,4
  3. on behalf of the British Congenital Cataract Interest Group
    1. 1 National Institute for Health Research Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital, London, UK
    2. 2 Great Ormond Street Hospital for Children NHS Trust, London, UK
    3. 3 National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
    4. 4 Ulverscroft Vision Research Group, Institute of Child Health, University College, London, UK
    1. Correspondence to Professor Jugnoo S Rahi, Paediatric Epidemiology and Biostatistics, Insitute of Child Health, London WC1N 1EH, UK; j.rahi{at}


    Background We investigated glaucoma related adverse events, predictors and impact at 5 years following surgery in the IoLunder2 cohort

    Methods Population based observational cohort study of children undergoing cataract surgery aged 2 years or under between January 2009 and December 2010. Glaucoma was defined using internationally accepted taxonomies based on the consequences of elevated intraocular pressure (IOP). Glaucoma related adverse events were any involving elevated IOP. Multivariable analysis was undertaken to investigate potential predictors of secondary glaucoma with adjustment for within-child correlation in bilateral cataract. Unilateral and bilateral cataract were analysed separately.

    Results Complete follow-up data were available for 235 of 254, 93% of the inception cohort. By 5 years after primary cataract surgery, 20% of children with bilateral cataract and 12% with unilateral had developed secondary glaucoma. Glaucoma related complications had been diagnosed in 24% and 36% of children, respectively. Independent predictors of glaucoma were younger age at surgery (adjusted OR for reduction of week in age: 1.1, 95%C I 1.1 to 1.2, p<0.001); the presence of significant ocular comorbidity (adj OR 3.2, 95% CI 1.1 to 9.6, p=0.01); and shorter axial length (adj OR for each mm 1.7, 95% CI 10.0 to 1, p=0.05) for bilateral cataract. Shorter axial length was the single independent factor in unilateral disease (adj OR 9.6, 95% CI 1.7 to 52, p=0.009)

    Conclusions Both younger age at surgery (the strongest marker of ocular ‘immaturity’) and smaller ocular size (a marker of both immaturity and developmental vulnerability) can be used to identify those at greatest risk of glaucoma due to early life cataract surgery.

    • child health (paediatrics)
    • lens and zonules
    • glaucoma
    • treatment surgery
    • vision

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    • Collaborators Mr Joseph Abbott, Mr Manoj Parulekar, Mr John Ainsworth, Birmingham Children’s Hospital; Miss Gillian W Adams, Ms Maria Theodorou, Ms Joanne Hancox, Ms Annegret Dahlmann-Noor, Moorfields Eye Hospital; Professor Peng Khaw, National Institute of Health Research Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology; Ms Louise Allen, Addenbrokes Hospital; Mr Luis Amaya, St Thomas’ Hospital; Ms Samira Anwar, Leicester Royal Infirmary; Ms Jane Ashworth, Mr Susmito Biswas, Manchester Royal Eye Hospital; Mr John Barry, Birmingham and Midland Eye Centre; Professor Phillip Bloom, Western Eye Hospital; Mr Richard Bowman, Ms Isabelle Russell-Eggitt, Mr William Moore, Prof Anthony T Moore, Great Ormond Street Children’s Hospital; Mr John Bradbury, Ms Rachel Pilling, Mr Taras Gout, Bradford Royal Infirmary; Mr Donal Brosnahan, Our Lady’s Children Hospital Dublin; Mr Jeremy Butcher, Countess of Chester Hospital; Mr TK Jonathan Chan, Sheffield Children’s Hospital; Mr Arvind Chandna, Alder Hey Children’s Hospital; Ms Jessy Choi, Sheffield Children’s Hospital; Ms Amanda J Churchill, Bristol Eye Hospital; Mr Mike P Clarke, Mr Ayad Shafiq, Royal Victoria Infirmary; Ms Fiona Dean, University Hospitals Coventry; Professor Gordon Dutton, Yorkhill Hospital; Mr John Elston, Oxford Eye Hospital; Mr John Ferris, Cheltenham General Hospital; Dr Brian Fleck, Princess Alexandra Eye Pavilion; Mr Nick D George, Ninewells Hospital; Mr Lawrence Gnanaraj, Sunderland Eye Infirmary; Mr Richard Gregson, Nottingham University Hospital; Mr David Jones, Royal Cornwall Hospital; Ms Annie Joseph, North Staffordshire University Hospital; Mr David Laws, Singleton Hospital; Mr Tim Lavy, Yorkhill Hospital; Prof Ian Chris Lloyd, Manchester Royal Eye Hospital and Great Ormond Street Hospital; Mr Vernon Long, Leeds General Infirmary; Dr Mary MacCrae, Princess Alexandra Eye Hospital; Ms Jane MacKinnon, Yorkhill Hospital; Ms Jane Marr, Sheffield Children’s Hospital; Ms Kristina May, Mr Jay Self, Southampton Royal Eye Unit; Ms Eibhlin Mc Loone, Mr Gerry McGinnity, Royal Victoria Hospital Belfast; Dr Alan Mulvihill, Princess Alexandra Eye Pavilion; Mr William Newman, Alder Hey Children’s Hospital; Mr Qasim Mansor, South Tees NHS Trust; Mr Haamid Porooshani, Midd Essex Hospital; Mr Jacobus Pauw, Clacton Hospital; Mr Narman Puvanachandra, Norfolk and Norwich Hospitals; Mr Anthony G Quinn, Royal Devon and Exeter Hospital; Dr Clare Roberts, Western Eye Mr Christopher Scott, Royal Aberdeen Hospital; Mr Hans Soeldner, James Cook University Hospital; Ms Tamsin Sleep, Torbay Hospital; Professor David SI Taylor, Institute of Ophthalmology; Mr Robert H Taylor, York Hospitals NHS Foundation Trust; Mr Patrick Watts, Cardiff Eye Unit; Mr Wagih Aclimandos, Kings College Hospital; Mr A Aguirre Vila-Coro, Huddersfield Royal Infirmary; Ms Cathy Williams, Bristol Eye Hospital; Mr Simon Armstrong, Countess of Chester Hospital; Mr Nick Astbury, West Norwich Hospital; Mr Adam Bates, Pembury Hospital; Mr Godfrey Bedford, Dumfries Ms Natalie Boyle, Kilmarnock Hospital; Mr Larry Benjamin, Stoke Mandeville Hospital; Miss Brenda Billington, Royal Berkshire Hospital; Mr Andrew Blaikie, Queen Margaret Hospital; Mr John Brazier, Middlesex Hospital; Professor Anthony Bron, Oxford Eye Hospital; Mr Stephen Bryan, Whipps Cross Hospital; Mr John Burke, Royal Hallamshire Hospital; Miss Lucilla Butler, Birmingham Mr Anthony Casswell, Sussex Eye Hospital; Mr Richard Condon, St Peter’s Hospital; Mr Patrick Corridan, Wolverhampton Eye Infirmary; Mr Bichitra Das, Alexandra Hospital; Mr Sheraz Daya, Queen Victoria Hospital; Mr Romain De Cock, Kent and Canterbury Hospital; Mr Chrisjan Dees, James Cook University Hospital; Mr Clive Edelsten, Ipswich Hospital; Mr Hisam El-Kabasy, Southend Hospital; Mr Anthony Evans, Queen Alexandra Hospital; Mr Nick Evans, Royal Eye Infirmary; Dr Andrew Gaskell, Ayr Hospital; Miss Mary Gibbens, Queen Mary’s Hospital; Mr Caspar Gibbons, North Devon District Hospital; Mr Peter Gregory, Conquest Hospital; Mr Jamil Hakim, Queen Mary’s Hospital; Mr Stephen Hardman-Lea, Ipswich Hospital; Mr Mohammed Hassan, Barnsley District Hospital; Mr Mohammad Heravi, William Harvey Hospital; Ms Melanie Hingorani, Bedford Hospital; Mr Roger Holden, Derbyshire Royal Infirmary; Mr Roger Humphrey, Odstock Hospital; Mr Jim Innes, Hull Royal Infirmary; Mr Chris Jenkins, Kent County Ophthalmic and Aural Hospital; Mrs Nuka Kayali, Whipps Cross Hospital; Mr Simon Keightley, North Hampshire Hospital; Mr Anastassios Kostakis, Doncaster Royal Infirmary; Mr Satish Kotta, Grimsby District General Hospital; Mr Rajakopal Kumar, Coventry and Warwickshire Hospital; Ms Jane Leitch, Sutton Hospital; Mr Christopher Liu, Sussex Eye Hospital; Ms Carrie MacEwen, Ninewells Hospital; Mr Brendan Moriarty, Leighton Hospital; Mr Robert Morris, Southampton Eye Hospital; Mr Mark Neugebager, Leighton Hospital; Mr Gerard O’Connor, Cork University Hospital; Miss Rita Ohri, Whipps Cross Hospital; Mr Stephen Perry, Kidderminster General Hospital; Mr Aravind Reddy, Royal Aberdeen Children’s Hospital; Mr Stephen Scotcher, Hereford Hospital; Mr James Scott, Stirling Royal Infirmary; Mr Peter Sellar, West Cumberland Hospital; Mr Adrien Georges Shun Shin, Wolverhampton Eye Infirmary; Mr Peter Simcock, Royal Devon and Exeter Hospital; Mr Ian Simmons, St James’ University Hospital; Mr John D Stokes, Dublin; Mr Mike Tappin, St Peter’s Hospital; Mr Vladimir Thaller, Royal Eye Infirmary; Mr Mehm Thoung, Broomfield Hospital; Mr Stephen Tuft, Moorfields Eye Hospital; Mr John Twomey, Musgrove Park Hospital; Ms Sarah Vickers, Sussex Eye Hospital; Mr Anthony Vivian, West Suffolk Hospital; Mr Geoff Woodruff, Leicester Royal Infirmary.

    • Contributors All authors contributed equally to study conceptualisation and design, data acquisition and analysis, interpretation, manuscript drafting and revision. All authors give final approval of the submitted version. ALS and JSR agree to be accountable for all aspects of the work. This work is presented on behalf of the collaborating clinical research group, the British Isles Congenital Cataract Interest Group.

    • Funding AL Solebo received support from an Ulverscroft Vision Research Group fellowship, an Academy of Medical Sciences Lecturer award, and from the National Institute for Health Research Biomedical Research Centre (NIHR BRC) based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, and is funded by an NIHR Clinician Scientist award. Jugnoo Rahi receives support from the NIHR BRC based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, and is also supported by an NIHR Senior Investigator award. This work was undertaken at UCL Institute of Child Health/Great Ormond Street Hospital for children which received a proportion of funding from the Department of Health’s NIHR BRC funding scheme.

    • Competing interests None declared.

    • Patient consent for publication Parental/guardian consent obtained.

    • Ethics approval Ethics approval was obtained from the Health Research Authority in the UK, and through institutional committees in Ireland.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement No data are available.

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