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Clinical science
Incidence of and risk factors for suspected and definitive glaucoma after bilateral congenital cataract surgery: a 5-year follow-up
  1. Jinghui Wang1,2,
  2. Xianghua Wu1,
  3. Qiwei Wang1,
  4. Fengqi Zhou3,
  5. Hui Chen1,
  6. Wan Chen1,
  7. Duoru Lin1,
  8. Xiayin Zhang4,
  9. Ruixin Wang1,
  10. Jingjing Chen1,
  11. Zhenzhen Liu1,
  12. Zhuoling Lin1,
  13. Xiaoyan Li1,
  14. Jing Li1,
  15. Ying Han5,
  16. Yizhi Liu1,
  17. Haotian Lin1,2,6,
  18. Weirong Chen1
  1. 1State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong Province, People's Republic of China
  2. 2Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Haikou, Hainan Province, People's Republic of China
  3. 3Ophthalmology, Mayo Clinic Health System, Eau Claire, Wisconsin, USA
  4. 4Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People's Republic of China
  5. 5Ophthalmology, University of California San Francisco, San Francisco, California, USA
  6. 6Centre for Precision Medicine and Department of Genetics and Biomedical Informatics, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, People's Republic of China
  1. Correspondence to Professor Weirong Chen, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong 510060, China; chenwr_q{at}aliyun.com; Professor Haotian Lin, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong Province, People's Republic of China; gddlht{at}aliyun.com

Abstract

Aims To report the incidence and associated risk factors for developing suspected and definitive glaucoma after bilateral congenital cataract (CC) removal with a 5-year follow-up.

Methods Secondary analysis of a prospective longitudinal cohort study. Bilateral CC patients who had undergone cataract surgery between January 2011 and December 2014 at Zhongshan Ophthalmic Centre were recruited. Suspected glaucoma was defined as persistent ocular hypertension requiring medical treatment. Definitive glaucoma was defined as accompanied by the progression of glaucomatous clinical features. According to postoperative lens status in 5 years follow-up: 130 eyes in the aphakia group; 219 in the primary intraocular lens (IOL) implantation group and 337 in the secondary IOL implantation group. The Kaplan-Meier survival and Cox regression analyses were used to explore the cumulative incidence and risk factors for suspected and definitive glaucoma.

Results Three hundred fifty-one children (686 eyes) with bilateral CCs were enrolled in the study. The mean age at surgery was 1.82±2.08 years, and the mean follow-up duration was 6.26±0.97 years. Suspected and definitive glaucoma developed at a mean time of 2.84±1.75 years (range 0.02–7.33 years) postoperatively. The cumulative incidence of suspected and definitive glaucoma was 9.97% (35 of 351 patients), including 6.12% (42 eyes) for definitive glaucoma and 2.48% (17 eyes) for suspected glaucoma. Microcornea (HR 4.103, p<0.0001), CC family history (HR 3.285, p=0.001) and initial anterior vitrectomy (HR 2.365 p=0.036) were risk factors for suspected and definitive glaucoma. Gender, age at surgery, intraocular surgery frequency, length of follow-up and frequency of neodymium-doped yttrium aluminumaluminium garnet laser were non-statistically significant. Primary IOL implantation was a protective factor (HR 0.378, p=0.007).

Conclusions Identifying suspected and definitive glaucoma after bilateral CC surgery can lower the risk of secondary blindness in children. Patients with related risk factors need to pay more attention and thus reach early intervention and treatment during clinical practice. Primary IOL implantation may be a potential protective factor, need more clinical trials to be verified.

Trial registration number NCT04342052.

  • Child health (paediatrics)
  • Glaucoma

Data availability statement

Data are available on reasonable request.

http://dx.doi.org/10.1136/bjo-2022-322589

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    Data availability statement

    Data are available on reasonable request.

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    Footnotes

    • JW and XW are joint first authors.

    • YL, HL and WC are joint senior authors.

    • Contributors WC and HL: the guarantors of this study, had full access to all the data in the study and supervised the study. JW and XW: contributed equally, accepted responsibility for the integrity of the data and the accuracy of the data analysis, study concept and design. YL and WeC: performed the cataract surgeries. WaC, QW, HC, ZheL, XL, FZ. XZ, RW, JC, ZhuL and DL: collected, analysed and interpreted the data. JW and XW: drafted the manuscript. HL, YH, WC, JW and HC: critically revised the manuscript for important intellectual content. The authors thank the CCPMOH study group and the Glaucoma Department of Zhongshan Ophthalmic Centre for assisting with the follow-up of the patients with glaucoma and suspected glaucoma. In addition, the authors are grateful to the patients and their family members for participating in this research study.

    • Funding This study was funded by the National Key R & D Program of China (2020YFC2008200), the National Natural Science Foundation of China (81970778) and the Guangdong Basic and Applied Basic Research Foundation (2020A1515010987).

    • Competing interests None declared.

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