Paper 15

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Risk of Developing Glaucoma/Glaucoma Suspect within 18 Months after Pediatric Cataract Surgery

Sharon F. Freedman, MD; Michael X. Repka, MD; Raymond T. Kraker, MSPH; David K. Wallace, MD; Alejandra de Alba Campomanes, MD; Tammy L. Yanovitch, MD; Faruk H. Orge, MD; Matthew D. Gearinger, MD
Jaeb Center for Health Research
Tampa, FL

Introduction:  Children undergoing lens removal from birth to <13 years of age were enrolled into a clinical research registry.  We describe the incidence of glaucoma/glaucoma suspect within 18 months of cataract surgery.

Methods:  Data were collected from medical records at enrollment (<=45 days post-cataract surgery) and annually.  We analyzed follow-up data <=18 months after first eye surgery.  The primary outcome was development of glaucoma/glaucoma suspect (similar to the Infant Aphakia Treatment Study and international definitions [1, 2], and hereafter termed ‘glaucoma-related adverse events’).

Results:  The overall incidence of glaucoma-related adverse events was 6.0% (95% confidence interval = 4.6 to 7.7) in 1101 eyes.  There was a strong association between age at surgery and glaucoma-related adverse events; and presence of anterior segment (AS) abnormalities (cornea, iris, or anterior chamber abnormalities noted at surgery) and glaucoma-related adverse events.  The adjusted glaucoma-related adverse event risk was 15.6% for 259 eyes <3 months of age versus 4.3% for 841 eyes >=3 months, P<0.001; and 11.7% for 161 eyes with AS abnormalities versus 5.7% for 928 eyes without, P=0.01.||Sex, race/ethnicity, axial length, laterality, intraocular lens implantation, anterior vitrectomy, and baseline intraocular pressure were not related to glaucoma-related adverse event development.

Discussion:  Glaucoma-related adverse events occurred in a minority of eyes within 18 months of cataract surgery. Although very young age at surgery and the presence of AS abnormalities were strong predictors of glaucoma-related adverse events, these complications occurred in all enrolled age cohorts.

Conclusion:  These data from a large registry lend support to findings of prior studies [2, 3], underlining the risk of glaucoma-related adverse events following cataract removal in early infancy.

References:
[1] Beck AD, Freedman SF, Lynn MJ, Bothun E, Neely DE, Lambert SR. Glaucoma-related adverse events in the Infant Aphakia Treatment Study: 1-year results. Arch Ophthalmol. 2012;130:300-5.
[2] Beck  AD, Chang TC, Freedman SF. Definition, Classification and Differential Diagnosis. In: Weinreb RN, Grajewski A, Papadopoulos M, Grigg J, Freedman SF, editors. Childhood Glaucoma WGA Consensus Series – 9. Amsterdam: Kugler Publications; 2013. p. 3-10.
[3] Mataftsi A, Haidich AB, Kokkali S, Rabiah PK, Birch E, Stager DR, Jr., et al. Postoperative glaucoma following infantile cataract surgery: an individual patient data meta-analysis. JAMA Ophthalmol. 2014;132:1059-67.

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