Comparison of delayed-onset glaucoma and early-onset glaucoma after infantile cataract surgery.
OBJECTIVE
To investigate the causes and characteristics of glaucoma in children following cataract surgery.


METHODS
Twenty-four patients (37 eyes) with uncomplicated congenital cataracts who developed glaucoma after cataract surgery were studied retrospectively. Variables included cataract morphology, surgical techniques, post-operative complications, time to the onset of glaucoma, gonioscopic findings, presence of microcornea and the histopathologic characteristics of the filtration angle (in one case).


RESULTS
There was a bimodal onset of glaucoma after cataract surgery. Early-onset glaucoma occurred at a mean age of 6 months in 15 eyes and delayed-onset glaucoma at a mean age of 12 years in 22 eyes. Early-onset glaucoma was significantly (p = 0.018) more likely to be due to angle closure than delayed-onset glaucoma. With delayed-onset glaucoma, the filtration angle was open in 86% of eyes and significantly (p = 0.006) more eyes in the delayed-onset group had microcornea. Medical treatment was sufficient to control intraocular pressure in the delayed-onset group while the early-onset group required surgical treatment (P < 0.001).


CONCLUSIONS
The onset of glaucoma after cataract surgery during infancy follows a bimodal pattern that is correlated with the configuration of the filtration angle. The early-onset glaucoma group had high incidence of angle closure requiring surgical treatment, while in the delayed-onset group non-surgical treatment was sufficient to control intraocular pressure. Prophylactic iridectomy in eyes at risk for pupillary block is recommended. Eyes with delayed-onset glaucoma have open filtration angles yet also have findings of incomplete development of filtration structures. Microcornea is a risk factor for delayed-onset glaucoma.
Kang
Kui Dong
KD
Department of Ophthalmology, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Yim
Hye Bin
HB
Biglan
Albert W
AW
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002386:Cataract / Q000151:congenital; D002387:Cataract Extraction / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D015812:Glaucoma, Angle-Closure / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D005902:Glaucoma, Open-Angle / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D006068:Gonioscopy; D006801:Humans; D007223:Infant; D007429:Intraocular Pressure; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors