title: Glaucoma following congenital cataract surgery--the role of early surgery and posterior capsulotomy.
abstract: BACKGROUND
  To determine the rate of glaucoma following congenital cataract surgery at Moorfields Eye Hospital (MEH), and to investigate potential risk factors for glaucoma in our case series.
  
  
  METHODS
  A retrospective case notes review was undertaken of all congenital cataract lensectomies performed at MEH between 1994 and 2000. The following parameters were ascertained: age at surgery, unilateral or bilateral cataract, whether a posterior capsulotomy (PC) was performed at the time of surgery, whether an intraocular lens (IOL) was inserted, duration of follow-up, and if aphakic glaucoma (AG) developed. All lensectomies were performed through a limbal incision by a single consultant surgeon.
  
  
  RESULTS
  A total of 47 subjects were identified - 40 patients with bilateral cataracts and 7 with unilateral. Of the 40 bilateral cataract patients, 76 eyes had lensectomies; with 37 of these patients (71 lensectomies) having at least 5 year follow-up. Based on patient count, the 5 year risk of AG in at least one eye following surgery was 21.6%. Based on eye count, the 5 year risk of AG after lensectomy was 15.5%. The average age at surgery of patients who did not develop AG, and had at least 5 years follow-up, was 28.7 months (range 2 weeks to 6 years), with 20% having surgery within the first month of life. In comparison, the average age at surgery of patients with at least 5 years follow-up, who developed AG was 1.6 months (range 2 weeks to 7 months), with 60% having surgery within the first month of life. In subjects with at least 5 years follow-up, a PC rate of 100% was identified in the eyes that developed AG, compared to 61% in eyes that did not develop AG. An IOL was inserted in O% of eyes with AG, compared to 57% in eyes that did not develop AG. Onset of AG ranged from one month post surgery to 7 years, with an average yearly incidence of 5.3%.
  
  
  CONCLUSIONS
  Early surgery in patients with bilateral cataracts is associated with a marked increase in risk of AG. Our data suggest that an intact posterior capsule may be associated with a lower rate of AG.
authors.affiliation: Department of Paediatric Ophthalmology and Strabismus, Moorfields Eye Hospital, City Road, London, EC1V 2PD, UK. michel.michaelides@ucl.ac.uk
authors.forename: Michel
authors.initials: M
authors.lastname: Michaelides
authors.forename: Catey
authors.initials: C
authors.lastname: Bunce
authors.forename: Gillian G W
authors.initials: GG
authors.lastname: Adams
mesh_terms: D001036:Aphakia, Postcataract / Q000150:complications*; D002386:Cataract / Q000151:congenital*; D002387:Cataract Extraction / Q000009:adverse effects* / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D005901:Glaucoma / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007903:Lens Capsule, Crystalline / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology