Pediatric pseudophakic glaucoma following surgery for isolated childhood cataract.
OBJECTIVE
To report the incidence and risk factors for pseudophakic glaucoma in children who underwent surgery for non-traumatic cataract without other ocular structural abnormality.


METHODS
Institutional retrospective case series (1990 to 2003) of patients younger than 12 years of age who underwent surgery with primary posterior chamber intraocular lens (PC-IOL) implantation for non-traumatic cataract. Patients with post-surgical follow-up of less than 5 years, microcornea, persistent fetal vascular, and/or other significant anterior segment abnormality were excluded. Glaucoma was defined as intraocular pressure (IOP) of 28 mm Hg or greater on at least two separate occasions.


RESULTS
Of 489 pediatric pseudophakic eyes, 8 (1.6%) were diagnosed as having glaucoma (5 of 326 patients, 1.5%) an average of 15.8 months (median: 8 months; range: 2 to 60 months) after cataract surgery with an average IOP at diagnosis of 32.4 mm Hg (standard deviation [SD] = 3.6). Mean follow-up was 66.9 months (SD = 12.6). The other 481 pseudophakic eyes (not diagnosed as having glaucoma) had an average follow-up of 70.5 months (SD = 12.5). For the former group, the average age at cataract surgery was 49.6 months (SD = 21.6; median: 60.5 months; range: 12 to 62 months), whereas for the latter group it was 45.5 months (SD = 32.4; median: 37 months; range: 5 to 141 months). One eye from the former group and 27 eyes from the latter group had sulcus placement of an all-acrylic PC-IOL.


CONCLUSIONS
Pediatric pseudophakic glaucoma was rare and had no obvious risk profile. Selection bias for PC-IOL placement favored eyes operated on after infancy (ie, after the period of highest risk for aphakic glaucoma). Most eyes were diagnosed as having glaucoma within 1 year of surgery, sooner than when most eyes are typically diagnosed as having aphakic glaucoma.
Al-Dahmash
Saad
S
King Khaled Eye Specialist Hospital, Medical Staff, P. O. Box 7191, Riyadh, 11462, Saudi Arabia.
Khan
Arif O
AO
D002386:Cataract / Q000150:complications*; D002387:Cataract Extraction / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D005901:Glaucoma / Q000209:etiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D007429:Intraocular Pressure; D019654:Lens Implantation, Intraocular; D057972:Posterior Eye Segment / Q000601:surgery; D011183:Postoperative Complications; D019591:Pseudophakia / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors