title: Postoperative glaucoma following infantile cataract surgery: an individual patient data meta-analysis.
abstract: OBJECTIVE
  Infantile cataract surgery bears a significant risk for postoperative glaucoma, and no consensus exists on factors that may reduce this risk.
  
  
  OBJECTIVE
  To assess the effect of primary intraocular lens implantation and timing of surgery on the incidence of postoperative glaucoma.
  
  
  METHODS
  We searched multiple databases to July 14, 2013, to identify studies with eligible patients, including PubMed, MEDLINE, EMBASE, ISI Web of Science, Scopus, Central, Google Scholar, Intute, and Tripdata. We also searched abstracts of ophthalmology society meetings.
  
  
  METHODS
  We included studies reporting on postoperative glaucoma in infants undergoing cataract surgery with regular follow-up for at least 1 year. Infants with concurrent ocular anomalies were excluded.
  
  
  METHODS
  Authors of eligible studies were invited to contribute individual patient data on infants who met the inclusion criteria. We also performed an aggregate data meta-analysis of published studies that did not contribute to the individual patient data. Data were pooled using a random-effects model.
  
  
  METHODS
  Time to glaucoma with the effect of primary implantation, additional postoperative intraocular procedures, and age at surgery.
  
  
  RESULTS
  Seven centers contributed individual patient data on 470 infants with a median age at surgery of 3.0 months and median follow-up of 6.0 years. Eighty patients (17.0%) developed glaucoma at a median follow-up of 4.3 years. Only 2 of these patients had a pseudophakic eye. The risk for postoperative glaucoma appeared to be lower after primary implantation (hazard ratio [HR], 0.10 [95% CI, 0.01-0.70]; P = .02; I(2) = 34%), higher after surgery at 4 weeks or younger (HR, 2.10 [95% CI, 1.14-3.84]; P = .02; I(2) = 0%), and higher after additional procedures (HR, 2.52 [95% CI, 1.11-5.72]; P = .03; I(2) = 32%). In multivariable analysis, additional procedures independently increased the risk for glaucoma (HR, 2.25 [95% CI, 1.20-4.21]; P = .01), and primary implantation independently reduced it (HR, 0.10 [95% CI, 0.01-0.76]; P = .03). Results were similar in the aggregate data meta-analysis that included data from 10 published articles.
  
  
  CONCLUSIONS
  Although confounding factors such as size of the eye and surgeon experience are not accounted for in this meta-analysis, the risk for postoperative glaucoma after infantile cataract surgery appears to be influenced by the timing of surgery, primary implantation, and additional intraocular surgery.
authors.affiliation: Second Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Asimina
authors.initials: A
authors.lastname: Mataftsi
authors.affiliation: Department of Hygiene and Epidemiology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Anna-Bettina
authors.initials: AB
authors.lastname: Haidich
authors.affiliation: Department of Hygiene and Epidemiology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Stamatia
authors.initials: S
authors.lastname: Kokkali
authors.affiliation: Division of Pediatric Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia4Department of Surgery, North Shore University Health System, Evanston, Illinois5Department of Surgery, University of Chicago Pritzker School of Medicine, Chicag.
authors.forename: Peter K
authors.initials: PK
authors.lastname: Rabiah
authors.affiliation: Crystal Charity Ball Pediatric Vision Evaluation Center, Retina Foundation of the Southwest, Dallas, Texas.
authors.forename: Eileen
authors.initials: E
authors.lastname: Birch
authors.affiliation: Pediatric Ophthalmology and Adult Strabismus, Plano, Texas.
authors.forename: David R
authors.initials: DR
authors.lastname: Stager
authors.affiliation: Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital, London, England9Western Eye Hospital, London, England.
authors.forename: Richard
authors.initials: R
authors.lastname: Cheong-Leen
authors.affiliation: Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital, London, England.
authors.forename: Vineet
authors.initials: V
authors.lastname: Singh
authors.affiliation: Division of Ophthalmology, Department of Surgery, Santa Clara Valley Medical Center, San Jose, California.
authors.forename: James E
authors.initials: JE
authors.lastname: Egbert
authors.affiliation: Vision Clinic, Alberta Children's Hospital, Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
authors.forename: William F
authors.initials: WF
authors.lastname: Astle
authors.affiliation: Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Lambert
authors.affiliation: Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Purohit
authors.initials: P
authors.lastname: Amitabh
authors.affiliation: Division of Pediatric Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
authors.forename: Arif O
authors.initials: AO
authors.lastname: Khan
authors.affiliation: Save Sight Institute, Discipline of Ophthalmology, Sydney Eye Hospital Campus, Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Grigg
authors.affiliation: Department of Hygiene and Epidemiology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Malamatenia
authors.initials: M
authors.lastname: Arvanitidou
authors.affiliation: Second Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Stavros A
authors.initials: SA
authors.lastname: Dimitrakos
authors.affiliation: Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital, London, England14UPMC Eye Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Ken K
authors.initials: KK
authors.lastname: Nischal
mesh_terms: D002387:Cataract Extraction / Q000009:adverse effects*; D016208:Databases, Factual; D005260:Female; D005901:Glaucoma / Q000209:etiology*; D006801:Humans; D007223:Infant; D019654:Lens Implantation, Intraocular / Q000009:adverse effects*; D008297:Male; D011183:Postoperative Complications; D012307:Risk Factors; D013997:Time Factors