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Brief Report
November 21, 2019

Incidence and Management of Glaucoma or Glaucoma Suspect in the First Year After Pediatric Lensectomy

Author Affiliations
  • 1Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
  • 2Jaeb Center for Health Research, Tampa, Florida
  • 3Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland
  • 4Eugene and Marilyn Glick Eye Institute, Department of Ophthalmology, Indiana University, Indianapolis
  • 5Department of Ophthalmology, University of California, San Francisco
  • 6Dean McGee Eye Institute, Oklahoma City, Oklahoma
  • 7Department of Ophthalmology and Visual Sciences, Case Western Reserve University School of Medicine, Rainbow Babies and Children’s Hospital, Cleveland, Ohio
  • 8Flaum Eye Institute, University of Rochester Medical Center, Rochester, New York
JAMA Ophthalmol. 2020;138(1):71-75. doi:10.1001/jamaophthalmol.2019.4571
Key Points

Question  What is the incidence risk of glaucoma or glaucoma suspect during the first year after lensectomy in children younger than 13 years, and what are the associated risk factors?

Findings  In this cohort study of 702 pediatric patients (970 eyes), glaucoma or glaucoma suspect developed in 66 of 970 eyes (adjusted overall incidence risk, 6.3%) within 1 year after unilateral or bilateral lensectomy. Age of 3 months or younger at lensectomy and aphakia were associated with subsequent glaucoma or glaucoma suspect.

Meaning  This study’s findings suggest that, although all children should be monitored for glaucoma following lensectomy, increased attention should be given to infants 3 months or younger at lensectomy and children with aphakia after lensectomy.

Abstract

Importance  Glaucoma can occur following cataract removal in children, and determining the risk for and factors associated with glaucoma and glaucoma suspect in a large cohort of children after lensectomy can guide clinical practice.

Objective  To estimate the incidence of glaucoma and glaucoma suspect and describe its management in the first year following lensectomy in children before 13 years of age.

Design, Setting, and Participants  A multicenter clinical research registry containing data for 1361 eyes of 994 children who underwent unilateral or bilateral lensectomy between June 2012 and July 2015 at 1 of 61 sites in the United States (n = 57), Canada (n = 3), and the United Kingdom (n = 1). Patients were eligible for inclusion in the study if they were enrolled in the registry within 45 days after lensectomy and had at least 1 office visit between 6 and 18 months after lensectomy. Patient data were reviewed, and glaucoma and glaucoma suspect were diagnosed by investigators using standardized criteria. Statistical analysis was performed between June 2017 and August 2019.

Exposures  Clinical care 6 to 18 months after lensectomy.

Main Outcomes and Measures  Incidence risk using standardized definitions of glaucoma and glaucoma suspect after lensectomy.

Results  Among 702 patients included in this cohort study, 353 (50.3%) were male and 427 (60.8%) were white; mean age at lensectomy was 3.4 years (range, 0.04-12.9 years). After lensectomy, glaucoma or glaucoma suspect was diagnosed in 66 of 970 eyes (adjusted overall incidence risk, 6.3%; 95% CI, 4.8%-8.3%). Glaucoma was diagnosed in 52 of the 66 eyes, and glaucoma suspect was diagnosed in the other 14 eyes. Mean age at lensectomy in these 66 eyes was 1.9 years (range, 0.07-11.2 years), and 40 of the 66 (60.6%) were eyes of female patients. Glaucoma surgery was performed in 23 of the 66 eyes (34.8%) at a median of 3.3 months (range, 0.9-14.8 months) after lensectomy. The incidence risk of glaucoma or glaucoma suspect was 15.7% (99% CI, 10.1%-24.5%) for 256 eyes of infants 3 months or younger at lensectomy vs 3.4% (99% CI, 1.9%-6.2%) for 714 eyes of infants older than 3 months (relative risk, 4.57; 99% CI, 2.19-9.57; P < .001) and 11.2% (99% CI, 7.6%-16.7%) for 438 aphakic eyes vs 2.6% (99% CI, 1.2%-5.6%) for 532 pseudophakic eyes (relative risk, 4.29; 99% CI, 1.84-10.01; P < .001). No association was observed between risk of developing glaucoma or glaucoma suspect and any of the following variables: sex, race/ethnicity, laterality of lensectomy, performance of anterior vitrectomy, prelensectomy presence of anterior segment abnormality, or intraoperative complications.

Conclusions and Relevance  This study found that glaucoma or glaucoma suspect developed in a small number of eyes in the first year after lensectomy and may be associated with aphakia and younger age at lensectomy. Frequent monitoring for signs of glaucoma following lensectomy is warranted, especially in infants 3 months or younger at lensectomy and in children with aphakia after lensectomy.

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