Clinical characteristics and treatment of secondary glaucoma, glaucoma suspects and ocular hypertension after congenital cataract surgery

2021 ◽  
pp. 112067212199135
Author(s):  
Katharina Eibenberger ◽  
Barbara Kiss ◽  
Ursula Schmidt-Erfurth ◽  
Eva Stifter
Keyword(s):  
Intraocular Pressure ◽  
Cataract Surgery ◽  
Ocular Hypertension ◽  
Congenital Cataract ◽  
Case Series ◽  
Secondary Glaucoma ◽  
Visual Axis ◽  
Retrospective Case ◽  
Pediatric Cataract ◽  
Congenital Cataract Surgery

Objective: To evaluate changes in intraocular pressure after congenital cataract surgery in a real-world setting. Methods: This retrospective case series included all children aged 0–2 years undergoing lens extraction due to congenital cataract. Development of an elevated intraocular pressure was divided into three groups: secG, suspG and OHT. Further, risk factors for IOP changes, the therapeutic approach and functional outcome were assessed during follow-up. Results: One hundred and sixty-one eyes of 110 patients aged 0–2 years were included, whereof 29 eyes of 17 children developed secondary glaucoma (secG; 11 eyes/8 patients), glaucoma suspect (suspG; three eyes/three patients) or ocular hypertension (OHT; 15 eyes/10 patients). No difference in surgrical procedure ( p = 0.62) was found, but age at cataract surgery differed significantly ( p = 0.048), with the secG group (1.74 ± 1.01 months) being the youngest (suspG: 3.93 ± 1.80 months; OHT group: 5.91 ± 5.36 months). Secondary surgical intervention was significantly higher in the secG (4.64 ± 3.41) followed by the suspG (2.00 ± 2.65) and OHT groups (0.40 ± 0.74; p < 0.001). Postoperative complications including nystagmus ( p = 0.81), strabismus ( p = 0.98) and amblyopia ( p = 0.73) showed no difference, in contrast to visual axis obscuration which was more common in the secG group ( p = 0.036). Conclusion: Initial lensectomy and anterior vitrectomy procedure together with or without IOL implantation seems to have no influence for the development of IOP changes after pediatric cataract surgery. However, children who developed secondary glaucoma had cataract surgery significantly earlier, within the first 2–3 months of life. Glaucoma surgery was required to achieve final IOP control in most eyes. The development of secondary glaucoma was also associated with a significant increase in surgical re-treatments.

Secondary glaucoma and visual axis opacification in aphakic and pseudophakic patients following congenital cataract surgery: A 28-year longitudinal case series

2019 ◽  
Vol 30 (6) ◽  
pp. 1370-1380 ◽  
Author(s):  
Melissa Murphy ◽  
Patrick Murtagh ◽  
Lisa McAnena ◽  
Azher Eldouri ◽  
Caitriona Kirwan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Relative Risk ◽  
Cataract Surgery ◽  
Congenital Cataract ◽  
Case Series ◽  
Secondary Glaucoma ◽  
Visual Axis ◽  
Post Surgery ◽  
Significant Difference

Purpose: To determine the incidence, timing and risk factors for glaucoma and visual axis opacification development following surgery for congenital cataract in the first year of life. Methods: A prospective case series of all cataract surgery performed in Temple Street Children’s University Hospital over a 28-year period was conducted. A total of 93 subjects (135 eyes) were analysed. Sixty-two eyes had a primary intraocular lens inserted at the time of surgery; 73 eyes were aphakic. We recorded patient demographics, age at surgery, length of follow-up, rates and time to diagnosis of glaucoma and rates of visual axis opacification. Relative risk analysis was performed to identify potential risk factors for secondary glaucoma and visual axis opacification. Results: Mean length of follow-up was 160.02 ± 64.42 months (13.3 years), range 40–336 months. Final mean LogMAR across all groups was 0.85 ± 0.51 (0.90). Overall 45 (33.33%) eyes developed secondary glaucoma, 12 (19.4%) in pseudophakic eyes and 33 (45.21%) in aphakic eyes. The incidence of glaucoma was highest in bilateral aphakia (relative risk 1.96, p = 0.0240) and in eyes with corneal diameter <9.5 mm (relative risk 1.93, p = 0.0364). There was no significant difference in glaucoma rates between pseudophakia and aphakia in those operated on less than 2.5 months of age. Secondary glaucoma occurred between 3 months to 16.5 years post surgery. Rates of visual axis opacification were lower in aphakia compared to pseudophakia (relative risk 0.59, p = 0.0098). Conclusion: Overall glaucoma rates of one-third are similar to those recorded in the infantile aphakic treatment study. It can occur up to 17 years post cataract surgery, evidence that long-term follow-up is imperative.

Outcomes of Ahmed glaucoma valve in paediatric glaucoma following congenital cataract surgery in persistent foetal vasculature

2020 ◽  
pp. 112067212091906 ◽  
Author(s):  
Karina Spiess ◽  
Jesús Peralta Calvo
Keyword(s):  
Intraocular Pressure ◽  
Cataract Surgery ◽  
Congenital Cataract ◽  
Cox Regression ◽  
Secondary Glaucoma ◽  
Final Visit ◽  
Cumulative Probability ◽  
Ahmed Glaucoma Valve ◽  
Probability Of Success ◽  
Congenital Cataract Surgery

Purpose To evaluate the outcomes of primary Ahmed glaucoma valve in refractory secondary glaucoma following congenital cataract surgery, particularly in persistent foetal vasculature. Method Retrospective review of paediatric patients after Ahmed glaucoma valve implantation for refractory post-lensectomy glaucoma in a tertiary referral centre in Spain. Surgical complications, additional and/or replacements of Ahmed glaucoma valve, intraocular pressure, cup-to-disc ratio, glaucoma medications and final visual acuity were studied. Results A total of 29 eyes, 41% with persistent foetal vasculature and 59% with non–persistent foetal vasculature were included with mean follow-up of 105 ± 67 and 74 ± 45 months, respectively, after first Ahmed glaucoma valve implant. Median survival time for the first Ahmed glaucoma valve was significantly lower in persistent foetal vasculature (7.0 ± 3.2 months) compared to non–persistent foetal vasculature (over 129 months), p = 0.001. The cumulative probability of success in persistent foetal vasculature and non–persistent foetal vasculature eyes with Ahmed glaucoma valve were, respectively, 37.5% and 88.2% at year 1 and 28.1% and 71.9% at year 5. Cox regression model suggested persistent foetal vasculature as predictive risk factor of time to Ahmed glaucoma valve failure (hazard ratio: 5.77, p = 0.004). Four eyes developed phthisis bulbi. Mean intraocular pressure prior glaucoma surgery was 32.66 ± 6.73 mmHg and decreased to 16.54 ± 2.75 mmHg (p < 0.001) at final visit. The most frequent early postoperative complication was severe hypotony (32.6%) which tended to be self-limiting. Vitreous haemorrhage was associated with persistent foetal vasculature (p = 0.024). Ahmed glaucoma valve replacements after complications and additional Ahmed glaucoma valve implantations due to unsatisfactory intraocular pressure were more common in the persistent foetal vasculature group. Conclusion Eyes with persistent foetal vasculature and secondary glaucoma after congenital cataract surgery followed by AGV implantation had a higher number of complications and a decreased probability of success compared to the non-persistent foetal vasculature group. Both groups achieved a significant decrease in intraocular pressure; thus, Ahmed glaucoma valve may be considered as first-line treatment in refractory glaucoma following congenital cataract surgery.

scholarly journals Management of Aphakia with Visual Axis Opacification after Congenital Cataract Surgery Based on UBM Image Features Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Wensi Chen ◽  
Shiping He ◽  
Daoman Xiang
Keyword(s):  
Cataract Surgery ◽  
Mixed Type ◽  
Congenital Cataract ◽  
Ultrasound Biomicroscopy ◽  
Image Features ◽  
Imaging Features ◽  
Visual Axis ◽  
Anterior Vitrectomy ◽  
Congenital Cataract Surgery

Objective. The purpose of this study was to study the imaging features of ultrasound biomicroscopy (UBM) in the aphakia with visual axis opacification (VAO) after congenital cataract surgery. Methods. From May 2015 to May 2018, aphakia patients with VAO who underwent congenital cataract surgery were examined by high-resolution bag/balloon UBM technique, and the results of UBM imaging were analyzed. According to UBM imaging features, different types of VAO were classified. Results. A total of 38 children (55 eyes) with VAO were included. 17 patients were bilateral, and 21 patients were unilateral. Patients with VAO were classified into 3 groups according to the UBM imaging features: membranous fibrosis VOA (17 cases, 28 eyes), cortical regeneration VOA (15 cases, 20 eyes), and mixed VOA (6 cases, 7 eyes). The patients in the membranous fibrosis group underwent Nd:YAG laser posterior capsulotomy, those in the cortical regeneration group underwent anterior vitrectomy, and those in the mixed type group underwent anterior vitrectomy with RF capsulotomy tip. After surgery, VAO were removed in all patients. During the follow-up period, in the membranous fibrotic VAO group, iris adhesion and pupillary occlusion were found in 2 eyes, and anterior vitrectomy combined with separation of iris adhesion was performed. In cortical regenerative and mixed type VAO groups, anterior vitrectomy was performed without opacity in the axial region. The total recurrence rate of VAO was 3.46%. Conclusion. After congenital cataract surgery, the UBM imaging features of aphakia with VAO are helpful to evaluate the condition of VAO before reoperation so as to choose the optimal surgical method to achieve better therapeutic effect.

scholarly journals Primary and Secondary Intraocular Lens Implantation in Congenital Cataract Surgery: A Retrospective Comparative Study of the Visual Outcomes

2017 ◽  
Vol 1 (1) ◽  
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Cataract Surgery ◽  
Intraocular Lens ◽  
Congenital Cataract ◽  
Iol Implantation ◽  
Visual Outcomes ◽  
Secondary Iol Implantation ◽  
Myopic Shift ◽  
Congenital Cataract Surgery

Objectives: To compare visual outcomes, principally myopic shift, visual acuity, intraocular pressure and strabismus between primary and secondary intraocular lens (IOL) implantation following congenital cataract surgery. Methods: A retrospective study of the long-term ocular outcomes in primary versus secondary IOL implantation (IOL-I) following congenital cataract surgery was conducted. We analyzed the files of all children with congenital cataract who underwent unilateral or bilateral lensectomy, posterior capsulotomy and anterior vitrectomy followed by primary or secondary IOL-I between 2000 to 2012, at King Abdulaziz University Hospital, Jeddah. Preoperative and postoperative assessment of each operated eye in terms of axial length, refractive errors, strabismus as well as (post IOL-I) intraocular pressure (IOP) and best corrected visual acuity (BC-VA) were collected and analyzed. Results: Data of 26 eyes of 14 patients (9 males, 6 females) was analyzed: 16 (61.5%) eyes underwent lensectomty and anterior vasectomy with primary IOL-I and 10 (38.5%) eyes underwent lumpectomy and anterior vasectomy with secondary IOL-I. Mean age at cataract surgery was 67.53 (± 48.70) months in the group of primary IOL-I versus 5.90 (± 3.72) months in the group of secondary IOL-I; and patients were followed up for 49.33 (± 26.23) versus 86.50 (± 23.36) months, respectively (p=.051). In the secondary IOL-I group, the mean of time from primary lensectomy to IOL-I was 50.44 (± 18.41) months. Last BC-VA showed better outcomes in primary IOL-I group as 10 eyes (83.3%) with good VA versus only 2 eyes (20%) in the secondary IOL-I, (p=0.009). Myopic shift was greater in secondary IOL group 10.86 (± 11.62) versus 0.19 (± 2.38) diopters (D) in primary IOL (p=0.046*); while no significant difference was observed in IOP (p=0.697). No case of isotropic was detected in primary versus 6 cases in the secondary IOL group. Conclusion: Visual outcomes, including visual acuity, strabismus and myopic shift were better in the group of children who underwent primary IOL implantation at age of >2 years, when compared to those with secondary IOL implantation at the age of <2 years, following congenital cataract surgery. However, poor visual acuity in the secondary IOL group was mainly explained by the relatively higher prevalence of eye complications in this group.

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