Glaucoma following Infant Lensectomy: 2021 Update

Purpose To review information pertaining to glaucoma following infant lensectomy surgery and to provide evidence to support the responsible mechanism of this condition. Methods and Results Described risk factors and proposed mechanisms for infantile aphakic glaucoma were assessed. The clinical evidence observed in affected glaucoma patients was analyzed, and evidence of postoperative anterior chamber fibrosis was reviewed and interpreted. Conclusion The review and assessment of laboratory and clinical evidence support the proposal that infantile aphakic glaucoma is caused, in part, by postoperative anterior chamber fibroization related to lens cell dispersion and active epithelial-mesenchymal transition with resultant filtration angle tissue injury and loss of function.

Original Article PEDIATRIC APHAKIC GLAUCOMA (REVISED) (1)

Purpose: To know the occurrence and pathogenesis of post operative aphakic glaucoma in children operated for congenital cataract at Mardan Medical Complex, Mardan KP (Pakistan). Study Design: Retrospective Cohort study Place and duration of Study: Mardan Medical Complex, Mardan (KP) between January 2001 and December 2014. Material and Methods: A retrospective analysis of all cases was conducted who were operated for congenital cataracts between the ages from 2 months to 30 months in the Department of Ophthalmology Mardan Medical Complex, Mardan (Pakistan) between January, 2001 and December, 2014. Babies having congenital cataracts with increased intraocular pressure (IOP), those showing signs of congenital glaucoma and those having congenital cataracts with specific syndromes were not included in the study. Results: We reviewed the records of 110 patients who had bilateral lens aspiration for congenital cataracts. We found 7 patients (12 eyes) who developed increased intra-ocular pressure (IOP) after bilateral lens matter aspiration for congenital cataracts. Four patients (three males one female), developed early onset pupil block glaucoma, (2 bilateral and 2 unilateral) while in 3 female patients the onset of glaucoma was delayed for several months to years and was of the open angle type in both the eyes. Conclusions: Poor compliance with follow up, poor pupillary dilatation, prolonged surgical time, severe inflammation and residual lens matter are some of the risk factors for early onset pupillary block aphakic glaucoma in pediatric age group. The exact mechanism of open angle glaucoma detected later on remains unclear and difficult to manage. Key Words : Pediatric aphakic glaucoma, Congenital cataract, Aphakic open angle glaucoma, Pupil block, Primary posterior capsulotomy,

Pediatric Aphakic Glaucoma

Purpose: To find the frequency and pathogenesis of post-operative aphakic glaucoma in children operated for congenital cataract at Mardan Medical Complex, Mardan, Pakistan. Study Design: Retrospective Cohort study. Place and Duration of Study: Mardan Medical Complex, Mardan between January 2001 and December 2014. Material and Methods: All cases were operated for congenital cataracts between the ages of 2 months to 30 months were included in the study. Babies having congenital cataracts with increased intraocular pressure (IOP), those showing signs of congenital glaucoma and those having congenital cataracts with specific syndromes were not included in the study. Results: We reviewed the records of 110 patients who had bilateral lens aspiration for congenital cataracts. We found 7 patients (12 eyes) who developed increased intra-ocular pressure (IOP) after bilateral lens matter aspiration for congenital cataracts. Four patients (three males one female), developed early onset pupil block glaucoma, (2 bilateral and 2 unilateral) while in 3 female patients the onset of glaucoma was delayed for several months to years and was of the open angle type in both the eyes. Poor compliance with follow up, poor pupillary dilatation, prolonged surgical time, severe inflammation and residual lens matter are some of the risk factors for early onset pupillary block aphakic glaucoma in pediatric age group. Conclusions: Pediatric aphakic glaucoma is a significant complication of congenital cataract surgery which requires continuous followup of the patients. Key Words: Pediatric aphakic glaucoma, Congenital cataract, Aphakic open angle glaucoma, Pupil block, Primary posterior capsulotomy,

Clinical outcomes of Ahmed glaucoma valve implantation in pediatric glaucoma

Purpose: To evaluate the outcomes of Ahmed glaucoma valve implantation in refractory primary congenital glaucoma as well as primary procedure in aphakic glaucoma. Method: In this retrospective study, medical records of patients who underwent Ahmed glaucoma valve implantation for refractory glaucoma and aphakic glaucoma were reviewed. Primary outcome measures were the surgical success defined as intraocular pressure ≤21 mm Hg and decreased ≥20% and no secondary glaucoma surgery. Secondary outcome measures were the number of glaucoma medications, complications, best corrected visual acuity, and intraocular pressure. Results: A total of 62 eyes of refractory primary congenital glaucoma patients (group 1) and 33 eyes of aphakic glaucoma patients (group 2) were included in our study. Mean follow-up was 51 ± 33 months in group 1 and 49 ± 41 months in group 2 (p = 0.82). The cumulative probability of success was 90% in both groups at the first year; however, the success rate was 52.5% in group 1 and 71.5% in group 2 at 5 years’ follow-up visit. In group 1, the mean intraocular pressure ± standard deviation was 33.1 ± 8.6 mm Hg at the baseline and decreased to 17.1 ± 5.3 mm Hg at 1 year and 18.5 ± 6.4 at 3 years postoperatively (all p’s < 0.001). Corresponding values for group 2 were 28.9 ± 6.1, 15.2 ± 4.6, and 16.0 ± 5.9 mm Hg, respectively (all p’s < 0.001). The baseline number of glaucoma medications was 3 ± 0.7 that decreased to 2 ± 0.8 at final follow-up (p = 0.02). Conclusion: Ahmed glaucoma valve implantation has a moderate success rate in the management of refractory primary congenital glaucoma with an increased chance of tube-related complications. The surgical success rate is higher in case of primary Ahmed glaucoma valve implant for aphakic glaucoma with acceptable safety profile.

Outcome of Pediatric Cataract Surgeries in a Tertiary Center in Switzerland

Purpose. To determine and to analyze the outcome of pediatric cataract surgery. Methods. A retrospective chart review of individuals aged up to 10 years who underwent cataract surgery between January 1, 2004, and December 31, 2014, at the UniversityHospital Zurich, Switzerland. Results. 63 children (94 affected eyes) with bilateral (68/94) or unilateral (26/94) cataract were identified. Surgery was performed at a median age of 1.5 months (IQR: 1.3–2.6 months) for the aphakic group (45/94) and of 50.7 months (IQR: 38.0–78.4 months) for the IOL group (49/94). At the last follow-up visit (median 31.1 months, IQR: 18.4–50.2 months), visual acuity was better in bilateral than in unilateral cataract cases. Posterior capsular opacification (PCO) was diagnosed in 30.9% of eyes without a significant difference in the IOL and aphakic groups (p=0.12). Aphakic glaucoma was diagnosed in 12/45 eyes at a median of 6.8 months (IQR 2.1–13.3 months) after surgery. Microcornea (5/12) and anterior segment anomalies (8/12) were associated with glaucoma development (p<0.05). Conclusion. Laterality and timing of surgery influence the outcome of pediatric cataract surgery. PCO was the most frequent postoperative complication. Aphakic glaucoma is often associated with ocular developmental abnormalities and a poor visual outcome.