Incidence and Risk Factors for Glaucoma After Pediatric Cataract Surgery With and Without Intraocular Lens Implantation

Purpose: We sought to report the incidence of glaucoma in the eyes of children who underwent cataract surgery with and without intraocular lens implantation and to report the risk factors for developing glaucoma. Methods: We undertook a retrospective review of pediatric cataract surgery charts, excluding traumatic cataract, aniridia and Lowe syndrome, steroid-induced cataract, lens subluxation, uveitis, retinoblastoma, radiation-induced cataract, retinopathy of prematurity, secondary IOL implantation, and patients with less than 1 month of postoperative follow-up. Results: After pediatric cataract surgery, 10 (3.8%) of 266 eyes with primary intraocular lens implantation were diagnosed with glaucoma, whereas 8 (17.0%) of 47 aphakic eyes were diagnosed with glaucoma. During the initial analyses, we noted that all of the patients who developed glaucoma underwent cataract surgery when they were 4.5 months or younger. For all patients who underwent surgery during the first 4.5 months of their life, the glaucoma incidence was 24.4% (10/41) in children with pseudophakic eyes and 19.0% (8/42) in age-matched children with aphakic eyes (risk ratio = 1.1, CI = 0.7–1.9; P = .555). In patients who underwent surgery during the first 4.5 months of their life, the average age of the patients who developed glaucoma was not significantly different than those who did not develop glaucoma in pseudophakic eyes (2.0 months ± 1.4 vs. 1.9 months ± 1.0, P = .700) or aphakic eyes (2.6 months ± 1.5 vs. 1.4 months ± 0.9, P = .070). The corneal diameter of the eyes that developed glaucoma versus eyes that did not was not significantly different in patients with pseudophakic eyes ( P = .860) or aphakic eyes ( P = .254). Glaucoma was diagnosed in patients at an average of 8.6 months and 117.9 months after cataract surgery in those with pseudophakic eyes and aphakic eyes, respectively. Conclusions: Patients undergoing cataract surgery at an early age are at high risk for the development of glaucoma with or without an intraocular lens implant.