Glaucoma-Related Adverse Events Common After Pediatric Lensectomy

Erick D. Bothun, MD

The cumulative risk of glaucoma-related adverse events during the first 5 years after pediatric lensectomy was investigated in a recent analysis, with the findings indicating a greater need for closer monitoring in children.

According to the results, glaucoma-related adverse events were frequent with surgery in children less than 3 months old in mostly aphakic eyes, but uncommon in children 1 to 12 years of age in mostly pseudophakic eyes.¹

“The incidence of glaucoma in aphakic and pseudophakic eyes increased slowly during follow-up, suggesting the need for continued monitoring for the development of glaucoma,” wrote investigators.¹

Factors associated with glaucoma risk after cataract removal have not been prospectively studied in a large cohort of children undergoing lensectomy prior to 13 years of age, according to the investigator’s knowledge. Over a 5-year period, the Pediatric Eye Disease Investigator Group (PEDIG) developed a registry to collect data on children undergoing lensectomy prior to 13 years of age. Children with at least 1 office visit after unilateral or bilateral lensectomy were enrolled across 61 sites from June 2012 to July 2015.

The PEDIG team, led by Erick D. Bothun, MD, Jaeb Center for Health Research, aimed to uncover the cumulative incidence of glaucoma-related adverse events and baseline factors associated with the risk of these adverse events. Data were analyzed from February through December 2022. Analyses were stratified by whether an intraocular lens (IOL) was implanted in the eye at the time of initial lensectomy (pseudophakia) or not (aphakia).

A total of 810 children (1049 eyes) were included in the analyses. Of this population, 443 eyes of 321 children (55% female; mean age, 0.89 years) were aphakic after lensectomy, and 606 eyes of 489 children (53% male; mean age, 5.65 years) were pseudophakic.

According to the analysis, the 5-year cumulative incidence of glaucoma-related adverse events was 29% (95% CI, 25% - 34%) in 443 eyes with aphakia and 7% (95% CI, 5% - 9%) in 606 eyes with pseudophakia (32 events).¹ Data show 7% of phakic eyes and 3% of psuedophakic eyes were diagnosed as glaucoma suspect.

The results how a higher risk for a glaucoma-related adverse event within 5 years among aphakic eyes was associated with age less than 3 months (adjusted hazard ratio [aHR], 2.88; 99% confidence interval [CI], 1.57 - 5.23), abnormal anterior segment (ahR, 2.88; 99% CI, 1.56 - 5.30), intraoperative complications at the time of lensectomy (aHR, 2.25; 99% CI, 1.04 - 4.87), and bilaterality (aHR, 1.88; 99% CI, 1.02 - 3.48).

The highest rates of glaucoma-related events were reported for infants younger than 6 weeks at lensectomy (44%) and for infants between 6 weeks and 3 months of age (35%). In the pseudophakic population, fewer children developed a glaucoma-related adverse event within 5 years and none of the evaluated factors were associated with an increased or decreased risk.

Investigators noted a comparison could not be made between the development of glaucoma or glaucoma suspect between aphakic and pseudophakic eyes.

“We were unable to compare the development of glaucoma or glaucoma suspect between aphakic and pseudophakic eyes because most aphakic eyes in the cohort were from children younger than 6 months (74%) at time of lensectomy and most primary IOLs were placed in children older than 6 months (99%),” they wrote.¹

References

1. Bothun ED, Repka MX, Kraker RT, et al. Incidence of Glaucoma-Related Adverse Events in the First 5 Years After Pediatric Lensectomy. JAMA Ophthalmol. Published online February 16, 2023. doi:10.1001/jamaophthalmol.2022.6413