Predictors of Glaucoma After Pediatric Cataract Surgery

Abstract

Précis: Glaucoma following pediatric cataract surgery is common and challenging. Age at surgery and presence of microcornea or other anterior segment abnormalities can be used to identify those at greatest risk. Purpose: To establish risk factors for developing glaucoma after pediatric cataract surgery (GFCS). Methods: Single-center, retrospective, longitudinal study of patients who underwent lensectomy for pediatric cataract from 2008 to 2020. Included eyes presented congenital or acquired pediatric cataracts or an anterior form of PFV, and a follow-up of at least one year. Exclusion criteria were the presence of pre-existing intraocular pressure (IOP) elevation, congenital glaucoma, syndromic cataract, and history of trauma or uveitis. Demographic and clinical data were collected. Our primary outcome was the development of GFCS. Multivariable logistic regression with generalized estimating equations (GEE) was used to model the association between potential predictors and the risk of GFCS. Results: 110 eyes from 74 patients were included, 38 with unilateral and 36 with bilateral pediatric cataract surgery. Average surgery age was 24.71±37.26 months, with 74 eyes (67.3%) undergoing surgery ≤12 weeks of age. Patients were followed for 9.96±3.64 years after surgery. 28 eyes (25.45%) developed GFCS, all requiring glaucoma surgery. In multivariable analysis, surgery before 12 weeks of age (OR 34.74; P<0.001), presence of microcornea (OR 12.90; P=0.002), and presence of other anterior segment (AS) abnormalities (OR 52.71; P<0.001) were significantly associated with the development of GFCS. Conclusions: The development of GFCS is a common and relevant adverse event after pediatric cataract surgery whose management is challenging. Age at surgery, presence of microcornea, and presence of other AS abnormalities can be used to identify those at greatest risk.