Cataract surgery in the first year of life: aphakic glaucoma and visual outcomes

Objective: To report the incidence of aphakic glaucoma following lensectomy in infants in their first year of life and examine the impact of this diagnosis on visual outcome. Design: Retrospective cohort study. Participants: All patients who had lensectomy for congenital cataract during the first year of life at British Columbia Children's Hospital between 1995 and 2006. Methods: Retrospective review of medical records. Results: Seventy-five eyes of 46 patients (29 bilateral, 17 unilateral) were included. The mean age at lensectomy was 93 days (range, 2-364 days) with a mean follow-up of 77.5 months (range, 36-166 months). Patients with bilateral cataracts had a better visual outcome than those with unilateral cataracts (p = 0.032). Of the patients with measurable visual acuity (VA), 34 of 45 eyes (75.6%) with bilateral cataracts and only 3 of 16 eyes (18.8%) with unilateral cataract achieved a VA of 20/40 or better. Eighteen of 75 eyes (24%) developed aphakic glaucoma at a mean of 30 months following lensectomy. Nine patients (50%) achieved final vision of 20/40 or better. The development of aphakic glaucoma was not associated with worse visual outcomes (p = 0.315). The mean intraocular pressure (IOP) at diagnosis was 28.6 +/- 5.9 mm Hg and mean final IOP was 14.1 +/- 3.0 mm Hg, a significant reduction (p < 0.0001). Fifteen of 18 eyes with aphakic glaucoma (83.3%) required surgical intervention to achieve IOP control. Conclusions: Children with aphakic glaucoma may have good visual outcomes if it is recognized early and managed appropriately. A significant proportion of patients required surgical intervention to control IOP.