Pediatric Pseudophakic Glaucoma Following Surgery for Isolated Childhood Cataract

BACKGROUND AND OBJECTIVE: To report the incidence and risk factors for pseudophakic glaucoma in children who underwent surgery for non-traumatic cataract without other ocular structural abnormality. PATIENTS AND METHODS: Institutional retrospective case series (1990 to 2003) of patients younger than 12 years of age who underwent surgery with primary posterior chamber intraocular lens (PC-IOL) implantation for non-traumatic cataract. Patients with post-surgical follow-up of less than 5 years, microcomea, persistent fetal vascular, and/or other significant anterior segment abnormality were excluded. Glaucoma was defined as intraocular pressure (IOP) of 28 mm Hg or greater on at least two separate occasions. RESULTS: Of 489 pediatric pseudophakic eyes, 8 (1.6%) were diagnosed as having glaucoma (5 of 326 patients, 1.5%) an average of 15.8 months (median: 8 months; range: 2 to 60 months) after cataract surgery with an average IOP at diagnosis of 32.4 mm Hg (standard deviation [SD] = 3.6). Mean follow-up was 66.9 months (SD = 12.6). The other 481 pseudophakic eyes (not diagnosed as having glaucoma) had an average follow-up of 70.5 months (SD = 12.5). For the former group, the average age at cataract surgery was 49.6 months (SD = 21.6; median: 60.5 months; range: 12 to 62 months), whereas for the latter group it was 45.5 months (SD = 32.4; median: 37 months; range: 5 to 141 months). One eye from the former group and 27 eyes from the latter group had sulcus placement of an all-acrylic PC-IOL. CONCLUSION: Pediatric pseudophakic glaucoma was rare and had no obvious risk profile. Selection bias for PC-IOL placement favored eyes operated on after infancy (ie, after the period of highest risk for aphakic glaucoma). Most eyes were diagnosed as having glaucoma within 1 year of surgery, sooner than when most eyes are typically diagnosed as having aphakic glaucoma.