Korean J Ophthalmol.  2006 Mar;20(1):41-46. 10.3341/kjo.2006.20.1.41.

Comparison of Delayed-Onset Glaucoma and Early-Onset Glaucoma after Infantile Cataract Surgery

• Kang KD
• Yim HB
• Biglan AW

• KMID: 1099071
• DOI: http://doi.org/10.3341/kjo.2006.20.1.41

Abstract

PURPOSE: To investigate the causes and characteristics of glaucoma in children following cataract surgery. METHODS: Twenty-four patients (37 eyes) with uncomplicated congenital cataracts who developed glaucoma after cataract surgery were studied retrospectively. Variables included cataract morphology, surgical techniques, post-operative complications, time to the onset of glaucoma, gonioscopic findings, presence of microcornea and the histopathologic characteristics of the filtration angle (in one case). RESULTS: There was a bimodal onset of glaucoma after cataract surgery. Early-onset glaucoma occurred at a mean age of 6 months in 15 eyes and delayed-onset glaucoma at a mean age of 12 years in 22 eyes. Early-onset glaucoma was significantly (p=0.018) more likely to be due to angle closure than delayed-onset glaucoma. With delayed-onset glaucoma, the filtration angle was open in 86% of eyes and significantly (p=0.006) more eyes in the delayed-onset group had microcornea. Medical treatment was sufficient to control intraocular pressure in the delayed-onset group while the early-onset group required surgical treatment (P<0.001). CONCLUSIONS: The onset of glaucoma after cataract surgery during infancy follows a bimodal pattern that is correlated with the configuration of the filtration angle. The early-onset glaucoma group had high incidence of angle closure requiring surgical treatment, while in the delayed-onset group non-surgical treatment was sufficient to control intraocular pressure. Prophylactic iridectomy in eyes at risk for pupillary block is recommended. Eyes with delayed-onset glaucoma have open filtration angles yet also have findings of incomplete development of filtration structures. Microcornea is a risk factor for delayed-onset glaucoma.

Keyword

Angle closure glaucoma; Congenital cataract surgery; Delayed-onset glaucoma; Early-onset glaucoma; Open angle glaucoma

MeSH Terms

Time Factors
Risk Factors
Retrospective Studies
Postoperative Complications
Male
Intraocular Pressure
Infant
Humans
Gonioscopy
Glaucoma, Open-Angle/diagnosis/*etiology/physiopathology
Glaucoma, Angle-Closure/diagnosis/*etiology/physiopathology
Follow-Up Studies
Female
Child, Preschool
Child
Cataract Extraction/*adverse effects
Cataract/congenital
Age Factors
Adult
Adolescent

Figure

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  Fig. 1 Time (years) to the onset of glaucoma following removal of cataracts diagnosed before one year of age and removed before five years of age.

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  Fig. 2 (A and B) Gonioscopic appearance of two eyes with microcornea and delayed-onset aphakic glaucoma. Note the high iris insertion, lack of angle recess, lack of iris surface undulation, visible iris vessels, and pigmented membranous tissue covering the angle (black arrows in A and B). The scleral spur (SS) is indiscriminate. (C) Gonioscopic appearance of an age-matched normal eye with congenital nuclear cataract and microcornea. Note the normal appearance of the iris, ciliary body band (CBB), SS, and trabecular meshwork (TM).

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  Fig. 3 (A) Histopathologic view of an angle with delayed-onset aphakic glaucoma. There is no identifiable Schlemm's canal (SC), the scleral spur (SS) is indistinct, and the trabecular meshwork (TM) is compact. The angle recess (AR) is poorly developed (H&E, magnification, ×12). (B) An age-matched normal filtration angle of a 15-year-old female who received enucleation due to retinoblastoma (H&E, magnification, ×12).

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