Factors associated with the time of glaucoma-related adverse events onset after pediatric cataract surgery and the preferred anti-glaucomatous surgical selection.

Abstract

Purpose: To describe the clinical characteristics of glaucoma-related adverse events (GRAE) after pediatric cataract surgery. More importantly, to identify the factors associated with the time of GRAE onset and the preferred anti-glaucomatous surgical procedure for this disease.

Methods: Hospitalized medical records of patients who developed GRAE, which include glaucoma and glaucoma suspect, after pediatric cataract surgery (surgical age ≤ 14 years) between 1994 and 2021 were retrospectively reviewed. If the interval between cataract surgery and GRAE diagnosis was less than one year, early-onset GRAE was diagnosed, otherwise it was late-onset type. Multivariate logistic regression analysis was performed to investigate the possible associated factors for the type of GRAE onset. Chi-square test was used to evaluate the differences of the re-operation rate between the two surgical groups of glaucoma valve implantation and trabeculectomy for controlling elevated intraocular pressure (IOP).

Results: 125 eyes in 94 patients with GRAE following pediatric cataract surgery were included in the study. Among them, 25 patients had unilateral cataracts and 100 eyes in 69 patients were bilateral. Of the 125 eyes, 63 (50.4%) had initial cataract surgery under 6 months of age, and 97 (77.6%) under 2 years of age. 76 eyes (60.8%) were aphakic, and 21 (16.8%) were with primary intraocular lens (IOL) implantation and the remaining 28 (22.4%) with secondary IOL implantation. More than half of the eyes (69/104, 66.3%) belonged to the group of late-onset GRAE. Multivariate analysis showed that a younger age at cataract surgery was associated with early-onset GRAE (P = 0.041). Closed angles were found in 72.1% (44/61) of eyes before the first anti-glaucomatous surgeries. 50% eyes (9/18) after trabeculectomy needed re-operation to control IOP compared with 12.1% (4/33) after glaucoma valve implantation (P = 0.003).

Conclusions: An earlier age at pediatric cataract surgery is more likely to develop early-onset GRAE. Glaucoma valve implantation seemed to be a preferred surgical intervention for patients with GRAE.