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Comparison of delayed-onset glaucoma and early-onset glaucoma after infantile cataract surgery.

Kang KD, Yim HB, Biglan AW - Korean J Ophthalmol (2006)

Bottom Line: Medical treatment was sufficient to control intraocular pressure in the delayed-onset group while the early-onset group required surgical treatment (P < 0.001).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.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

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.

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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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Figure 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.

Mentions: The onset of glaucoma after cataract surgery followed a bimodal pattern (Fig. 1). Fifteen eyes had an early onset of glaucoma (1 week to 13 months after cataract surgery), while 22 eyes had delayed-onset glaucoma (70 to 177 months after cataract surgery). Two patients with bilateral aphakia developed early-onset glaucoma due to pupillary block in the first eye and delayed-onset open angle glaucoma in the fellow eye. Out of 11 patients in the early-onset group, 5 patients had unilateral cataract surgery, 4 patients had bilateral cataract surgery, and 2 patients with bilateral aphakia developed early-onset glaucoma in one eye and delayed-onset glaucoma in the other eye. Out of 15 patients in the delayed-onset group, 6 patients had unilateral cataract surgery, 7 patients had bilateral cataract surgery, and 2 patients with bilateral aphakia developed delayed-onset glaucoma following early-onset glaucoma in the other eye. Early-onset glaucoma typically had an abrupt onset. Presenting symptoms and signs included pain, photophobia, lacrimation, pupillary block, angle closure, rapid myopic shift in the refractive error and corneal edema. Delayed-onset glaucoma (in 18 of 22 eyes) had an insidious, painless onset with an increased IOP that was discovered on routine examination. Age at cataract surgery and type of glaucoma onset were not significantly related (p=0.08).


Comparison of delayed-onset glaucoma and early-onset glaucoma after infantile cataract surgery.

Kang KD, Yim HB, Biglan AW - Korean J Ophthalmol (2006)

Time (years) to the onset of glaucoma following removal of cataracts diagnosed before one year of age and removed before five years of age.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2908815&req=5

Figure 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.
Mentions: The onset of glaucoma after cataract surgery followed a bimodal pattern (Fig. 1). Fifteen eyes had an early onset of glaucoma (1 week to 13 months after cataract surgery), while 22 eyes had delayed-onset glaucoma (70 to 177 months after cataract surgery). Two patients with bilateral aphakia developed early-onset glaucoma due to pupillary block in the first eye and delayed-onset open angle glaucoma in the fellow eye. Out of 11 patients in the early-onset group, 5 patients had unilateral cataract surgery, 4 patients had bilateral cataract surgery, and 2 patients with bilateral aphakia developed early-onset glaucoma in one eye and delayed-onset glaucoma in the other eye. Out of 15 patients in the delayed-onset group, 6 patients had unilateral cataract surgery, 7 patients had bilateral cataract surgery, and 2 patients with bilateral aphakia developed delayed-onset glaucoma following early-onset glaucoma in the other eye. Early-onset glaucoma typically had an abrupt onset. Presenting symptoms and signs included pain, photophobia, lacrimation, pupillary block, angle closure, rapid myopic shift in the refractive error and corneal edema. Delayed-onset glaucoma (in 18 of 22 eyes) had an insidious, painless onset with an increased IOP that was discovered on routine examination. Age at cataract surgery and type of glaucoma onset were not significantly related (p=0.08).

Bottom Line: Medical treatment was sufficient to control intraocular pressure in the delayed-onset group while the early-onset group required surgical treatment (P < 0.001).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.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

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.

Show MeSH
Related in: MedlinePlus