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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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(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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Figure 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).

Mentions: Figure 3 shows an angle in the eye of a patient with delayed-onset glaucoma; the meshwork is compact and hypercellular, the iris stroma and neovascular tissue encroaches on the partially developed angle recess and the lumen of Schlemm's canal cannot be clearly identified.


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

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

(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).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 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).
Mentions: Figure 3 shows an angle in the eye of a patient with delayed-onset glaucoma; the meshwork is compact and hypercellular, the iris stroma and neovascular tissue encroaches on the partially developed angle recess and the lumen of Schlemm's canal cannot be clearly identified.

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