Cataract surgery in the first year of life: aphakic glaucoma and visual outcomes.

OBJECTIVE

To report the incidence of aphakic glaucoma following lensectomy in infants in their first year of life and examine the impact of this diagnosis on visual outcome.

DESIGN

Retrospective cohort study.

PARTICIPANTS

All patients who had lensectomy for congenital cataract during the first year of life at British Columbia Children's Hospital between 1995 and 2006.

METHODS

Retrospective review of medical records.

RESULTS

Seventy-five eyes of 46 patients (29 bilateral, 17 unilateral) were included. The mean age at lensectomy was 93 days (range, 2-364 days) with a mean follow-up of 77.5 months (range, 36-166 months). Patients with bilateral cataracts had a better visual outcome than those with unilateral cataracts (p < 0.032). Of the patients with measurable visual acuity (VA), 34 of 45 eyes (75.6%) with bilateral cataracts and only 3 of 16 eyes (18.8%) with unilateral cataract achieved a VA of 20/40 or better. Eighteen of 75 eyes (24%) developed aphakic glaucoma at a mean of 30 months following lensectomy. Nine patients (50%) achieved final vision of 20/40 or better. The development of aphakic glaucoma was not associated with worse visual outcomes (p < 0.315). The mean intraocular pressure (IOP) at diagnosis was 28.6±5.9 mm Hg and mean final IOP was 14.1 ± 3.0 mm Hg, a significant reduction (p < 0.0001). Fifteen of 18 eyes with aphakic glaucoma (83.3%) required surgical intervention to achieve IOP control.

CONCLUSIONS

Children with aphakic glaucoma may have good visual outcomes if it is recognized early and managed appropriately. A significant proportion of patients required surgical intervention to control IOP.