Aphakic Glaucoma

One of the most serious complications that can occur following pediatric cataract surgery is glaucoma. It is usually open angle and has been reported to develop in up to one-third of children after a lensectomy and vitrectomy. Known risk factors for aphakic glaucoma include microcornea, persistent fetal vasculature, and cataract surgery during infancy. Parks and coworkers [35] reported that 54% of the children in their series who developed aphakic glaucoma underwent cataract surgery when they were younger than 2 months of age. Rabiah [36] reported that 37 % of children undergoing cataract surgery when 9 months of age or younger developed glaucoma compared to only 6 % of children undergoing surgery thereafter.Vishwanath and colleagues [43] noted that 50% of children undergoing bilateral lensectomies during the 1st month of life developed glaucoma in one or both eyes after a 5-year follow-up compared to only 15 % of children undergoing cataract surgery when 1 month of age or older. Lundvall and Kugelberg [30] also reported that 80% of the children in their series who developed glaucoma underwent cataract surgery during the first 4 weeks of life. Finally, Watts and co-workers [44] reported that aphakic glaucoma was more prevalent in children undergoing surgery when 14-34 days of age. While it is possible that eyes with congenital cataracts requiring very early surgery are more prone to developing glaucoma than eyes that acquire cataracts later in infancy, it is more likely that very early surgery increases the risk of these eyes developing glaucoma. For this reason, Vishwanath and co-workers [43] have proposed that cataract surgery should be deferred until after the first 4 weeks of life.

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