Incidence of Glaucoma-Related Adverse Events in the First 5 Years After Pediatric Lensectomy
Authors: Bothun Erick D. , Repka Michael X. , Kraker Raymond T. , Wu Rui , Leske David A. , Hatt Sarah R. , Li Zhuokai , Freedman Sharon F. , Astle William F. , Cotter Susan A. , Holmes Jonathan M. ,   Pediatric Eye Disease Investigator Group, Wallace David K. , Enyedi Laura B. , Prakalapakorn Sasapin , Jones Sarah K. , Hug Denise , Stahl Erin D. , Dent Rebecca J. , Kong Lingkun , Wang Serena , Gallerson Bryan K. , Hutchinson Amy K. , Lenhart Phoebe , Brower Judy , Morrison David G. , Ruark Scott T. , Mets-Halgrimson Rebecca , Yoon Hawke , Ralay-Ranaivo Hantamalala , Hamidullah Aaliyah , Areaux Raymond , Anderson Jill S. , Holleschau Ann M. , Superstein Rosanne , Belanger Caroline , Fallaha Nicole , Hamel Patrick , Thibeault Maryse , Tamkins Susanna M. , Chang Ta , Park Hee-Jung S. , Trumler Anya A. , Liu Xiaonong , Sanders Emi N. , Traboulsi Elias , Ghasia Fatema , McOwen Diana C. , Gray Michael E. , Yang Michael B. , Bowman Corey S. , Galvin Jennifer , Therriault Margaret , Smith Heather , Whitaker Michele E. , Orge Faruk , Grigorian Adriana P. , Baird Alicia M. , Strominger Mitchell B. , Chen Vicki , Klein Shelley , Kemmer Jacquelyn D. , Neiman Alexandra E. , Mendoza Myra N. , Frohwein Jill J. , Bremer Don , Cassady Cybil , Golden Richard , Jordan Catherine , Rogers David , Oravec Sara A. , Yanovitch Tammy L. , Lunsford Keven , Nye Christina , Shea Caroline , Stillman SueAnn M. , LaRoche G. Robert , Van Iderstine Stephen C. , Robertson Elisa , Cruz Oscar A. , Ghadban Rafif , Govreau Dawn , Larson Scott A. , Longmuir Susannah , Shan Xiaoyan , Clarke Michael P. , Taylor Kate , Powell Christine , Hammond Benjamin P. , Gearinger Matthew D. , Czubinski Andrea , Hendricks Dorothy H. , Jin Jing , Salvin Jonathan H. , Fisher Alicia , Lee Katherine A. , Brooks Daniel , Schweinler Bonita R. , Sala Nicholas A. , Sala Allyson M. , Summers Allison I. , Karr Daniel J. , Wilson Lorri B. , Rauch Paula K. , O'Hara Mary , Gandhi Nandini , Hashmi Tania , Colburn Jeffrey , Dittman Eileen , Whitfill Charles R. , Wheeler Amy M. , McCourt Emily A. , Singh Jasleen , Welnick Nanastasia , Azar Nathalie F. , Baker Joseph , Droste Patrick J. , Peters Robert J. , Hilbrands Jan , Pineles Stacy L. , Bernardo Marianne J. , Peterson Edward , Peterson Charla H. , Kumar Kartik , Melese Ephrem , Lingua Robert , Grijalva Jeff , Crouch Earl R. , Crouch Earl R. , Ventura Gaylord , Anninger William , Benson Shawn L. , Karp Karen A. , Smith Jordana M. , Brickman-Kelleher Jill , Ticho Benjamin H. , Khammar Alexander J. , Clausius Deborah A. , Guo Suquin , Suh Donny , Chamberlain Carolyn , Schloff Susan , Madigan William P. , Burkman Donna , Christiansen Stephen P. , Ramsey Jean E. , McConnell Kate H. , Friedman Ilana , Rosado Jose , Sauberan Donald P. , Hemberger Jody C. , Davis Patricia L. , Rudaitis Indre , Lowery Robert S. , Cupit Shawn , Mohney Brian G. , Wernimont Suzanne M. , Neilsen Rebecca A. , Herlihy Erin P. , Baran Francine , Gladstone Amy , Smith Justin , Mellott Mei , Kieser Troy , Erzurum S. Ayse , Colon Beth , Shah Birva , Quebbemann Micaela , Beck Roy W. , Austin Darrell S. , Boyle Nicole M. , Conner Courtney L. , Chandler Danielle L. , Donahue Quayleen , Fimbel Brooke P. , Robinson Julianne L. , Hercinovic Amra , Hoepner James E. , Kaplon Joseph D. , Henderson Robert J. , Melia B. Michele , Ortiz Gillaine , Woodard Victoria C. , Stutz Kathleen M. , Sutherland Desirae R. , Everett Donald F. , Diener-West Marie , Baker John D. , Davis Barry , Phelps Dale L. , Poff Stephen W. , Saunders Richard A. , Tychsen Lawrence , Bradfield Yasmin S. , Foster Nicole C. , Plager David A. , Salchow Daniel J. , Birch Eileen E. , Manny Ruth E. , Silver Jayne L. , Weise Katherine K. , Verderber Lisa C. , Dean Trevano W. , Yen Kimberly G. , de Alba Campomanes Alejandra G. , Young Marielle P. , Rahmani Bahram , Haider Kathryn M. , Whitehead George F. , Lambert Scott R. , Kurup Sudhi P. , Kraus Courtney L. 
Published: February 2023

Importance

Glaucoma can develop following cataract removal in children.

Objective

To assess the cumulative incidence of glaucoma-related adverse events (defined as glaucoma or glaucoma suspect) and factors associated with risk of these adverse events in the first 5 years after lensectomy prior to 13 years of age.

Design, Setting, and Participants

This cohort study used longitudinal registry data collected at enrollment and annually for 5 years from 45 institutional and 16 community sites. Participants were children aged 12 years or younger with at least 1 office visit after lensectomy from June 2012 to July 2015. Data were analyzed from February through December 2022.

Exposures

Usual clinical care after lensectomy.

Main Outcomes and Measures

The main outcomes were cumulative incidence of glaucoma-related adverse events and baseline factors associated with risk of these adverse events.

Results

The study included 810 children (1049 eyes); 443 eyes of 321 children (55% female; mean [SD] age, 0.89 [1.97] years) were aphakic after lensectomy, and 606 eyes of 489 children (53% male; mean [SD] age, 5.65 [3.32] years) were pseudophakic. The 5-year cumulative incidence of glaucoma-related adverse events was 29% (95% CI, 25%-34%) in 443 eyes with aphakia and 7% (95% CI, 5%-9%) in 606 eyes with pseudophakia; 7% (95% CI, 5%-10%) of aphakic eyes and 3% (95% CI, 2%-5%) of pseudophakic eyes were diagnosed as glaucoma suspect. Among aphakic eyes, a higher risk for glaucoma-related adverse events was associated with 4 of 8 factors, including age less than 3 months (vs ≥3 months: adjusted hazard ratio [aHR], 2.88; 99% CI, 1.57-5.23), abnormal anterior segment (vs normal: aHR, 2.88; 99% CI, 1.56-5.30), intraoperative complications at time of lensectomy (vs none; aHR, 2.25; 99% CI, 1.04-4.87), and bilaterality (vs unilaterality: aHR, 1.88; 99% CI, 1.02-3.48). Neither of the 2 factors evaluated for pseudophakic eyes, laterality and anterior vitrectomy, were associated with risk of glaucoma-related adverse events.

Conclusions and Relevance

In this cohort study, glaucoma-related adverse events were common after cataract surgery in children; age less than 3 months at surgery was associated with elevated risk of the adverse events in aphakic eyes. Children with pseudophakia, who were older at surgery, less frequently developed a glaucoma-related adverse event within 5 years of lensectomy. The findings suggest that ongoing monitoring for the development of glaucoma is needed after lensectomy at any age.