Glaucoma development common in children after lensectomy

In the 5 years after undergoing lensectomy, the development of glaucoma or glaucoma suspect in children <13 years of age was common, according to a new study. Researchers also noted that during the same period after placement of an intraocular lens, myopic shift was modest.

In this prospective cohort study, the medical records of 994 children (1268 eyes) undergoing bilateral or unilateral lensectomy were reviewed annually for 5 years after undergoing lensectomy for any reason.

There was a total of 701 eyes with available visual acuity (VA) data after 5 years. The median VA for these eyes was 20/63 in 182 of 316 bilateral aphakic eyes (58%), 20/32 in 209 of 386 bilateral pseudophakic eyes (54%), 20/200 in 124 of 202 unilateral aphakic eyes (61%), and 20/65 in 186 of 364 unilateral pseudophakic eyes (51%).

The 5-year cumulative incidence of glaucoma or glaucoma suspect by condition was:
-46% in those with bilateral aphakia
-7% in those with bilateral pseudophakia
-25% in those with unilateral aphakia
-17% in those with unilateral pseudophakia

Clearing the visual axis was the most common additional eye surgery needed; The 5-year cumulative incidence was:
-13% in those with bilateral aphakia
-33% in those with bilateral pseudophakia
-11% in those with unilateral aphakia
-34% in those with unilateral pseudophakia

The median 5-year change in spherical equivalent refractive error was
– −8.38 D among 89 bilateral aphakic eyes
– −1.63 D among 130 bilateral pseudophakic eyes
– −10.75 D among 43 unilateral aphakic eyes
– −1.94 D among 112 unilateral pseudophakic eyes.

The authors suggested that the small myopic shift “should be factored into implant power selection.”
Reference
Repka MX, Dean TW, Kraker RT, et al. Visual Acuity and Ophthalmic Outcomes 5 Years After Cataract Surgery Among Children Younger Than 13 Years. JAMA Ophthalmol. Published online February 10, 2022. doi:10.1001/jamaophthalmol.2021.6176