Risk of glaucoma after pediatric cataract surgery

PURPOSE. To determine the risk of glaucoma after surgery for pediatric cataract and to evaluate risk factors for glaucoma. METHODS. A population-based cohort of all children in Denmark aged 0 to 17 years during the period 1977 to 2001, who underwent surgery for pediatric cataract, was established by retrospective chart review. Glaucoma cases were defined as those in which glaucoma surgery (trabeculectomy and/or diode laser transscleral cyclophotocoagulation) was performed and/or permanent medical therapy prescribed after cataract surgery. RESULTS. Of 946 eyes (595 patients) undergoing pediatric cataract surgery, 72 eyes (48 patients) had subsequent development of glaucoma. Early surgery (< 9 months of age) was associated with a 7.2-fold increased risk of glaucoma compared with late surgery (< 9 months of age). Ten years after cataract surgery, glaucoma developed in 31.9% (95% confidence interval [CI], 24.4-41.1) of children undergoing surgery before 9 months of age compared with 4.1% (95% CI, 2.4 to 6.8) of children aged >= 9 months at the time of surgery. Glaucoma cases continued to occur more than 10 years after cataract surgery. After adjustment for age at surgery, no other risk factor appeared important. CONCLUSIONS. The risk of glaucoma after surgery for pediatric cataract is substantial and particularly high for those below 9 months of age at the time of surgery. Because the increased risk persists for many years after surgery, careful continuous monitoring for glaucoma is mandatory.