Incidence of Glaucoma-Related Adverse Events in the First 5 Years After Pediatric Lensectomy

Media type: E-Article
Title: Incidence of Glaucoma-Related Adverse Events in the First 5 Years After Pediatric Lensectomy
Contributor: 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.; 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; [...]
Published: American Medical Association (AMA), 2023
Published in: JAMA Ophthalmology, 141 (2023) 4, Seite 324
Language: English
DOI: 10.1001/jamaophthalmol.2022.6413
ISSN: 2168-6165
Keywords: Ophthalmology
Origination:
Footnote:
Description: <jats:sec id="ab-eoi220095-4"><jats:title>Importance</jats:title><jats:p>Glaucoma can develop following cataract removal in children.</jats:p></jats:sec><jats:sec id="ab-eoi220095-5"><jats:title>Objective</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec id="ab-eoi220095-6"><jats:title>Design, Setting, and Participants</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec id="ab-eoi220095-7"><jats:title>Exposures</jats:title><jats:p>Usual clinical care after lensectomy.</jats:p></jats:sec><jats:sec id="ab-eoi220095-8"><jats:title>Main Outcomes and Measures</jats:title><jats:p>The main outcomes were cumulative incidence of glaucoma-related adverse events and baseline factors associated with risk of these adverse events.</jats:p></jats:sec><jats:sec id="ab-eoi220095-9"><jats:title>Results</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec id="ab-eoi220095-10"><jats:title>Conclusions and Relevance</jats:title><jats:p>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.</jats:p></jats:sec>

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