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    Clinical Round Up: No glaucoma protection from primary IOL placement in children


    Glaucoma-related adverse events encompassed the outcomes of glaucoma and glaucoma suspect, and there were standard definitions for those diagnoses. Glaucoma was defined as IOP >21 mm Hg with one or more anatomic changes related to elevated IOP (corneal enlargement, asymmetrical progressive myopic shift with enlargement of corneal diameter and/or axial length, increased optic nerve cupping) or the need for a surgical procedure to control IOP.

    Children were identified as glaucoma suspects if they had two consecutive IOP measurements >21 mm Hg on separate visits after topical corticosteroids were discontinued or needed medications to control IOP and did not have any of the anatomic changes included in the glaucoma definition.

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    At the age 5 follow-up (mean follow-up after surgery 4.8 years), 113 of 114 children remained in the study. The incidence of glaucoma-related adverse events in the operated eye had increased from 12% at follow-up conducted when children reached age 1 year to 32% (18% glaucoma, 14% glaucoma suspect). Nineteen (95%) of the 20 cases of glaucoma were open angle.

    There were no glaucoma-related adverse events in fellow eyes. Visual acuity at age 5 was not significantly different comparing glaucoma eyes, glaucoma suspects, and those with neither condition.

    Though the risk of a glaucoma-related adverse event increased with time, there was biphasic pattern noted in time to diagnosis, Dr Freedman noted. A number of cases occurred within the first 6 months after surgery, and then there was a relative plateau over the next 2.5 years.

    Kaplan-Meier analyses showed there were no significant differences comparing the IOL and CL groups in the 5-year cumulative probability of having glaucoma (19% versus 16%) or being a glaucoma-related adverse even (28% versus 35%).

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    Multivariate analyses explored baseline factors of age, IOL versus CL group, persistent fetal vasculature, corneal diameter, and baseline IOP as possible risk factors for developing glaucoma or a glaucoma-related adverse event. For glaucoma, only younger age at surgery was a risk factor—children ages 28 to 48 days at surgery had a 3.2-fold increased risk compared with their older counterparts.

    The only significant predictor for a glaucoma-related adverse event was smaller corneal diameter, with eyes having a corneal diameter ≤10 mm having a 2.9-fold greater risk than eyes with a larger corneal diameter.

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