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    Glaucoma risk may increase after cataract removal in early infancy

    Theory over whether IOL implantation provides protective effect under study

    Atlanta—Consider this case scenario: A 6-week-old infant undergoes bilateral lensectomy. The child is fitted with contact lenses after surgery. Two months postoperatively, the mother reports the baby’s right cornea is hazy, and the child seems to prefer the left eye. IOP is 24 and 18 mm Hg in the right and left eyes, respectively.  

    “This patient is the typical child in whom glaucoma develops after cataract surgery,” said Scott R. Lambert, MD.

    “It has been reported that 15% to 30% of these children who undergo cataract extraction during infancy will develop glaucoma,” said Dr. Lambert, professor of ophthalmology, Emory University, Atlanta. “Glaucoma rarely develops in children who undergo cataract surgery after more than 6 months of age.”

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    Following this populace throughout childhood may shed some light on factors involved in glaucoma development, and if IOL implantation has any protective effect against glaucoma, he noted.

    There are a few theories behind the development of glaucoma in early infancy, one being that the immature angle collapses. Another is there is a disturbance in the maturation of the trabecular meshwork.

    More: Tracking glaucoma progression with precision medicine

    However, the actual cause remains unclear, Dr. Lambert said.

    There are a number of risk factors for glaucoma after cataract extraction in children: surgery performed at a young age, persistent fetal vasculature (PFV), microphthalmos, repeated surgeries, retained lens material, and chronic inflammation.

    Implantation of an IOL is one factor thought to be protective against glaucoma development in this patient population. However, this theory has arisen out of retrospective studies with selection bias and other confounding variables.

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    “It is not really clear if IOL implantation is a protective factor,” he said.

    Evaluating IOL effectiveness

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