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    Glaucoma risk may increase after cataract removal in early infancy

    Theory over whether IOL implantation provides protective effect under study

     

    Evaluating IOL effectiveness

    In 2004, Dr. Lambert and colleagues started a prospective, randomized trial, the Infant Aphakia Treatment Study, to evaluate how effective IOLs are for treating children who were to undergo unilateral cataract surgery.

    The recently published study (Friedman et al. JAMA Ophthalmol. 2015;33:907-914) included 114 infants who ranged in age from 1 to 6 months. The children were randomly assigned to a unilateral cataract surgery with or without implantation of an IOL. When the children reached age 5, they underwent tonometry, pachymetry, and an optic disc evaluation to determine the presence of glaucoma.

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    The National Eye Institute provided funding to cover examinations of these children when they reach age 10. That examination will include more extensive glaucoma evaluations including, tonometry, anterior segment optical coherence tomography, analysis of the retinal nerve fiber layer, and photography of the optic disc.

    To date, 24 children have reached their 10th birthdays and undergone the evaluation. The other 90 also will be evaluated over the next 2.5 years.

    Outcomes at 5 years indicated the incidence of glaucoma was higher in patients who had cataract surgery at a younger age. The authors divided the children into those who were 28 to 48 days old and those who were 49 to 210 days old.

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    Risk of glaucoma development

    The probability of glaucoma was 16% in the younger group compared with 3% in the older group. By age 5, the probability increased to 26% in the younger group compared with 9% in the older group. This difference was highly statistically significant (p = 0.014), Dr. Lambert said.

    There was more than a three-fold greater risk of developing glaucoma if surgery is performed when the children are 6 weeks of age or younger, he noted.

    Investigators found that in the 24 eyes with PFV, glaucoma developed in 29% compared with 13% in the 90 children who did not have PFV. This difference, however, did not reach significance (p = 0.083).

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    Regarding development of glaucoma, the cumulative probability indicated that most cases develop early, within 6 months after cataract surgery, or when the children were between 3 and 5 years old. Analysis of glaucoma or glaucoma suspects differed in that the incidence of glaucoma was more gradual and increased to development in 31% of children by age 5.

    A comparison of the children who received an IOL implant after cataract surgery, and those who did not, showed glaucoma incidence was higher in children with an IOL throughout the 5 years after cataract surgery, but the difference was not significant (p = 0.62).

    Glaucoma suspects

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