Risk Factors of Secondary Glaucoma after Congenital Cataract Surgery in Korean Patients

Ga-In Lee; Jong Chul Han; Si Bum Kim; Eun Jung Lee; Chang Won Kee

doi:10.3341/jkos.2018.59.6.569

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Lee, Han, Kim, Lee, and Kee: Risk Factors of Secondary Glaucoma after Congenital Cataract Surgery in Korean Patients

Original Article

J Korean Ophthalmol Soc 2018;59(6):569-576.

Published online: 25 September 2018

DOI: https://doi.org/10.3341/jkos.2018.59.6.569

Risk Factors of Secondary Glaucoma after Congenital Cataract Surgery in Korean Patients

Ga-In Lee, MD, Jong Chul Han, MD, Si Bum Kim, MD, Eun Jung Lee, MD, Chang Won Kee, MD, PhD

Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Address reprint requests to Chang Won Kee, MD, PhD Department of Ophthalmology, Samsung Medical Center, #81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Tel: 82-2-3410-3548, Fax: 82-2-3410-0074 E-mail: ckee@skku.edu

Received 30 March 2017 Revised 19 October 2017 Accepted 15 December 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To assess the risk of development of secondary glaucoma after congenital cataract surgery using a long-term fol-low-up study.

Methods

In total, 148 eyes of 91 patients who underwent congenital cataract surgery at our hospital or other hospitals were included in a retrospective chart review. A diagnosis of secondary glaucoma was made if the intraocular pressure (IOP) exceeded 21 mmHg and the corneal diameter, axial length, or the cup-to-disc ratio increased, or surgery was performed to control the IOP. To analyze the clinical features and risk factors of secondary glaucoma, we evaluated the mean age at cataract surgery, binoc-ularity, presence of a nuclear cataract, methods of cataract surgery, presence of an intraocular lens (IOL), duration of diagnosis of secondary glaucoma after cataract surgery, duration of follow-up, recent best-corrected visual acuity, and refractive errors.

Results

Thirty-five eyes (23.6%) were diagnosed with secondary glaucoma as a complication of congenital cataract surgery. Of these, 11 eyes (31.4%) were treated with glaucoma surgery a mean of 3.4 times. The mean duration from congenital cataract surgery to diagnosis of glaucoma was 112.2 ± 113.1 months. Patients with aphakia had a higher risk of developing secondary glaucoma compared with patients undergoing primary IOL implantation (p = 0.001). Younger age (<3 months at surgery), a nuclear cataract, and aphakia were risk factors for the development of secondary glaucoma (p = 0.03, p = 0.006, and p < 0.001, respectively), and the risk of developing secondary glaucoma increased with secondary IOL implantation (p = 0.052).

Conclusions

Secondary glaucoma after congenital cataract surgery was more common in patients with secondary IOL implantation, aphakia, a younger age (<3 months), and a nuclear cataract. Patients who underwent congenital cataract surgery had an increased risk for developing secondary glaucoma. Long-term monitoring of the IOP and optic nerve is therefore required for these patients.

Keywords: Aphakia, Congenital cataract surgery, Primary intraocular lens (IOL) implantation, Secondary glaucoma

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Figure 1.

Kaplan-Meier curves showing cumulative probability of an eye's developing glaucoma or glaucoma suspect after congenital cataract surgery over times. The probability of development glaucoma or glaucoma suspect was estimated to be 38.2 ± 0.1% by 20 years after congenital cataract surgery.

Figure 2.

Kaplan-Meier curves showing cumulative probability of an eye's developing glaucoma or glaucoma suspect after congenital cataract surgery between each group; primary intraocular lens (IOL) implantation, secondary IOL implantation and aphakia. There were statistical differences of developing glaucoma by logrank test (p < 0.001).

Figure 3.

Angle photo of a case with secondary glaucoma associated with congenital cataract at the time of glaucoma surgery. Ciliary body band was not visible and scleral spur was partially observed.

Table 1.

Demographics of 148 eyes with congenital cataract

Characteristics	Eyes (n, %)
Surgery performed at our hospital	122 (82.4)
Surgery performed at other hospital	19 (12.8)
Lensectomy performed at other hospital and secondary IOL implantation in our hospital	7 (4.7)
Age at cataract surgery (range)	3.5 ± 4.5 years (1 month-18.7 years)
Follow-up (range)	8.4 ± 5.1 years (0.45 month-20.7 years)
Sex (male:female)	40:51
Eye (right:left)	74:74
Laterality (bilateral:unilateral)	114:34
Spherical equivalent on last follow-up (median)	–3.8 ± 6.2 D (−3.8 D)
BCVA (logMAR scale) on last follow-up (median)	0.60 ± 0.75 (0.50)

Values are presented as mean ± SD unless otherwise indicated. IOL = intraocular lens; BCVA = best corrected visual acuity.

Table 2.

Type of cataract surgical procedures

Type of surgical procedures	Primary IOL implantation (n = 107, 72.3%)	Secondary IOL implantation (n = 28, 18.9%)	Aphakia (n = 13, 8.8%)
Posterior chamber IOL implantation in the bag	65 (60.7)	10 (35.7)	–
IOL implantation in the sulcus	8 (7.5)	6 (21.4)	–
IOL implantation with scleral fixation	2 (1.9)	12 (42.9)	–
Piggyback IOL insertion	32 (29.9)	0 (0.0)	–

IOL = intraocular lens.

Table 3.

Diagnosis with glaucoma and glaucoma suspect

	Normotensive	Glaucoma	Glaucoma suspect
Eyes (n, %)	113 (76.4)	25 (16.9)	10 (6.8)
Surgery for glaucoma (n, %)	–	11 (44.0)	–
Use IOP lowering agent (n, %)	–	14 (56.0)	–
Duration from cataract surgery to diagnosis of glaucoma (months, median)	–	82.0 ± 99.3 (37.5)	187.4 ± 115.2 (171.0)
IOP max (mmHg, median)	19.6 ± 1.7 (20.0)	33.7 ± 9.0 (32.0)	25.0 ± 2.7 (25.0)

Values are presented as mean ± SD (range) or n (%) unless otherwise indicated. IOP = intraocular pressure.

Table 4.

Univariate cox regression analysis of potential predictors to secondary glaucoma after congenital cataract surgery

Parameter	Hazard ratio (95% CI)	p-value
Sex	–	0.879
Cataract surgery before 3 months of birth	2.59 (1.05–6.40)	0.040
Nuclear cataract	3.80 (1.40–10.28)	0.008
Bilaterality	–	0.340
Anterior vitrectomy	–	0.350
Secondary IOL implantation^*	3.16 (1.33–7.50)	0.009
Aphakia^*	7.37 (2.97–18.30)	<0.001

IOL = intraocular lens; CI = confidence interval.

^* Reference category: Primary IOL implantation.

Table 5.

Univariate cox regression analysis of potential predictors to secondary glaucoma in variable surgical methods

Parameter	Hazard ratio (95% CI)	p-value
Primary IOL implantation in the bag^*
Primary IOL implantation in the sulcus	4.36 (0.39–48.24)	0.230
Primary IOL implantation c scleral fixation	101.29 (13.16–779.92)	<0.001
Primary IOL implantation c piggybacking	5.87 (1.13–30.58)	0.035
Secondary IOL implantation in the bag	11.52 (2.18–60.86)	0.004
Secondary IOL implantation in the sulcus	11.19 (2.0–62.5)	0.006
Secondary IOL implantation c scleral fixation	7.93 (1.48–42.40)	0.017
Aphakia	23.32 (5.02–108.29)	<0.001

IOL = intraocular lens; CI = confidence interval.

^* Reference category.

Table 6.

Multivariate cox analysis of potential predictors to secondary glaucoma after congenital cataract surgery

Parameter	Hazard ratio (95% CI)	p-value
Cataract surgery before 3 months of birth	6.31 (1.18–33.70)	0.030
Nuclear cataract	7.40 (1.78–30.70)	0.006
Primary IOL implantation^*
Secondary IOL implantation	4.82 (0.99–23.54)	0.052
Aphakia	29.32 (4.22–203.70)	<0.001

IOL = intraocular lens; CI = confidence interval.

^* Reference category.

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