Long-term Outcome of Pediatric Aphakic Glaucoma

Rahul Bhola, M.D.
Ronald V. Keech, M.D., Richard J. Olson, M.D., sponsors

Purpose: To determine long term outcome of eyes with aphakic glaucoma following pediatric cataract extraction.

Method: A retrospective analysis of 130 patients diagnosed with aphakic glaucoma between 1969 and 2004 was performed. A total of 36 patients (55 eyes) were included in this study after excluding those that had cataract extraction after age 10 and patients with other ocular conditions, systemic syndromes, traumatic cataracts, congenital glaucoma or inadequate follow-up. Outcome variables studied included visual acuity, number of medication changes required over the course of the follow-up, maximum number of medications used at a time for more than 6 months to control intraocular pressures and surgical interventions required. Mean follow-up period was 18.7 years (range, 6.9-35 years).

Results: At the time of last follow-up 54.5% of the patients had visual acuity 20/40 or better, 34.5% had 20/50 to 20/200, and 11% had acuity worse than 20/200. Over the course of follow-up 34% required 1-2 medication changes for controlling glaucoma, 33% required 3-5 medication changes and 33% required 6 or more medication changes. Thirty-six percent of the eyes required a maximum of 1-2 medications for more than 6 months during the course of follow-up, 33 % required 3 and 31% required 4 or more medications or a surgical intervention for controlling intraocular pressure. Of the 55 eyes, 27% required surgical intervention (40% 1 surgery, 47% 2-3 surgeries and 11% 4-6 surgeries).

Conclusion: Patients with glaucoma following pediatric cataract surgery have a good visual outcome although most will require 3 or more medications and 1/4^th will require one or more surgical procedures to control the glaucoma.