Age at the time of cataract surgery and relative risk for aphakic glaucoma in nontraumatic infantile cataract

Abstract

To report the relative risk for aphakic glaucoma as a function of age at surgery in infants who underwent cataract surgery before 10 months of age for nontraumatic infantile cataract without microcornea. This was an institutional retrospective case series (January 1985 to February 2003) of children who underwent cataract surgery without intraocular lens implantation for nontraumatic infantile cataract before 10 months of age. Patients with less than 5 years' postsurgical follow-up, microcornea, persistent fetal vasculature, and/or other significant anterior segment abnormality were excluded. The surgical procedure in all cases was lens aspiration, posterior capsulotomy, and anterior vitrectomy with anterior small-incision techniques. Of 210 eyes (121 patients), 55 eyes (26.2%; 31 patients [25.6%]) developed aphakic glaucoma. Relative risk for later aphakic glaucoma as a function of age at the time of surgery decreased from 1.85 (95% CI, 0.88-3.86) at 0-1 months of age to a nadir at 3-4 months of age (0.22 [95% CI, 0.05-0.96]) and then increased again to peak at 3.17 (95% CI, 1.1-9.11) at 5-6 months of age. The lowest relative risk for later aphakic glaucoma in our cohort was for surgery performed at 3-4 months of age, for which the 95% CI remained less than 1.0. Further conclusions are limited by overlapping confidence intervals. However, because of amblyopia issues, we do not recommend delaying congenital cataract surgery beyond 4 weeks of life.