Abstract
Monitoring intraocular pressure (IOP) is essential for pediatric cataract treatment but always difficult due to lack of cooperation in young children. We present the baseline characteristics and the first-year results of a long-term prospective cohort study, which are aimed to determine the relationship of the incidence of ocular hypertension (OH) in children after cataract surgery during the first-year period and the risk of developing late-onset glaucoma. Children were included with the following criteria: they were≤10 years old and scheduled to undergo cataract surgery with/without intraocular lens implantation; they were compliant with our follow-up protocol, which included monitoring IOP using a Tono-Pen under sedation or anesthesia. Incidence of OH, peak OH value, OH onset time and OH duration within a 12-month period following surgery were measured. In brief, 206 patients (379 eyes) were included and OH developed in 66 of 379 (17.4%) eyes. The mean follow-up period was 14.0±3.2 months (median, 12 months; range, 10–16 months). Moreover, 33 of 196 (16.8%) aphakic eyes and 33 of 183 (18.0%) IOL eyes were diagnosed with OH. The peak OH onset times were at 1-week (34/66, 51.5%) and 1-month (14/66, 21.2%) appointments postsurgery. The peak IOP value in the OH eyes was 29.9±7.5 mmHg (median, 29 mmHg; range, 21–48 mmHg). The duration of OH was 30.9±31.2 days (median, 30 days; range, 3–150 days). OH recurred in 13 eyes with a history of OH diagnosed within 1 month postsurgery (13/54, 24.1%), which needed temporary or long term use of antiglaucoma medications. In conclusion, the incidence of OH in children after cataract surgery was 17.4% during the first-year period. Children who have suffered elevated IOP in the first year after cataract surgery should be followed closely to determine if there is an increased risk of developing late-onset glaucoma.
Highlights
[1] Ocular hypertension (OH), which is defined as intraocular pressure (IOP) greater than 21 mm Hg, and secondary glaucoma, which is defined as a particular pattern of optic nerve and visual field damage, both have been reported with a wide frequency during long-term follow-up of pediatric cataract surgery patients. [2,3,4] It has been hypothesized that OH is a risk factor for glaucoma and years of OH might precede a lateonset glaucoma diagnosis [1,5]
We report the first-year result of monitoring IOP in children after cataract surgery, in which we aimed to determine the incidence of OH in a cohort of the included children, and to present the baseline characteristics for an ongoing prospective cohort study to address the significance of the first-year elevation in IOP to late-onset glaucoma
Monitoring IOP to prevent secondary irreversible optic nerve damage is essential for pediatric cataract treatment, but the incidence and significance of the first-year elevated IOP to lateonset glaucoma is unclear [16,17,18,19]
Summary
Ocular hypertension (OH) and glaucoma are significant postoperative complications of pediatric cataract surgery, but their causes are complex and not fully understood. [1] OH, which is defined as intraocular pressure (IOP) greater than 21 mm Hg, and secondary glaucoma, which is defined as a particular pattern of optic nerve and visual field damage, both have been reported with a wide frequency during long-term follow-up of pediatric cataract surgery patients. [2,3,4] It has been hypothesized that OH is a risk factor for glaucoma and years of OH might precede a lateonset glaucoma diagnosis [1,5].Most previously reported studies have focused on late-onset OH and glaucoma, and it has been reported that the rate of progression from late-onset OH to glaucoma is 23% based on 5and 10-year examinations. [1] few studies have addressed the elevation in IOP in the first year following pediatric cataract surgery and the significance of the first-year elevation in IOP to late-onset glaucoma. [1] few studies have addressed the elevation in IOP in the first year following pediatric cataract surgery and the significance of the first-year elevation in IOP to late-onset glaucoma. [4] It has been hypothesized that many factors, such as surgical inflammation and/or steroid response, [5,6,7,8,9,10,11,12] would elevate IOP and cause OH immediately after pediatric cataract surgery, which may differ from the time frame of late-onset OH that has been previously reported [1,2,3].
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