Paediatric Aphakic Glaucoma

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Aphakic glaucoma is the most common long-term complication seen following congenital cataract surgery. It has a reported incidence of between 15% and 45%. Many risk factors have been identified including microcornea, early surgery, persistent fetal vasculature, congenital rubella syndrome, Lowe syndrome, chronic inflammation and retained lens material. Diagnosis is often difficult as the classic signs of congenital glaucoma such as epiphora, blepharospasm and buphthalmos are usually absent. Additionally, it is also difficult to perform accurate ocular examinations on young children and examination under anaesthesia is usually required. Surgical intervention is often required with medical treatment providing adjunctive therapy. Surgical techniques performed include trabeculectomy with or without antifibrotic agents, glaucoma drainage devices (valved and non-valved), cyclodestructive procedures, goniotomy and trabeculotomy. Trabeculectomy with mitomycin C and glaucoma drainage devices are the two most commonly performed procedures. In spite of considerable advances having been made in the management of aphakic glaucoma, it still poses a significant management dilemma. Despite best standard of care two thirds of aphakic children end up with a mean visual acuity of ≤ 20/400.