NEW YORK (Reuters Health) - Several factors may be tied to a lower risk of glaucoma after infantile cataract surgery, according to a meta-analysis: later surgery, primary implantation, and fewer additional procedures.
"We were surprised to find that having additional intraocular interventions following infantile cataract surgery increased the risk for postoperative glaucoma and yet pseudophakic eyes, that are more likely to have an additional intervention, seemed to run a lower risk for postoperative glaucoma compared to aphakic eyes," Dr. Asimina Mataftsi from Aristotle University of Thessaloniki, Greece told Reuters Health.
Studies on the influence of primary implantation of an intraocular lens (IOL) on postoperative glaucoma rates have yielded different results, and there is no consensus on what age is best to perform cataract surgery in infants.
The ongoing prospective Infant Aphakia Treatment Study may provide solutions to these issues, but results may take several years.
In the meantime, Dr. Mataftsi and colleagues used an individual patient data meta-analysis to assess the effect of the timing of surgery and of primary IOL implantation during cataract extraction among infants on the incidence of postoperative glaucoma.
"This type of meta-analysis has not been applied to pediatric ophthalmic intraocular surgery previously and it seems to us that it is a useful tool to draw on the experience and results of several centers around the world," Dr. Mataftsi said. "This particular study has involved most of the leading pediatric cataract centers in the world."
Seven medical centers provided data on 470 infants, 106 with IOL implantation and 364 without.
As reported June 12th online in JAMA Ophthalmology, 80 infants (17.0%) developed glaucoma at a median 4.3 years after surgery. All but two of these infants did not have IOL implantation.
About a quarter of these 80 patients (n=18, 23.8%) with glaucoma had undergone cataract surgery when they were four weeks old or younger, and a similar number had an additional postoperative procedure before the glaucoma event.
The risk of postoperative glaucoma was 90% lower in children who had primary IOL implantation, 2.10-fold higher in children who had surgery at no older than four weeks, and 2.52-fold higher in children who had an additional procedure after their cataract surgery.
In multivariable analysis, both primary IOL implantation and additional procedures remained independently predictive of glaucoma risk, whereas the age at surgery was no longer predictive.
Surgeons who care for patients with infantile cataracts "may alter their preferred practice based on the findings from this individual patient data meta-analysis, with regards to factors such as timing of surgery and primary implantation, that seem to influence the risk for postoperative glaucoma," Dr. Mataftsi said.
"Multicenter, preferably prospective, long-term trials are still needed to confirm our finding that pseudophakic eyes appear to have a reduced risk for early- to intermediate-onset glaucoma, as this will mean a significant contribution in reducing the risk for this devastating complication," Dr. Mataftsi concluded.
JAMA Ophthalmol 2014.
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