Incidence of and Factors Associated with Glaucoma after Surgery for Congenital Cataract: Findings from the British Congenital Cataract Study
Received 6 March 2007; received in revised form 5 September 2007; accepted 5 September 2007. published online 03 January 2008.
Purpose
To report the incidence of and factors associated with postoperative open-angle glaucoma in a nationally representative group of children undergoing surgery for congenital or infantile cataract.
Design
Noncomparative interventional cohort study.
Participants
All children in the United Kingdom who were newly diagnosed with congenital or infantile cataract in a 12-month period in 1995 and 1996 (the British Congenital/Infantile Cataract Study) were eligible for this study. One hundred sixty-five children with congenital or infantile cataract underwent cataract surgery.
Methods
All the children were traced through their managing ophthalmologists. Standardized outcome data were collected at least 6 years after diagnosis. For children undergoing cataract extraction, Cox regression analysis was performed to determine incidence of postoperative open-angle glaucoma and the effect of key factors considered, a priori, potentially to be associated with it (i.e., age at detection and surgery, type of cataract surgery, primary intraocular lens implantation, severe postoperative uveitis, and microphthalmia).
Main Outcome Measures
Development of open-angle glaucoma after cataract surgery.
Results
Postoperative glaucoma developed in 27 of 275 eyes of 165 children who underwent cataract surgery. The overall annual incidence of postoperative glaucoma was 5.25 per 100 cataract operations. The median time to development of postoperative glaucoma was 1.34 years (range, 0.39 months–6.73 years). Younger age at detection of cataract was the only factor independently associated with the development of glaucoma when all other factors of interest (which were all statistically associated with age at detection) were accounted for. A 10-fold increase in the age at detection (for example, 30 days compared with 3 days) was associated with a 64% decrease in the hazard ratio (95% confidence interval, 41%–79%; P<0.001).
Conclusions
Median time to development of postoperative open-angle glaucoma in the present study was lower than that reported previously, emphasizing the need for vigilance from the early postoperative period. Earlier detection of cataract was the only significant factor associated with the development of glaucoma after surgery for congenital cataract.
Available online: December 27, 2007.
1Centre for Paediatric Epidemiology, Institute of Child Health, London, United Kingdom.
2Division of Epidemiology, Institute of Ophthalmology, London, United Kingdom.
Correspondence to Jugnoo Sangeeta Rahi, PhD, Centre for Paediatric Epidemiology, Institute of Child Health, 30 Guilford Street, London WC1N 1EH, United Kingdom.
Manuscript no. 2007-311.
There are no conflicts of interest.
Supported by the Guide Dogs for the Blind Association, Reading, United Kingdom (grant no. Fre07801 OR2001–26b). Research at the Institute of Child Health and Great Ormond Street Hospital for Children National Health Service Trust benefits from research and development funding received from the National Health Service Executive, London, United Kingdom.
⁎ See “Appendix” for a full list of members of the British Congenital Cataract Interest Group (available at http://aaojournal.org).
ABSTRACT