Changes in Intraocular Pressure and Anterior Chamber Angle after Congenital Cataract Extraction.

PRéCIS:: Anterior chamber angle narrowing continues to occur for at least 2 years after congenital cataract surgery. Risk factors for IOP elevation after congenital cataract surgery were higher central corneal thickness and surgery at <2 months.

PURPOSE: To study the changes in intraocular pressure (IOP) and in the anterior chamber angle (ACA) during the first 2 years after pediatric cataract surgery and to determine risk factors for such changes.

METHODS: A retrospective observational study was done on infants who underwent pediatric cataract surgery in Cairo University Hospitals and completed a 1-year follow-up. Demographic and clinical characteristics were recorded including age at surgery, sex, corneal diameter, central corneal thickness (CCT) pupil diameter, intraocular pressure, gonioscopic findings, presence of persistent hyperplastic primary vitreous, surgical approach, primary IOL implantation, and perioperative subconjunctival steroids injection. Changes in IOP and in the AC angle were recorded, and the risk factors for such changes were analyzed.

RESULTS: Postoperative IOP elevation >18▒mmHg occurred in 23 eyes of 206 eyes (11%) who completed Year 1 and in 9 (13%) of 86 eyes who completed Year 2. Risk factors for IOP elevation were larger preoperative CCT (P=0.01) in Year 1, and younger age at surgery (P=0.01), and aphakia (P=0.05) in Year 2. In multivariate analysis only younger age at surgery was a risk factor for IOP elevation in Year 2. ACA narrowing occurred in 49% and in 21% of the examined eyes in Year 1and 2 respectively. Aphakia was not a significant risk factor of angle narrowing in Years 1 and 2 (P=0.17 and 0.42 respectively).

CONCLUSIONS: Higher preoperative CCT was a risk factor for early onset IOP elevation. Surgery at >2 months was associated with lower susceptibility to late onset IOP elevation.