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Glaucoma or glaucoma suspect was common in young children after lensectomy over the long term, a prospective cohort study found.

Among nearly 1,000 kids, the 5-year cumulative incidence of glaucoma or glaucoma suspect was 46% (95% CI 28-59) in participants with bilateral aphakia and 25% (95% CI 15-34) in those with unilateral aphakia, reported Michael Repka, MD, MBA, of the Jaeb Center for Health Research in Tampa, Florida, and colleagues.

Children with pseudophakia had better outcomes. Incidence of glaucoma or glaucoma suspect was 7% (95% CI 1-12) in those with bilateral pseudophakia, and 17% (95% CI 5-28) in those with unilateral pseudophakia, the study group noted in .

Overall, 14% of eyes were reported to have developed a glaucoma-related adverse event after lensectomy.

"The development of glaucoma-related adverse events is perhaps the most important long-term complication of childhood lensectomy," Repka and team wrote.

Five years after the initial lensectomy, median visual acuity (VA) among 701 eyes with available data was:

• 20/63 in 58% of bilateral aphakic eyes
• 20/32 in 54% of bilateral pseudophakic eyes
• 20/200 in 61% of unilateral aphakic eyes
• 20/65 in 51% of unilateral pseudophakic eyes

Of note, infants with unilateral cataracts had better VA outcomes at 5 years when lensectomy was performed at a younger age, but the same did not hold true for infants with bilateral cataracts.

Over the study period, additional intraocular surgery was performed on 33% of eyes, most often to clear the visual axis or implant a secondary intraocular lens (IOL).

The increase in secondary IOL procedures "would be expected because as children with aphakia approached school age, contact lens management may have become more difficult and the child's refractive error may have stabilized," Repka and colleagues noted.

The median 5-year change in spherical equivalent refractive error was -8.38 D among 89 bilateral aphakic eyes, -1.63 D among 130 bilateral pseudophakic eyes, -10.75 D among 43 unilateral aphakic eyes, and -1.94 D among 112 unilateral pseudophakic eyes.

"Myopic shift was modest during the 5 years after placement of an intraocular lens, which should be factored into implant power selection," the authors wrote.

In a , Jeff Yunglam Hui, MB, ChB, MPH, of Clarity Medical Group in Hong Kong, pointed out that glaucoma after cataract surgery "can occur decades after lensectomy."

"This highlights the importance of having a thorough discussion with the family about the monitoring and management of glaucoma in the immediate postoperative period and long term," he added.

Study Details

From 2012 to 2015, 994 children (1,268 eyes) from 61 eye care practices mostly based in the U.S. were enrolled in the Pediatric Eye Disease Investigator Group's clinical research registry. Children were included if they were younger than 13 years old and had undergone lensectomy in the preceding 45 days. Data were collected annually from medical record reviews for the next 5 years until September 2020.

Of the participants, 51% were male and the median age was 3.6 years; 43% had a bilateral lensectomy, and 59% had an IOL implanted.

Repka and colleagues acknowledged that they only successfully followed up with 66% of patients in the fifth year of the study, although there were no differences in major baseline characteristics between those who finished the study and those who did not.

Hui noted that another limitation of the study was its lack of diversity. "It provided good generalizability for a mostly white population," he wrote. "However, it provided relatively little information regarding possible racial and ethnic disparities."

"Regardless of the initial operative approach, the study demonstrates the importance of careful lifelong follow-up," Hui concluded.

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