Younger Age at Cataract Surgery Increases Glaucoma Risk; Glaucoma Valve Implantation Outperforms Trabeculectomy, Study Finds
China: Recent findings published in International Ophthalmology highlight key factors associated with the onset of glaucoma-related adverse events (GRAE) in children following pediatric cataract surgery. The study revealed that undergoing pediatric cataract surgery at a younger age significantly raises the risk of early-onset GRAE, especially in children under six months, who are most vulnerable.
"In evaluating different surgical options, glaucoma valve implantation emerged as the preferred choice, demonstrating a notably lower re-operation rate of 12.1%, compared to 50% for trabeculectomy. This positions glaucoma valve implantation as a more effective solution for managing intraocular pressure (IOP) in these pediatric patients," the researchers reported.
Glaucoma valve implantation involves the placement of a drainage device to regulate intraocular pressure, and in children with GRAE, this procedure can provide long-term control of glaucoma. Na Wu & Xinghuai Sun from Shanghai Medical College in Fudan University, Shanghai, China, aimed to outline the clinical characteristics of glaucoma-related adverse events following pediatric cataract surgery. It also sought to identify the factors influencing the timing of GRAE onset and determine the preferred surgical approach for managing these glaucoma complications.
For this purpose, the researchers retrospectively reviewed hospitalized medical records of patients who developed GRAE, including glaucoma and glaucoma suspects, following pediatric cataract surgery (performed at or before 14 years of age) between 1994 and 2021. If the interval between cataract surgery and the diagnosis of GRAE was less than one year, the condition was classified as early-onset GRAE; otherwise, it was considered late-onset. Multivariate logistic regression analysis was conducted to identify potential factors associated with the timing of GRAE onset. Additionally, the re-operation rates between two surgical approaches—glaucoma valve implantation and trabeculectomy—used for controlling elevated intraocular pressure were compared using the chi-square test.
The study led to the following findings:
- The study included 125 eyes from 94 patients who developed glaucoma-related adverse events following pediatric cataract surgery.
- Among the patients, 25 had unilateral cataracts, while 69 had bilateral cataracts (100 eyes).
- Of the 125 eyes, 63 (50.4%) underwent initial cataract surgery before 6 months, and 97 (77.6%) before 2 years of age.
- Seventy-six eyes (60.8%) were aphakic, 21 (16.8%) had primary intraocular lens (IOL) implantation, and the remaining 28 (22.4%) had secondary IOL implantation.
- Sixty-nine out of 104 eyes (66.3%) developed late-onset GRAE.
- Multivariate analysis revealed that younger age at cataract surgery was associated with early-onset GRAE.
- Closed angles were observed in 72.1% of eyes before the first anti-glaucomatous surgeries.
- After trabeculectomy, 50% of eyes required re-operation to control intraocular pressure, compared to 12.1% after glaucoma valve implantation.
"The findings suggest that pediatric cataract surgery performed at an earlier age is associated with a higher likelihood of developing early-onset glaucoma-related adverse events. Additionally, glaucoma valve implantation appears to be the preferred surgical intervention for managing GRAE in these patients," the researchers concluded.
Reference:
Wu, N., Sun, X. Factors associated with the time of glaucoma-related adverse events onset after pediatric cataract surgery and the preferred anti-glaucomatous surgical selection. Int Ophthalmol 45, 28 (2025). https://doi.org/10.1007/s10792-025-03412-w
