Does primary intraocular lens implantation prevent "aphakic" glaucoma in children?

Purpose: Open-angle glaucoma may develop after surgery for congenital or de velopmental cataract with an incidence ranging from 3% to 41%. The pathogen esis of "aphakic" (open-angle) glaucoma remains unknown. Despite numerous r eported clinical series (>1000 eyes), we are unaware of any reported case o f open-angle glaucoma after primary intraocular lens (IOL) implantation for congenital or developmental cataract. We decided to test the hypothesis th at primary posterior chamber IOL implantation might decrease the incidence of open-angle glaucoma in children, Methods: Pseudophakic eyes were collect ed from surgeons who contributed data to a refractive study and who monitor ed intraocular pressure on a regular basis. IOL implantation was commonly p erformed in eyes with a corneal diameter >10 mm. Comparable primary data on aphakic eyes were included from 2 published studies on aphakic glaucoma, w hich included corneal diameters and the patient's age at surgery. Glaucoma- free survival estimates for each cohort were estimated. Results: Only 1 cas e of glaucoma was found among 377 eyes with primary pseudophakia (mean age of patient, 5.1 +/- 4.7 years; mean follow-up, 3.9 +/- 2.7 years). There we re 14 eyes (11.3%) with glaucoma among 124 aphakic eyes (mean age of patien t, 2.7 +/- 2.6 years; mean follow-up time, 7.2 +/- 3.9 years). Conclusions: We report a decreased incidence of open-angle glaucoma among eyes rendered primarily pseudophakic compared with those that remained aphakic after cat aract surgery. We propose 2 theories on the possible mechanism of reduction in the incidence of glaucoma in pseudophakic eyes.