GLAUCOMA AFTER CATARACT-EXTRACTION AND POSTERIOR CHAMBER LENS IMPLANTATION IN CHILDREN

Purpose: To evaluate the incidence of postoperative glaucoma in childr en who have cataract extraction and posterior chamber intraocular lens (IOL) implantation. Setting: Children's Hospital of Pittsburgh, Pitts burgh, Pennsylvania, USA. Methods: The incidence of glaucoma of all et iologies was evaluated in 45 eyes of 37 selected consecutive patients aged 1 to 18 years who had cataract extraction and posterior chamber I OL implantation from 1991 to 1994. Mean follow-up was 23 months (range 6 to 38 months). Nineteen patients had traumatic and 18 had developme ntal cataract. Exclusion criteria were microcornea smaller than 9.0 mm in diameter, preoperative glaucoma, or poor pupil dilation. The surgi cal technique comprised a continuous curvilinear anterior capsulorhexi s in most cases, extracapsular aspiration by Ocutome(R) or phacoemulsi fication, and retention of the posterior capsule. A peripheral iridect omy was done in 7 eyes (16%). Postoperative medications included topic al atropine combined with topical, subconjunctival, and systemic corti costeroids and antibiotics. Results: Three patients with traumatic cat aract developed postoperative glaucoma during the follow-up. One devel oped pseudophakic pupillary block; however, a peripheral iridectomy pr evented glaucoma. Two other patients developed late-onset glaucoma: on e secondary to angle recession and the other to peripheral anterior sy nechias. No patient with developmental cataract developed glaucoma. Co nclusion: Careful patient selection, atraumatic surgical technique, co ntinuous curvilinear capsulorhexis, in-the-bag IOL placement, postoper ative atropine, and topical and systemic corticosteroids significantly lower the incidence of pseudophakic pupillary block and glaucoma. Alt hough no patient developed glaucoma, lifelong follow-up is mandatory t o detect chronic open-angle and traumatic angle-recession glaucoma.