Does primary intraocular lens implantation prevent “aphakic” glaucoma in children?

Sanjay Asrani, Sharon Freedman, Vic Hasselblad, Edward G. Buckley, James Egbert, Elie Dahan, Howard Gimbel, David Johnson, Scott McClatchey, Marshall Parks, David Plager, Eduardo Maselli

Research output: Contribution to journalArticlepeer-review

149 Scopus citations


PURPOSE: Open-angle glaucoma may develop after surgery for congenital or developmental cataract with an incidence ranging from 3% to 41%. The pathogenesis of "aphakic" (open-angle) glaucoma remains unknown. Despite numerous reported clinical series (>1000 eyes), we are unaware of any reported case of open-angle glaucoma after primary intraocular lens (IOL) implantation for congenital or developmental cataract. We decided to test the hypothesis that primary posterior chamber IOL implantation might decrease the incidence of open-angle glaucoma in children. METHODS: Pseudophakic eyes were collected from surgeons who contributed data to a refractive study and who monitored intraocular pressure on a regular basis. IOL implantation was commonly performed in eyes with a corneal diameter >10 mm. Comparable primary data on aphakic eyes were included from 2 published studies on aphakic glaucoma, which included corneal diameters and the patient's age at surgery. Glaucoma-free survival estimates for each cohort were estimated. RESULTS: Only 1 case 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 were 14 eyes (11.3%) with glaucoma among 124 aphakic eyes (mean age of patient, 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 cataract surgery. We propose 2 theories on the possible mechanism of reduction in the incidence of glaucoma in pseudophakic eyes.

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Ophthalmology

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