Clinical characteristics and management of glaucoma following congenital cataract surgery and IOL implantation

• Glaucoma following cataract surgery and IOL implantation performed before the age 1 year occurred in 14.3% of cases. • Glaucoma was diagnosed after interval of 3.9±3.9 years with 28% of eyes diagnosed with 6 months of cataract surgery. • Surgery was needed in 44% of eyes with half of the eyes needing at least 2 surgeries. • Need for glaucoma surgery was associated with: early cataract surgery (p=0.02), early glaucoma diagnosis (p=0.04), use of vision blue (p=0.03) and associated ocular anomalies (p=0.01). To present the clinical characteristics, management and outcomes of glaucoma following congenital cataract surgery with primary intraocular lens (IOL) implantation. Retrospective, monocentric consecutive case series We included patients with glaucoma following congenital cataract surgery and IOL implantation before the age of one year. Therapeutic success was defined as intraocular pressure (IOP) <21 mmHg at last follow-up without sight threatening complications, with or without medication. Sixty-one eyes of 42 patients were included. Mean age at cataract surgery was 121.4±82.1 days. The mean interval between cataract surgery and glaucoma diagnosis was 3.9±3.9 years. During follow-up, 34 eyes were treated medically (55%) while 27 (45%) needed surgery. The glaucoma surgeries included: trabeculectomy in 17 eyes, laser diode in 14 eyes, Ahmed glaucoma valve in 6 eyes and MicroShunt PRESERFLO in 2 eyes. Glaucoma was treated successfully in 48 eyes (80%). Need for glaucoma surgery was associated with: early cataract surgery (p=0.02), early glaucoma diagnosis (p=0.04), use of trypan blue (p=0.03) and associated anomalies (p=0.01). BCVA at last follow-up was worse in eyes undergoing surgery than eyes receiving medical treatment (1.4±1.0 vs. 0.63±0.57 logMAR, p=0.001). Eyes that underwent cataract surgery earlier and eyes associated with other anomalies were more likely to require surgery. The earlier glaucoma developed after cataract surgery, the more likely surgery was needed in the follow-up. Age at cataract surgery and time to glaucoma diagnosis did not affect surgical success. However, visual prognosis remains poor despite IOP control.