The long-term anterior segment configuration after pediatric cataract surgery and the association with secondary glaucoma

Ding Chen, Xian-Hui Gong, He Xie, Xue-Ning Zhu, Jin Li, Yun-E Zhao, Ding Chen, Xian-Hui Gong, He Xie, Xue-Ning Zhu, Jin Li, Yun-E Zhao

Abstract

Secondary glaucoma constitutes major sight-threatening complication of pediatric cataract surgery, yet the etiology remains unclear. The purpose of this study was to investigate the long-term anterior segment configuration and the association with secondary glaucoma in pediatric pseudophakia. Ultrasound biomicroscopy (UBM) was performed on 40 eyes of 26 children underwent pediatric cataract surgery and intraocular lens (IOL) implantation. The anterior chamber depth (ACD), angle-opening distance at 500 μm (AOD500), trabecular-iris angle (TIA), central corneal thickness (CCT), structural abnormities, IOL position, IOP, and incidence of glaucoma were evaluated. High insertion of iris, in which the iris root is attached more anteriorly than normal, was seen in 13 eyes (32.50%). IOL was located in the capsular bag in 19 eyes and in the ciliary sulcus in 21 eyes. Logistic regression analysis identified high insertion of iris (OR 3.40, 95% CI 1.03-11.17, p = 0.03) and IOL implantation in sulcus (OR 1.39, 95% CI 1.07-4.85, p = 0.04) as independent risk factors for glaucoma. The presence of high insertion of iris and IOL implantation in ciliary sulcus may increase the long-term risk of the development of secondary glaucoma after pediatric cataract surgery.

Conflict of interest statement

The authors declare no competing financial interests.

Figures

Figure 1. Abnormities in the configuration of…
Figure 1. Abnormities in the configuration of the anterior segment in ultrasound biomicroscopy images.
(A) The normal angle structure of a phakic normal control. (B) High insertion of iris in the pediatric pseudophakia. The iris root was located more anteriorly than that of normal control. (C) Peripheral anterior synechia of iris. (D) Image of an iridociliary cyst causing localized angle narrowing. (E) An enlarged Soemmering’s ring causing angle narrowing. (F) Image of residual lens material in the capsular bag.
Figure 2. The intraocular lens (IOL) position…
Figure 2. The intraocular lens (IOL) position in ultrasound biomicroscopy images.
(A) IOL implantation in the capsular bag with good position. (B) IOL implantation in the ciliary sulcus with good position. (C) IOL tilting due to asymmetric fixation with optic and one haptic in the bag while the other haptic in the sulcus. (D) IOL decentration and anterior synechia of iris. (E) IOL subluxation due to insufficient support of capsular bag. (F) IOL forward shifting and embedding into iridociliary tissue.
Figure 3. Ultrasound biomicroscopy (UBM) of the…
Figure 3. Ultrasound biomicroscopy (UBM) of the anterior segment of pediatric pseudophakia.
(A) UBM images of the anterior chamber and intraocular lens (IOL). Anterior chamber depth (ACD) was determined from the central inner corneal surface, perpendicular to the corneal surface to the most anteriorly visible part of the IOL. (B) Quantitative angle measurement. Angle-opening distance at 500 μm (AOD500) was measured on a line perpendicular to the trabecular meshwork at points 500 μm from the scleral spur. Trabecular-iris angle (TIA) was measured with the apex in the iris recess and the arms of the angle passing through a point on the trabecular meshwork 500 μm from the scleral spur and the point on the iris perpendicularly opposite.

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