Pediatric aphakic glaucoma: A study of 65 patients

Purpose: The anterior segment findings of children with glaucoma following pediatric cataract extraction were studied to determine the mechanism of this complication. Methods: The clinical records of 65 children with glaucoma cared for by the author were studied. Patients with bilateral lensectomy followed by bilateral glaucoma, bilateral lensectomy followed by unilateral glaucoma, and unilateral lens surgery followed by glaucoma were identified and studied. Results: It was determined that vitreous cutting instruments were used for 80% of the lensectomy procedures, with 77% of the lens procedures done in the first year. Eighty-seven percent of the patients were recognized to have glaucoma two or more years after their lensectomy. Preoperative gonioscopy revealed no consistent angle defect, while postoperative gonioscopy revealed a near constant (96%) but variable angle defect characterized by blockage of the trabecular meshwork by an acquired repositioning of the iris against the posterior trabecular meshwork, associated with abnormal pigmentation anti synechia formation. Conclusion: The results reported document the development of a characteristic acquired filtration angle deformity in children with glaucoma following early lensectomy frequently associated with significant residual lens tissue anti unassociated with evidence of chronic anterior segment inflammation.