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Glaucoma
attention to the surgical technique for paediatric cataracts, including anaesthesia may be erroneously low. Another fallback is the fact that
posterior capsulorhexis and anterior vitrectomy. This technique was the central corneal thickness may be higher in children having had
found to be associated with an increased risk of glaucoma in one cataract surgery with or without IOL, which may lead to a
study;
5
however, as the author argues, posterior capsulorhexis/ measurement of erroneously higher IOPs.
31
anterior vitrectomy was used on almost all patients who were
operated on at the high-risk age of <9 months. In another study, the Conclusion
surgical technique was no longer significant when adjusting for age at It is beyond doubt that a child born with dense bilateral congenital
surgery.
8
The role of primary intraocular lens (IOL) implantation in cataract requires early surgery to avoid amblyopia, probably before
decreasing
21–23
or increasing
24–26
the risk of glaucoma has been debated. eight to 10 weeks of age.
32–34
However, there is a high risk of post-
Theories for the former effect are that the IOL may prevent vitreous operative development of glaucoma in children with early surgical
substances from accessing the trabecular meshwork or that the IOL intervention, even >10 years after surgery where the risk is up to
provides mechanical support mimicking that of the natural lens. 30%.
8
The risk is higher among children who are <9 months of age at
However, the seemingly protective role of IOL is more likely to be due surgery, with a seven-fold increased risk compared with children who
to the fact that most children with primary IOL implantation are older are older at surgery, and the risk is very high during the first four
at the time of surgery than children left aphakic.
8,18
weeks of life. Whether or not the child has a primary IOL or not, they
should have a close follow-up for life with the necessary
The most important risk factor for glaucoma after paediatric cataract examinations appropriate for age performed at each visit. ■
surgery is age at surgery.
1,5,8,17,18–20,27–29
In one study, early age at detection
was the only significant risk factor for secondary open-angle
Birgitte Haargaard is a Resident in the Department of
glaucoma, but the authors argue that this is because of the close
Ophthalmology at Glostrup Hospital at Copenhagen
correlation between age at detection and age at surgery.
29
The risk of University Hospital. In 2009, she completed the European
glaucoma is higher among children with an age at surgery below nine
Society of Ophthalmology European Leadership
Programme (SOE EuLDP), a European ophthalmology
to 12 months. The risk is increased seven-fold in children <9 months of
leadership development programme. Dr Haargaard’s
age at surgery compared with children who were older at the time of main research interests are childhood cataract and
surgery.
8
Cataract surgery should be avoided during the first four
glaucoma, and her published work has mainly focused
on population-based studies on the epidemiology of
weeks of life because of a particularly higher risk in this age group.
27
childhood cataract, risk factors for the disease and post-operative complications. She is
The risk of glaucoma after cataract surgery continues to be present a Board Member and Scientific Secretary of the Danish Ophthalmological Society and a
many years after surgery.
8,27,29 member (co-opted) of the steering group of the Swedish Registry of Paediatric Cataract
Surgery. Dr Haargaard received her MD and PhD, entitled ‘Childhood cataract in
Denmark: incidence and risk factors’, from the University of Copenhagen.
Diagnosis of Glaucoma
Open-angle glaucoma in children <4–5 years of age may remain John Thygesen is an Associate Professor in the
undetected because of difficulties in measuring the IOP in an
Department of Ophthalmology at Rigshospitalet at the
University Hospital of Copenhagen and Director of
unco-operative child, but also because glaucoma diagnosis may be
Glaucoma and Traumatology Services. He is a Senior
difficult in children <2 years of age. In this age group, IOP is not always Consultant Ophthalmologist at the same hospital. He is
clearly increased. Indications of glaucoma are an increase in
an Executive Committee member and member of the
Educational Committee of the European Glaucoma
excavation of the optic disc with a thinning of the nerve fibre rim, an
Society (EGS), and co-author of the EGS Guidelines
increase in corneal diameter with ruptures of Descemet’s membrane 1998, 2003 and 2008. Dr Thygesen is the EGS
and/or an increase in axial length.
30
The increase in axial length is
representative at the World Glaucoma Association and President of the Danish
Glaucoma Society. He is a medical advisor for the Danish Medicines Agency under the
particularly characteristic in children <2 years of age because of the
auspices of the Ministry of the Interior and Health. He has given 468 presentations at
elasticity of the young eye bulb. Therefore, it is crucial to measure not national and international glaucoma and perimetry meetings and authored 158 papers
only IOP in these children, but also axial length and corneal diameter,
and abstracts on glaucoma, ocular pharmacology, automated perimetry and ocular
traumatology. He has moderated 92 national and international meetings. Dr Thygesen
as well as to perform ophthalmoscopy at every post-operative
is an Associate Editor for Acta Ophthalmologica and a reviewer for several
examination. Depending on the method of measuring IOP, it is international journals.
important to realise that the values measured under general
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