Predicting 10 Year Glaucoma Using Anterior Segment Biometry for Infants with Unilateral Congenital Cataract.

Abstract

Glaucoma following congenital cataract surgery is the most common secondary form of glaucoma in children and a serious sight-threatening complication following congenital cataract surgery. Therefore, risk assessment for future glaucoma is integral to the management of infants undergoing cataract surgery. Biometry of the anterior segment may offer the opportunity to enhance estimation of an infant's risk of developing glaucoma. This study aims to use preoperative anterior segment biometry to predict future glaucoma among infants undergoing congenital cataract surgery and provide a risk calculator based on predictive models. Posthoc cohort analysis from a multicenter randomized controlled trial in the United States (NCT00212134). This cohort included 114 participants with unilateral congenital cataract who underwent cataract surgery between 2004 and 2007 and were followed for 10.5 years as part of the Infant Aphakia Treatment Study. A total of 110 participants were analyzed. A total of 88 participants had at least one biometry measurement available. Overall, 41% of the cohort was diagnosed as glaucoma or glaucoma suspect by study endpoint. Preoperative biometry measured on the day of cataract surgery was used to collect anterior chamber depth (ACD) and lens thickness. Subject characteristics, corneal diameter, and axial length were included in logistic regression analysis. ACD was the primary predictor of interest, and glaucoma or glaucoma suspect status at 10.5 years was the primary outcome of interest. The main outcome measures were model coefficients and odds ratios with 95% confidence intervals for glaucoma or glaucoma suspect diagnosis at 10.5 years following congenital cataract surgery. Subjects with glaucoma had ACD of 2.76 ± 0.48 mm compared to 3.08 ± 0.38 mm among subjects without glaucoma or glaucoma suspect (mean difference = 0.32 mm, P = .003). Logistic regression models found shallower ACD was a strong predictor of glaucoma (OR 5.8 [1.8, 18.9], P = .004), compared to shorter axial length (OR 1.0 [0.7, 1.4], P = .9), thinner lens (OR 1.5 [0.7, 3.1], P = .3), decreased corneal diameter (OR 1.6 [0.95, 2.9], P = .08), and younger age (OR 1.01 [1.0, 1.02], P = .04). ACD has a significant association with glaucoma following congenital cataract surgery.