Does secondary intraocular lens implantation increase the risk of glaucoma in aphakic patients who underwent cataract surgery in childhood?

Abstract

Secondary intraocular lens (IOL) implantation is reported to increase glaucoma development and progression in paediatric patients. We evaluated the risk of new-onset glaucoma or progression following secondary IOL implantation in children and young adults. Retrospective cohort study of secondary IOL implantation following paediatric cataract surgery at Moorfields Eye Hospital (2017-2025). Anterior chamber IOLs or retinal pathology were excluded. Primary outcome was glaucoma progression (worsening optic disc appearance, sustained intraocular pressure (IOP) elevation requiring medical therapy escalation and/or glaucoma surgery). Secondary outcomes included longitudinal IOP trends and best-corrected visual acuity. 57 eyes were included (30 paediatric, 0-16 years; 27 young adult, 17-30 years); mean follow-up 28.2 months (SD±26.4). Aetiology was congenital (49%), uveitic (26%) and traumatic (25%). IOL position was ciliary sulcus (68%), capsular bag (18%) and scleral-fixated (14%). Glaucoma progression occurred in 16 eyes (28%), predominantly in eyes with pre-existing glaucoma (15/21, 71%), vs 1/36 eyes (3%) without pre-existing glaucoma (relative risk 25.7; 95% CI 3.7 to 181.0; p<0.0001). Progression was most frequent in uveitic eyes (67%) and was not observed in traumatic cataract (p=0.00012). No significant association was observed between age group or IOL position and glaucoma progression. Secondary IOL implantation is associated with a significant risk of glaucoma progression in eyes with pre-existing glaucoma but appears unlikely to induce new-onset glaucoma in eyes without prior disease. These findings highlight the importance of careful patient selection, counselling and close postoperative surveillance in patients with pre-existing glaucoma undergoing secondary IOL implantation.