Evaluation of whether intracameral dexamethasone predisposes to glaucoma after pediatric cataract surgery

Abstract

PURPOSE: To evaluate the effect of intracameral dexamethasone during pediatric cataract surgery on the incidence of postoperative glaucoma. SETTING: Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital, London, United Kingdom. DESIGN: Retrospective case series. METHODS: This case-note review comprised all infants who had cataract surgery with intraocular lenses between January 1, 2007, and December 31, 2008, and were given preservative-free intracameral dexamethasone intraoperatively. The definition of glaucoma was an intraocular pressure (IOP) of 21 mm Hg or greater on more than 2 occasions or moderate or firm digital IOP with 1 of the following: myopic shift, increased cup-to-disc ratio, increased horizontal corneal diameter, or corneal edema. RESULTS: Eighteen patients (24 eyes) were included. The median age at surgery was 3 months (mean 4 months ± 3 (SD); range 1 to 11 months). The median follow-up was 38 months (mean 34 ± 10 months; range 20 to 48 months). In 4 eyes, transient postoperative antihypertensive medication was used; however, no eye developed glaucoma during the follow-up period. Fifteen eyes had a second procedure to clear the visual axis due to posterior visual axis opacification a mean of 6.4 ± 3.5 months postoperatively (median 4.8 months; range 3.5 to 14.5 months); however, no eye developed anterior membranes. CONCLUSION: Intracameral preservative-free dexamethasone in infantile cataract surgery did not seem to cause an increased risk for glaucoma and appeared to protect against anterior membrane formation.