Intraoperative challenges and outcomes of pediatric cataract surgery following glaucoma filtering surgery

Purpose: - To analyze the intraoperative challenges of cataract surgery in children, following glaucoma filtering surgery. Methods- This was a retrospective study to analyze intra-op challenges and outcomes of pediatric cataract surgery in post-glaucoma filtration surgery eyes, between January 2007 to December 2019. Results- We included 20 eyes of 16 children. The most common glaucoma surgery performed was trabeculectomy and trabeculotomy (14 eyes). The median age at the time of cataract surgery was 74.5 months. The most common cataract surgery performed was lens aspiration with posterior chamber intraocular lens implantation (LA+PCIOL) (9/20). The most common intraoperative challenge faced was difficulty in capsulorrhexis (10 eyes), followed by extension of primary posterior capsulotomy (6 eyes). At the final follow up 8 eyes had improvement in visual acuity, 5 eyes had stable visual acuity and 5 eyes had a drop in visual acuity. In 12/20 eyes IOL was implanted, 9 eyes in-the-bag and 3 eyes had in ciliary sulcus. None of the IOLs in the bag had decentration of IOL. The median postoperative IOP (p=0.12) and median number of postoperative AGM (p=0.13) at 2 years remained stable compared to the preoperative values. The IOP remained well controlled in 4 eyes without anti-glaucoma medications and in 14 eyes with anti-glaucoma medications and none needed additional surgery for IOP control. Two eyes developed retinal detachment postoperatively. Conclusion- Cataract surgery in pediatric eyes with prior glaucoma surgeries, have challenges with capsulorrhexis and IOL stability. The visual outcomes were reasonably good so was the IOP control.