Aphakic Glaucoma or Secondary Glaucoma Following Cataract Surgery

It is a condition in which the natural lens of the eye is absent. The most common cause for aphakia is cataract surgery. In adults undergoing cataract surgery, the natural lens is replaced with an artificial intraocular lens (IOL) – this is called pseudophakia. However, in children who are born with cataracts (congenital cataract) and undergo cataract surgery, an IOL may or may not be placed.

It is a form of secondary glaucoma that frequently follows cataract surgery in infants and children. The cause is thought to be related to changes to the drainage system where fluid exits the eye. Eyes that have either aphakia or pseudophakia can develop glaucoma following cataract surgery in children. Therefore, the name of this condition has been changed from Aphakic Glaucoma to Secondary Glaucoma Following Cataract Surgery (SGFC).

SGFC is characterized by high pressure in the eye which can lead to irreversible optic nerve damage. Many studies report that about two thirds of eyes with this type of glaucoma develop visual impairment. However, early treatment can prevent vision loss and even improve the appearance of the optic nerve. 

Early cataract surgery has been associated with a higher risk of developing SGFC. However, it is not always possible to delay cataract surgery in order to reduce this risk. Congenital cataracts can cause permanent vision loss in infants, and early cataract surgery (typically by 8 weeks of age) is the most effective treatment especially in cases where only one eye is affected. A case-by-case evaluation aimed at preventing permanent vision loss from the cataract as well as from SGFC is necessary to decide on the ideal timing of cataract surgery for infants.

Approximately 6% of children who undergo surgery to remove congenital cataracts develop SGFC, and on average, glaucoma develops 4-6 years after surgery. Advancements in surgical techniques for cataract removal have improved outcomes. Despite this, regular examinations of children who have undergone cataract surgery are crucial for timely diagnosis and treatment of SGFC.

Initial management of SGFC is typically eye drops but surgery is often required to control the glaucoma. Multiple surgeries may be necessary over the patient’s lifetime and regular, lifelong, follow-up is very important. With timely diagnosis and continuous care by a physician experienced in the management of these disorders, many children will retain good vision and lead a normal life.

Article by Robert Feldman, MD and Elza Rachid, MD. Dr. Rachid is an ophthalmologist who graduated from the American University of Beirut. She completed her subspecialty training at Bascom Palmer Eye Institute and the University of Texas Health Science Center in Houston.

Posted on August 6, 2025.