Secondary Eye High Pressure After Lensectomy In Congenital Cataract: Management Of A Aphakic Young Patient Trough Trabeculotomy.

To evaluate possible surgical management in patients with secondary high eye pressure after lensectomy due to congenital cataract and low response to hypotensive topical eye drop medication.

Young patient who had  lensectomy with anterior vitrectomy due to unilateral congenital cataract  at AORN Santobono Pausilipon (Naples, Italy) in January 2024 and further management until February 2025.

4 weeks old young male had lensectomy and anterior vitrectomy with no IOL implant in his right eye on January 2024. At three month follow up review corneal oedema was noticed in his operated eye, with anterior and posterior synechiae as well as inferior pupil stretching. After checking his right IOP with available tonometer, high eye pressure was suspected, so according with literature hypotensive drops medication was prescribed (Timolol/Dorzolamide) BD. In next follow up his corneal oedema slightly improved, therefore in June 2024 right surgical synechiolysis was performed.  At one months of his surgical follow up review corneal oedema was still reported in right eye consequently a second hypotensive drop was prescribed (prostaglandin analogues) OD at night. At his IOP check after two weeks any improvement of corneal oedema was noticed, probably because a poor medical adherence of child’ parents declared, so narcosis examination and possible surgical treatment in his right eye was planning. High eye pressure associated with increased of right corneal diameters, and of his right axial length was reported at time of patient narcosis examination in November 2024, so Trabeculotomy was performed. Surgical plan was an ab-externo approach with temporal access and a trabecular meshwork stripping size of approximately 150°. At his two-month narcosis examination check, corneal oedema resolved, associated with a good IOP with one hypotensive topical drop (Timolol/Dorzolamide).

In young patients with diagnosis of congenital cataract, secondary high eye pressure is one of most frequent post- surgical complication reported after lensectomy with anterior vitrectomy and no IOL implant (aphakic patients). Corneal oedema could be one of the main suspect sings and work like eye pressure target check as well as common tonometre instrument, especially in no cooperative patient like children. According with literature patients usually achieved a good IOP control with topical hypotensive medication as first line of treatment, however trabeculotomy could be a safe surgical option if IOP is not well controlled and surgery will be needed.