Use of Integrated Intraoperative Ocular Coherence Tomography in Pediatric Cataract Surgery: Thinking outside the Box.

To observe the rate of secondary glaucoma after pediatric congenital cataract surgery in the first 36 months of life. Retrospective case series. The records of children who underwent surgery for congenital cataract within the first 36 months of life between July 1995 and July 2005 at Qingdao Eye Hospital were reviewed. Children with preoperative conditions associated with glaucoma were excluded. Age at surgery, unilateral or bilateral cataract, type of congenital cataract, primary intraocular lens (IOL) insertion, duration of follow-up, postoperative best corrected visual acuity, development of aphakic glaucoma, and development of glaucoma after secondary IOL implantation were evaluated. A total of 115 patients (204 eyes) with an average surgery age of (12.5 ± 9.2) months were included; the mean follow-up time was (83.7 ± 43.8) months. 15 eyes (11 patients) (7.4%) had subsequent development of glaucoma, 7 of which (4 patients) developed late-onset open-angle glaucoma. Of the 15 eyes, 13 eyes had surgery within 9 months, and 12 eyes developed nuclear or total cataract. None of the primarily pseudophakia eyes developed glaucoma in our study. Of 86 eyes that received implantation of secondary intraocular lens in the ciliary sulcus, 13 eyes (15.1%) developed pseudophakia glaucoma. Secondary glaucoma occurred after pediatric bilateral cataract surgery. As late-onset glaucoma usually occurred several years after primary surgery, long-time follow-up after pediatric cataract surgery needs to be emphasized.

Commentary: Pediatric cataract management during the COVID-19 era.

ABSTRACTPurpose: Advances in surgical techniques allow implantation of intraocular lenses (IOL) with cataract extraction, even in young children. However, there are several challenges unique to the pediatric population that result in greater degrees of postoperative refractive error compared to adults. Methods: Literature review of the techniques and outcomes of pediatric cataract surgery with IOL implantation. Results: Pediatric cataract surgery is associated with several sources of postoperative refractive error. These include planned refractive error based on age or fellow eye status, loss of accommodation, and unexpected refractive errors due to inaccuracies in biometry technique, use of IOL power formulas based on adult normative values, and late refractive changes due to unpredictable eye growth. Conclusions: Several factors can preclude the achievement of optimal refractive status following pediatric cataract extraction with IOL implantation. There is a need for new technology to reduce postoperative refractive surprises and address refractive adjustment in a growing eye.

Background: In Saudi Arabia, cataract is considered the major cause of blindness as 55% of the total cases are caused by cataract. Moreover, 35.5% of visual loss is caused due to cataract making it the second leading cause of visual loss. Therefore, the aim of the study was to determine the outcome of visual acuity after paediatric cataract surgery. Methods: The preferred reporting items for systematic review and meta-analysis (PRISMA) were used in this systematic review. Cochrane handbook guidelines were used for all aspects of this study. It includes published and unpublished studies with different study designs. Such studies were found from databases including Google Scholar, Medline, PSYCHInfo, Embase Google, and Cochrane library, from their inception through the second week of March 2022 without any language restriction and identified all RCTs related to the results of visual acuity after Cataract Surgery in children. We used the following search keywords: ‘‘visual’’, ‘‘visual acuity’’, ‘‘cataract’’, ‘‘childhood blindness’’, ‘‘visual impairment’’, ‘‘amblyopia’’, ‘‘cataract surgery’’ and ‘‘pediatric cataract surgery’’ and ‘‘randomized controlled trial’’. In addition, we manually reviewed the references of a few journals to uncover more works that might be linked. Result: All RCTs connected to outcomes of visual acuity after pediatric cataract surgery were found using a total 376 articles from the electronic databases PubMed, Embase, PSYCHInfo, and the Cochrane Library, which were searched without language barriers from their inception. "Visual", "visual acuity", "cataract", "childhood blindness", "visual impairment", "amblyopia", "cataract surgery", and "pediatric cataract surgery" and "randomized controlled trial" were some of the search keywords. In addition, the references of a few journals were searched to find more potentially relevant studies. Due to redundancy, 92 articles were excluded from the total of 376. A total of 167 articles were reviewed, with 108 being rejected following a preliminary review. There were 59 full-text papers reviewed for eligibility, and 7 of them met the inclusion requirements, with all of the selected articles being of high quality. The parameters of the trials differed greatly in terms of treatment length and population investigated. Conclusion: According to the findings, most pediatric cataracts are inherited. Cataract extraction with Intraocular Lens (IOL) implantation with primary posterior capsulectomy and anterior vitrectomy (PPC+ AV) is the preferred method for pediatric cataract therapy. Active case discovery, parent counseling, and clear referral paths, are required to address cataract blindness. There may be a refractory surprise after the surgery in pediatric cataract instances, most often due to incorrect measuring, as the youngsters will be uncooperative for precise measurement or under the anesthetic influence. The surgery should be done in a fully equipped unit with qualified cooperative staff, and various techniques might be necessary to improve follow-up after the surgery. Keywords: visual acuity, cataract, childhood blindness, visual impairment, blindness

ObjectivesThe aim of this study was to evaluate the outcomes of pediatric developmental cataract surgery with primary intraocular lens (IOL) implantation.Materials and MethodsPatients between 2 and 16 years old who underwent cataract surgery with primary IOL implantation were retrospectively evaluated. Age at time of surgery, pre- and postoperative best corrected visual acuities, postoperative ocular complications, and any accompanying ocular pathologies were obtained from the patients’ charts. Mean refractive changes and degree of myopic shift were analyzed according to the age groups. Operated eyes were also compared with the fellow eyes in unilateral cases.ResultsA total of 101 eyes of 65 patients were included. The average age at time of surgery was 76±40 months and the average follow-up period was 44±30 months. Among the 78 eyes that could be assessed for visual acuity improvement, 66 (84.6%) of them showed ≥2 lines of improvement. The difference in the mean refractive change between the 2-5 years old and 8-16 years old age groups was found to be statistically significant. However, the mean refractive change per year was not found to be significant between the same age groups. In unilateral cases, the operated eyes showed a greater myopic change than the fellow eyes, with no statistically significant difference. The most common postoperative complication was visual axis opacity.ConclusionGood visual outcomes can be achieved following pediatric cataract surgery with primary IOL implantation. Optic axis opacities were the most common postoperative complications. Overall, refractive changes following surgery are inevitable, and more prominent in younger age groups.

About 10 % of pediatric cataract patients have preexisting posterior capsular defects. The common types of posterior capsular defects include posterior capsular plaque, congenital membranous cataract, posterior polar cataract, posterior lenticonus, and posterior polar or posterior subcapsular cataracts with persistent fetal vasculature. Pediatric cataract surgery in the eyes with posterior capsular defects often has a significantly increased risk of intraoperative complications, and the biggest challenge lies in how to avoid or manage lens material dropping into the vitreous cavity during surgery. This chapter will describe the clinical features, diagnosis, timing of operation, and surgical techniques for each of these cataract types.

Reply

Pediatric cataract surgery and intraocular lens implantation: Practice styles and preferences of the 2001 ASCRS and AAPOS memberships

To determine the incidence and risk factors of secondary glaucoma after pediatric cataract surgery. Two hundred and forty nine eyes of 148 patients underwent cataract surgery without intraocular lens (IOL) implantation (group 1), and 220 eyes of 129 patients underwent cataract surgery with IOL implantation (group 2) retrospectively, were evaluated between 2000 and 2011. The outcome measure was the presence or absence of post-cataract surgery glaucoma, defined as an intraocular pressure (IOP) ≥26mmHg, as measured on at least two occasions along with corneal or optic nerve changes. The mean follow-up periods of group 1 and 2 were (60.86±30.95) months (12-123 months) and (62.11±31.29) months (14-115 months) respectively. In group 1, 12 eyes of 8 patients (4.8%) developed glaucoma. None of the patients developed glaucoma after surgery in group 2. The mean age of the patients at the cataract surgery was (2.58±0.90) months (1 month-4 months) and the average period for glaucoma development after surgery was (9.50±4.33) months (4-16 months) in group 1. Three of the 12 glaucomatous eyes were controlled with antiglaucomatous medication and 9 eyes underwent trabeculectomy+mitomycin C surgery. One patient underwent a second trabeculectomy + mitomycin C operation for both of his eyes. The incidence of glaucoma after pediatric cataract surgery is very low in patients in whom IOL is implanted. The aphakic eyes after pediatric cataract surgery are at an increased risk for glaucoma development particularly if they underwent surgery before 4 months of age.

Posterior Capsulorhexis with Optic Capture in Pediatric Cataract and Intraocular Lens Surgery

PurposeTo describe the clinical characteristics of glaucoma-related adverse events (GRAE) after pediatric cataract surgery. More importantly, to identify the factors associated with the time of GRAE onset and the preferred anti-glaucomatous surgical procedure for this disease.MethodsHospitalized medical records of patients who developed GRAE, which include glaucoma and glaucoma suspect, after pediatric cataract surgery (surgical age ≤ 14 years) between 1994 and 2021 were retrospectively reviewed. If the interval between cataract surgery and GRAE diagnosis was less than one year, early-onset GRAE was diagnosed, otherwise it was late-onset type. Multivariate logistic regression analysis was performed to investigate the possible associated factors for the type of GRAE onset. Chi-square test was used to evaluate the differences of the re-operation rate between the two surgical groups of glaucoma valve implantation and trabeculectomy for controlling elevated intraocular pressure (IOP).Results125 eyes in 94 patients with GRAE following pediatric cataract surgery were included in the study. Among them, 25 patients had unilateral cataracts and 100 eyes in 69 patients were bilateral. Of the 125 eyes, 63 (50.4%) had initial cataract surgery under 6 months of age, and 97 (77.6%) under 2 years of age. 76 eyes (60.8%) were aphakic, and 21 (16.8%) were with primary intraocular lens (IOL) implantation and the remaining 28 (22.4%) with secondary IOL implantation. More than half of the eyes (69/104, 66.3%) belonged to the group of late-onset GRAE. Multivariate analysis showed that a younger age at cataract surgery was associated with early-onset GRAE (P = 0.041). Closed angles were found in 72.1% (44/61) of eyes before the first anti-glaucomatous surgeries. 50% eyes (9/18) after trabeculectomy needed re-operation to control IOP compared with 12.1% (4/33) after glaucoma valve implantation (P = 0.003).ConclusionsAn earlier age at pediatric cataract surgery is more likely to develop early-onset GRAE. Glaucoma valve implantation seemed to be a preferred surgical intervention for patients with GRAE.

Heparin in the intraocular irrigating solution in pediatric cataract surgery

Pediatric cataract surgery with hydrophilic acrylic intraocular lens implantation in Nepalese children

PurposeTo assess the outcome of cataract surgery with hydrophilic acrylic intraocular lens (IOL) implantation in children with congenital and developmental cataracts.MethodA retrospective review of medical records of children with congenital or developmental cataracts who underwent cataract surgery with hydrophilic IOL implantation, from January 2011 to December 2014 in a tertiary eye hospital in Nepal. Primary posterior capsulotomy, anterior vitrectomy, and IOL implantation was done in children 8 years or younger, while older children underwent only lens aspiration and IOL implantation.ResultsA total of 178 eyes of 120 children underwent cataract surgery with primary IOL implantation. Mean age at the time of surgery was 6.9 years (range: 3 months to 15 years). Average follow-up time was 13.7 (±5.9) months. Associated ocular anomalies were present in 84 (47.1%) eyes. Postoperative complications were found in 33 eyes (18.13%) with inflammatory membrane being the most common (10.1%). Two eyes (1.1%) developed endophthalmitis. Second intervention was needed in 12 (6.5%) eyes. Preoperative vision of less than 6/60 was present in 105 eyes (57.69%). Final best corrected visual acuity of 6/12 or better was found in 81 (44.5%) eyes.ConclusionOur study shows that hydrophilic IOL is suitable for use in children. Results of this study are comparable with other studies on pediatric cataract surgeries using hydrophobic acrylic intraocular lenses. Low cost hydrophilic lens implantation is an effective approach in managing pediatric cataract surgery in developing countries like Nepal.

The efficacy of posterior optic capture (POC) in reducing posterior capsule opacification (PCO) in pediatric cataract is well recognized. The purpose of this paper was to identify the surgical challenges when attempting this technique and highlight the etiquettes to follow when performing this maneuver. Prospective observational noncomparative case series. Children diagnosed with congenital or developmental cataracts undergoing cataract surgery and primary IOL implantation with posterior optic capture (and no anterior vitrectomy) from June 2017 to April 2022 at a tertiary care referral institute were included. Records of all intraoperative findings and postoperative complications until the last follow-up were noted. Posterior optic capture was attempted in 53 eyes of 49 children aged 2.4 ± 1.98 years. The mean follow-up of the patients was 16.5 ± 14.2 months (range 6 months-5 years). Successful POC could be performed in 46 eyes (86.8%). Two eyes developed posterior capsular opacification at the last follow-up. In eyes where POC could not be performed, five of these (83%) were children below 12 months of age with half of them having a preexisting posterior capsular defect. Posterior optic capture is technically challenging with a steep learning curve that can be mastered over time. Adequate relative sizing of the anterior and posterior capsulorhexis is important. Caution is advised when using this technique in infants and in cases with posterior capsular defects.