Infantile Cataract Research Articles

Comparison Between Monofocal and Aspheric Monofocal Intraocular Lens With Higher Order Aspheric Optic in Pediatric Patients: Early Outcomes.

To retrospectively compare the visual acuity outcomes for far, intermediate, and near vision of an aspheric monofocal intraocular lens (IOL) with higher order aspheric optic with a monofocal IOL in pediatric patients. Thirty-eight eyes of 38 patients (mean age: 9.0 ± 2.3 years) affected by monolateral infantile cataract were evaluated 6 months after surgery performed with simultaneous IOL implantation. The Tecnis Eyhance ICB00 aspheric monofocal IOL (Johnson & Johnson Vision) was implanted in 17 eyes (Tecnis Eyhance group, mean age: 8.9 ± 2.5 years) and the Tecnis PCB00 monofocal IOL (Johnson & Johnson Vision) was implanted in 21 eyes (control group, mean age: 9.1 ± 2.2 years). Corrected visual acuity expressed in logarithm of the minimum angle of resolution (logMAR) was assessed for distance (CDVA) and, expressed in Jaeger standard, for intermediate (DCIVA) and near vision (CNVA). DCIVA was measured with distance correction and without addition. The Mann-Whitney test for two independent samples was performed, and a P value less than .05 was considered statistically significant. Six months postoperatively, mean CDVA was 0.20 ± 0.2 logMAR and mean DCIVA and CNVA were 5 ± 1 and 2 ± 1 Jaeger, respectively, in the Tecnis Eyhance group. In the control group, mean CDVA was 0.21 ± 0.2 logMAR and mean DCIVA and CNVA were 8 ± 1 and 3 ± 1 Jaeger, respectively. Only DCIVA showed a significant statistical difference between groups (P < .0001). In pediatric patients, the aspheric monofocal IOL with higher order aspheric optic seems to provide better intermediate distance visual acuity than a monofocal one, whereas no significant difference was observed for CDVA and CNVA. [J Refract Surg. 2024;40(10):e724-e727.].

Myopic shift in pediatric cataract surgery associated with age and surgical complications.

To investigate predictors for myopic shift after pediatric cataract surgery after at least 3 years follow-up. Cross-sectional and retrospective study. This study included patients treated for congenital or infantile cataract operated up to 5 years of age between 2010 and 2017. Patients were recruited for ophthalmologic evaluation. Surgical and medical data were acquired in medical charts. Univariate and multivariate regressions were performed to look for potential risk factors for myopic shift. This study evaluated 81 eyes of 50 patients, with 62 (77%) being bilateral cases, 48 (59%) with intraocular lens implantation, and 37 (74%) patients being strabismic. Age at surgery was 7.7 (3.7-30.5) months and at evaluation was 93.5 (55.1-113.0) months. Total myopic shift was Symbol -4.32 ± 3.25 D, significantly greater in patients operated on up to 6 months of life (-5.73 ± 3.14 D). The distant best-corrected visual acuity (BCVA) was 0.6 (0.3-1.0) log of minimum angle of resolution (logMAR). Regarding myopic shift, in univariate analysis, older age at surgery is a protective factor (+0.08 D for each month older, P = 0.001). The presence of strabismus (-2.52 D, P = 0.014), aphakia (-2.45 D, P = 0.006), distant BCVA (-0.15 D per 0.1 logMAR, P = 0.024), and surgical complications (-3.02 D, P = 0.001) are risk factors. In multivariate analysis, older age at surgery (+0.06 D, P = 0.012) and surgical complications (-2.52 D, P = 0.001) remain significant. In pediatric cataract surgery, myopic shift is greater when surgery is performed in a younger age and if associated with surgical complications.

Nationwide incidence of and risk factors for undergoing incisional glaucoma surgery following infantile cataract surgery

Nationwide incidence and risk factors for incisional glaucoma surgery post-infantile cataract (IC) surgery in children remain poorly understood. We conducted a population-based cohort study using the Korean national health claims database to identify IC patients diagnosed before age 1 who had IC surgery among all Korean born between 2008 and 2018 (n = 9,593,003). We estimated the annual occurrence of undergoing incisional glaucoma surgery following IC surgery in the general population aged 0–10. The risk factors for incisional surgery including systemic comorbidities and ophthalmic anomalies were analyzed by multivariable logistic regression. Of 650 patients who had undergone IC surgery with a mean (standard deviation [SD]) follow-up period of 6.2 (3.2) years, 92 (14.2%) were diagnosed with glaucoma following infantile cataract surgery (GFICS). Among them, 21 patients (22.8%) underwent incisional glaucoma surgery after a mean (SD) follow-up duration of 5.4 (2.8) years from the diagnosis of GFICS. Median (InterQuartile Range) age at incisional surgery was 4 (2,6) years old. Twenty of 21 patients (95.2%) underwent incisional glaucoma surgery within 3 years of diagnosis of GFICS. No factors, except younger age at glaucoma diagnosis (P = 0.03), were associated with undergoing incisional surgery. These findings can better understand the epidemiologic features and clinical courses of GFICS.

Secondary Glaucoma after Cataract Surgery Performed in Infancy in Congenital Rubella Syndrome: A Case Control Study

ObjectiveTo compare the incidence of secondary glaucoma after cataract surgery performed in infancy in children with congenital rubella syndrome (CRS) and children with non-rubella cataracts and to identify associated risk factors. DesignRetrospective case control study. ParticipantsChildren with CRS who had undergone cataract surgery in infancy and age matched infants who had undergone cataract surgery for infantile cataracts were included. MethodsIncidence of glaucoma and probability of survival was compared among the two groups. Risk factors for the development of glaucoma were assessed. The minimum follow up was 1 year after cataract surgery. ResultsThe study included 211 eyes of 115 children. The CRS group (cases) had 101 eyes (58 children) and the non-rubella cataract group (controls) included 110 eyes (57 children). There was no significant difference in the mean age at surgery among the two groups (p=0.96). Cumulative incidence of secondary childhood glaucoma for the entire study period of 14 years was 32.7% in the CRS group and 24.5% in the control group (p=0.19). Mean follow-up was 5.8 ± 3.7years for CRS group and 6.4± 3.4years for the non-rubella group. A significant difference in the cumulative probability of glaucoma free survival at 10 years after cataract surgery (cases 0.53 versus controls 0.8; log rank p-0.034) was present. Both groups had no significant difference in the time of onset of secondary glaucoma, average number of intraocular pressure lowering medications and number of eyes with surgical intervention for glaucoma (p>0.05). Microcornea was associated with the development of glaucoma (hazard ratio 2.83, 95% confidence interval 1.44-5.57; p=0.002) in CRS eyes. ConclusionThere was no significant difference in the incidence of secondary glaucoma after cataract surgery performed in infants with CRS compared to infants who had undergone surgery for infantile cataracts. Since the ten year probability of glaucoma free survival was significantly less in children with CRS, a closer and longer follow up is recommended especially in eyes with at-risk features.

Nationwide incidence of congenital and infantile cataract requiring surgery in Korea

Congenital and infantile (CI) cataract is one of the most important and preventable cause of blindness in children, but the incidence has not been studied in Korea. We collected data from the national claims database of the National Health Insurance Service of Korea from 2002 through 2019. We identified children who underwent cataract surgery within the age of 5 years, and cumulative incidence rates were calculated for each of the three age criteria. 989 patients out of 4,221,459 births underwent surgery with CI cataract during the period. The cumulative incidence rates per 10,000 births were 1.60 (0–1 years), 2.38 (0–3 years), and 2.95 (0–5 years), respectively. The incidence peaked in the 2007 birth cohort, which coincides with the start of the national screening program for infants/children. Primary intraocular lens implantation was performed in 439 patients (44%). Strabismus and glaucoma requiring surgery occurred in 291 patients (29.4%) and 32 patients (3.2%), respectively, within 8 years after cataract surgery. The incidence rates of CI cataract in Korea appear to be comparable to previous studies in other regions. The early screening program for infants may reduce delayed diagnosis and increase the proportion of patients undergoing surgery at a critical time for visual development.

PROFILE OF UNILATERAL CATARACT IN PEDIATRIC PATIENTS: A 3 YEAR RETROSPECTIVE STUDY

Introduction and Objective: Unilateral cataract presents from 19.6% to 55.5% of pediatric cataract. This condition is treatable, but delayed treatment may cause visual impairment. This study aims to understand characteristic of unilateral cataract in children. Methods: This study was descriptive review of patients aged 0-17 years old with unilateral cataract at Dr. Kariadi Hospital, Semarang. Data were collected from medical record of patients from January 2019 to December 2022. Results: Sixty patients were included in this study, 56.7% of whom were male and 43.3% were female. The mean age at presentation is 71.50 ± 48.34 months with whitish eye being the most common main complaint (65%), followed by blurred vision (35%) and squinting of eye (5%). Most of patients had congenital or infantile cataract (60%), followed by traumatic (36.6%), uveitis (1.7%) and iatrogenic (1.7%). Some of patients had microcornea (21.7%), persistent pupillary membrane (8.3%), retinopathy of prematurity (3.3%), persistent fetal vasculature (8.3%), nystagmus (8.3%), amblyopia (20%) and strabismus (40%), with exotropia being the most common type (33.3%). Most of patients did not have systemic disease (93.3%), but we found two patients had congenital rubella syndrome, one had congenital cytomegalovirus, one had down syndrome. Conclusion: Etiology of unilateral pediatric cataract mostly idiopathic followed by traumatic. Leukocoria was the most common complaint, followed by blurred vision and strabismus. In unilateral cataract, exotropia was more common type of strabismus.

Myopic shift, refractive, and visual outcomes after 5 years of infantile cataract surgery: Our experience and review of literature.

After infantile cataract surgery, axial elongation, induces a myopic shift that cannot be fully compensated by corneal flattening and the rate is unpredictable owing to the non-linear growth of the eye. The current prospective study assesses the myopic shift and visual outcomes in children undergoing cataract surgery in infancy over a follow-up period of 5 years. A prospective study conducted at a tertiary eye care center to evaluate the five-year myopic shift, refractive and visual outcomes in infants, who underwent surgery for congenital cataract in infancy. The visual acuity, myopic shift and biometric changes are compared between the aphakia and pseudophakia group. The mean best-corrected visual acuity (BCVA) recorded in logMAR at 5 years for aphakia group was 0.92±0.44 and for pseudophakia group was 0.66±0.42. (pvalue: 0.002102). The myopic shift was noted to be -5.9+/-5.16 in the aphakia group whereas it was -9.01+/- 3.11 in the pseudophakia group (P value= 0.002101) at 5 years after surgery for infantile cataract. IOL implantation in eyes of infants undergoing cataract surgery is feasible in eyes that strictly satisfy the pre-operative inclusion criteria and the visual outcomes in these eyes are better compared to aphakia group at 5 years follow up. Eyes with primary IOL implantation had a higher myopic shift compared to ones without primary IOL implantation. Eyes undergoing primary IOL implantation, need higher under correction compared to the current available formulae.

Timing of Diagnosis and Treatment of Glaucoma following Infantile Cataract Surgery

To report timing of diagnosis and treatment of glaucoma following cataract surgery (GFCS) in a large cohort of infants undergoing cataract surgery at a tertiary care center. Cross-sectional study. All consecutive infants that underwent cataract surgery over a 30-year period from January 1991 to December 2021 were included if they had at least 1 year follow-up. The data collection included age at time of cataract surgery, presence of associated ocular or systemic conditions, age at diagnosis of GFCS, and treatment required to control GFCS. Glaucoma diagnosis required intraocular pressure (IOP) > 21 mmHg on > 2 visits with glaucomatous optic nerve head changes and/or visual field changes, or in young children, other anatomic changes such as corneal enlargement or haze or accelerated axial elongation and myopic shift. The incidence of GFCS was calculated. Linear regression was performed to assess the effect of age at time of cataract surgery. Analysis of risk factors and treatment modalities was performed using univariate and multivariate analysis. Three hundred eighty-three eyes (260 patients) were analyzed. Median age at surgery was 52 days and median follow-up, 8 years. Glaucoma following cataract surgery was noted in 27% (104/383 eyes; median age at surgery, 45 days; median follow-up, 13 years.) Young age at surgery (< 3 months) was the greatest risk factor (P= 0.001) but the incidence was similar for infants operated in the first, second, or third month of life (25%, 36%, 40%, respectively, P= 0.4). Microcornea (41%, P < 0.0001), poorly dilating pupils (25%, P= 0.001), persistent fetal vasculature (PFV, 13%; P= 0.8), or anterior segment dysgenesis (3%, P= 0.02) were considered as additional risk factors. Surgical intervention was needed for 73% (24/33) eyes with early-onset GFCS compared with 14% (10/71) eyes with later-later onset GFCS (P < 0.0001). Medical treatment was effective in 86% with later-onset GFCS (P= 0.006). The incidence of GFCS was 27%, and timing of diagnosis occurred in a bimodal fashion. Early-onset GFCS usually requires surgical intervention; medical treatment is effective for later-onset GFCS. Cataract surgery within the first 3 months of life, microcornea, and poorly dilating pupils were major risk factors. The authors have no proprietary or commercial interest in any materials discussed in this article.

10-Year Outcomes of Pediatric Cataract Surgery with Foldable Intraocular Lens Implantation and Posterior Continuous Curvilinear Capsulorhexis.

We investigated the long-term outcomes of pediatric cataract surgeries performed with modern surgical techniques involving in-the-bag implantation of a foldable intraocular lens (IOL). Data were retrospectively collected from 42 eyes in 30 patients who underwent surgery at 6 years and younger (average 2.5 ± 2.3 years) and were followed up for an average of 12.2 ± 2.4 years (10-17 years). Surgical procedures included anterior continuous curvilinear capsulorhexis (CCC), lens removal, posterior CCC, anterior vitrectomy, and in-the-bag IOL implantation. There were 18 unilateral (2.7 ± 2.3 years) and 12 bilateral cases (2.3 ± 2.3 years), with no significant age difference between groups (p = 0.462). The mean best-corrected visual acuity (BCVA) at the final visit was 0.453 ± 0.488 (logMAR), correlating significantly with the age at surgery (r = -0.307, p = 0.048). The unilateral group had a worse BCVA (0.658 ± 0.615) than the bilateral group (0.298 ± 0.294) (p < 0.001). On average, eyes showed a myopic shift of -6.0 ± 6.3D, which significantly correlated with surgical age (r = 0.402, p = 0.008). While the myopic shift was -8.2 ± 6.1 D in the unilateral group and -4.9 ± 6.4 D in the bilateral group, the net shift for unilateral cases (comparing pseudophakic and fellow eyes) was -4.8 D. Three eyes (7.1%) exhibited suspected glaucoma (increased intraocular pressure), but no glaucoma or other severe complications were noted. IOL exchange surgery was necessary in two eyes (4.8%) due to pronounced myopic drift and significant IOL decentration. Three eyes (7.1%) required surgery for significant visual axis opacification. Contemporary surgical strategies appear to yield promising long-term outcomes in patients with infantile cataracts.

Managing Pediatric Cataract Patients – The Whole Story: Aphakic Contact Lenses in Children – Techniques and Challenges

ABSTRACT Infantile cataract is one of the major causes of visual impairment in children. This article will discuss some of the techniques, challenges, complications, and compliance issues with aphakic contact lenses.

Pediatric Cataract: Disparately Blinding Globally and in the United States

ABSTRACT Childhood cataract is a complex condition requiring longitudinal care, including early diagnosis, timely referral to a specialist, early surgical intervention, and dedicated postoperative care. Adherence to refractive correction and amblyopia therapy are critical for visual rehabilitation, even months to years after the cataract is removed. We review the impact of the social determinants of health on each step in the visual rehabilitation pathway for children with congenital and infantile cataracts. Children from socioeconomically marginalized backgrounds are more likely to experience delays in access to care and utilization of surgical services. They are also less likely to adhere to amblyopia therapy, with corresponding decrements in visual outcomes. Additional sociocultural factors, including parental stress, self-efficacy, and health literacy, pose barriers for these children. Standardizing clinical roles, improving health communication, managing parental stress, and implementing systemic policy changes may alleviate socioeconomic disparities in outcomes for children with cataracts.

Bibliometric analysis of the most cited articles on congenital cataract from 1980 to 2022

Aim: It was aimed to present a summary of the articles published between 1980-2022 on congenital cataract, to identify the most cited articles in the field, to analyze the most active journals and the development in countries by years.Material and Method: Search was made using keywords “Congenital Cataract”, “OR: Pediatric Cataract”, “OR: Infantile Cataract”, “AND: 1980-2022 (Year Published)”, “AND: English (Language)” in Web of Science (WOS) database via Boolean operators (Access Date: 01.11.2022). Bibliometric analyzes were made using VOSviewer (ver.1.6.18), statistical analyzes were made using rstudio (ver.2022.02.1), other analyzes were made using Microsoft Excel. Results: In the bibliometric analysis, 1383 articles were included between the dates determined. Over the past few decades, the total number of publications on congenital cataracts continually increased from 2 in 1980 to 68 in 2022 November. The most productive year was 2021 (n=93), while the most cited year was 2004 (1,184 citations, 32 publications). The most studied WOS categories were ophthalmology (n=900), pediatrics (183) and genetics (167). The most widely used keywords were congenital cataract (n=235), cataract (n=124) and pediatric cataract (n=75). The most cited paper in congenital cataract was “Pax6 gene dosage effect in a family with congenital cataracts, aniridia, anophthalmia and central-nervous-system defects”, which was published in Nature Genetics in 1994 and cited 562 times (impact factor: 8.78). In ophthalmology journals, the most cited article was published in Survey of Ophthalmology (267 times, 1996) and the Molecular Vision was the most attractive journal with 104 publications. The United States of America, England and Peoples R China had the highest total link strength (TLS), 226 (10,325 citations), 134 (3,621 citations) and 73 (3,871 citations), respectively.Conclusion: These findings provide useful information on the status and trends of current clinical research on congenital cataracts. Our study can be used to identify areas of study and standard bibliographic references for better diagnosis and disease control.

Outcomes of Paediatric Cataract Surgery in Southern Jordan

Background: Congenital cataract is the leading global cause of preventable childhood blindness, and the onset of infantile and congenital cataracts is rare. Managing congenital cataracts is still challenging due to associated complications. Objective: This study aimed to assess the outcomes of congenital cataract surgery with intraocular lens implantation in southern Jordan. Methods: A retrospective case series included 20 children with congenital cataracts who underwent lensectomy, aged between 1 to 5 years, recruited using a purposive sampling technique. The mean age was 2.9 years ± 1.4. Intraocular pressure was measured preoperatively at baseline and then every three months, followed up postoperatively until one year. Schiotz tonometer is used to measure intraocular pressure. Results: The distribution of IOP and change in IOP values at baseline and post-operative follow-ups showed statistically significantly higher IOP values at three months of follow-up (P=0.03) and the last follow-up visit at 12 months (P=0.001). The results showed a statistically significant increase from baseline in the IOP of the unilateral cataract eye compared to its normal fellow eye (P=0.028). The post-operative evaluation showed that 14 patients demonstrated twenty-seven post-operative complications. Four eyes (14.2%) with posterior synechiae, 2 (7.1%) with anterior synechiae, 3 (10.7%) with decentration of IOL, 8 (28.6%) with pigment on IOL, 3 (10.7%) with transient corneal oedema and 7 (25%) developed post-operative glaucoma. Conclusion: We concluded that post-operative follow-up of one year in pediatric patients treated with congenital cataract surgery showed a significant increase in intraocular pressure.

Nationwide Incidence of Infantile Cataract Surgery and Risk of Secondary Glaucoma in a Population-based Birth Cohort

To determine the nationwide birth cohort incidence of infantile cataract (IC) surgery and the risk of secondary glaucoma in a Korean population. A population-based, retrospective cohort study. We accessed the Korean National Health Claims database to identify patients with IC who were diagnosed before 1 year of age and who underwent IC surgery among all Koreans born between 2008 and 2018 (n=9,593,003). We estimated IC surgery incidence in a birth cohort. The incidence rates of post-IC surgery glaucoma were estimated per 100 person-years, based on the Poisson distribution. The risk factors for post-IC surgery glaucoma, including ophthalmic and systemic comorbidities, were analyzed by multivariable logistic regression analysis. During the 11-year study period, 692 patients underwent IC surgery. The annual birth cohort incidence of IC surgery in the general population ranged from 5.10 to 9.29 cases per 100,000 individuals. Among patients who had been followed up for longer than 1 year (n=650), 92 (14.2%) developed glaucoma, and its incidence rate was 2.29 (95% confidence interval, 1.86-2.80) per 100 person-years. The mean time from IC surgery to glaucoma development was 4.7 ± 3.5 years. No factors were identified as being associated with post-IC surgery glaucoma risk other than primary or secondary intraocular lens implantation, which reduces the risk (all P < .05). In patients without primary intraocular lens implantation, the risk of glaucoma increased steeply during the first 2 years after IC surgery. This study identified the birth cohort incidence of IC surgery and secondary glaucoma risk in individuals of East Asian ethnicity. These estimates may help to better understand the epidemiologic features and clinical courses of patients with IC.

Morphological changes in the iridocorneal angle and their relationship with intraocular pressure after infantile cataract surgery.

To evaluate morphological changes in the iridocorneal angle after pediatric cataract surgery. Children who underwent primary infantile cataract surgery were included and 64 eyes from 41 children, including 18 with unilateral cataracts (18 eyes) and 23 with bilateral cataracts (46 eyes) were examined. All patients underwent two gonioscopic examinations to evaluate the iridocorneal angle, before the primary lens removal and before the secondary intraocular lens implantation. The anatomical changes in the iridocorneal angle and the relationship between intraocular pressure (IOP) and iridocorneal angle changes were also analyzed. The iridocorneal angle was wide in 64 eyes before and after surgery. The trabecular meshwork pigmentation, number of iris processes in every quadrant of the iridocorneal angle, and the width of the ciliary body band in the superior and inferior quadrants at the second gonioscopic examination were significantly increased compared to those at the first examination (P<0.001, P<0.05, P<0.05, and P<0.05, respectively). IOP gradually increased at 1mo after operation, and returned to the preoperative level at 3mo. However, IOP still increased significantly at 6 and 12mo. The main changes after pediatric cataract surgery include an increase in trabecular meshwork pigmentation and number of iris processes, IOP gradually increase and has positive correlation with trabecular meshwork pigmentation and anterior insertion of iris process.

Systemic and ocular associations in pediatric patients undergoing cataract surgery.

Evaluation for systemic diagnosis is an important part of pediatric cataract management. While there are reports on associated systemic and ocular associations in children with infantile cataracts, reports specifying associations in large cohorts of children undergoing cataract surgery are lacking. Retrospective chart review of consecutive patients undergoing cataract surgery at a pediatric tertiary referral center during 30-year period was performed. Associated systemic and ocular associations were recorded. The etiologies were analyzed depending on laterality, age, and gender. Seven-hundred twenty-seven patients (1135 eyes) were included for analysis: 408 (56%) with bilateral and 319 (44%) with unilateral cataract. An identifiable cause for cataract was identified in 66% (270/408) bilateral and 55% (176/319) unilateral cataract patients. Hereditary cataract accounted for 22% of bilateral cataracts. An underlying syndrome or genetic diagnosis was found in 24% bilateral (97/408, 86 genetic/syndromic, 11 metabolic) but only in 2% of unilateral cases (5/319). Cataracts were the result of treatment for cancer, or other systemic conditions requiring steroids, in 60/408 bilateral (15%) and 15/319 (5%) unilateral cataract patients. In contrast, unilateral cataracts had higher ocular associations (49%, 156/319) than bilateral cataracts (6%, 23/408) primarily ocular trauma (20%, 64/319) and persistent fetal vasculature (20%, 62/319). Clinicians should be aware of potential systemic and ocular associations among children with visually significant cataracts. Those with no family history of juvenile cataract should be evaluated for systemic associations, and referral to genetics may be warranted in select cases.

Long-term strabismus outcomes after unilateral infantile cataract surgery in the Infant Aphakia Treatment Study

To characterize long-term strabismus outcomes in children in the Infant Aphakia Treatment Study (IATS).

Long-term strabismus outcomes after unilateral infantile cataract surgery in the Infant Aphakia Treatment Study

To characterize long-term strabismus outcomes in children in the Infant Aphakia Treatment Study (IATS). This study was a secondary data analysis of long-term ocular alignment characteristics of children aged 10.5 years who had previously been enrolled in a randomized clinical trial evaluating aphakic management after unilateral cataract surgery between 1 and 6 months of age. In the IATS study, 96 of 109 children (88%) developed strabismus through age 10.5 years. Half of the 20 children who were orthophoric at distance through age 5 years maintained orthophoria at distance fixation at 10.5 years. Esotropia was the most common type of strabismus prior to age 5 years (56/109 [51%]), whereas exotropia (49/109 [45%]) was the most common type of strabismus at 10.5 years (esotropia, 21%; isolated hypertropia, 17%). Strabismus surgery had been performed on 52 children (48%), with 18 of these (35%) achieving microtropia <10Δ. Strabismus was equally prevalent in children randomized to contact lens care compared with those randomized to primary intraocular lens implantation (45/54 [83%] vs 45/55 [82%]; P = 0.8). Median visual acuity in the study eye was 0.56 logMAR (20/72) for children with orthotropia or microtropia <10Δ versus 1.30 logMAR (20/400) for strabismus ≥10Δ (P = 0.0003). Strabismus-in particular, exotropia-is common irrespective of aphakia management 10 years following infant monocular cataract surgery. The delayed emergence of exotropia with longer follow-up indicates a need for caution in managing early esotropia in these children. Children with better visual acuity at 10 years of age are more likely to have better ocular alignment.

Visual outcomes and complications in infantile cataract surgery: a real - world scenario

ObjectiveTo evaluate visual outcomes and complications of infantile cataract surgery through a 1-year follow-up period in a real world scenario.Methods and analysisProspective observational study evaluating infants with cataract undergoing surgery.ResultsWe...

Referral patterns for infantile cataracts in two regions of the United States

Delayed treatment of congenital or infantile cataracts can cause deprivation amblyopia. Prompt diagnosis and surgical intervention is critical for optimal outcomes. This study assessed referral patterns for congenital or infantile cataracts in two regions of the United States. The medical records of children 0-1 years of age with congenital or infantile cataracts at Stanford University (2008-2018) and Emory University (2010-2015) were reviewed retrospectively. A total of 111 children were included. Of these, 82 (74%) were initially evaluated by a primary care doctor, of whom 40 (49%) were referred directly to a pediatric cataract surgeon. Of 61 newborns 0-2 months of age, 9 (15%) were initially referred to an eye care provider before 6 weeks of age, but the initial evaluation by a pediatric cataract surgeon was delayed until after 6 weeks of age. Referral patterns were similar between the two institutions (P=0.06). Many children with congenital of infantile cataracts are initially referred by a primary care doctor to an eye care provider who does not perform pediatric cataract surgery. Nevertheless, the majority of newborn infants with cataracts were evaluated by a pediatric cataract surgeon before 6 weeks of age.