Management Of Cataract In Children Research Articles

Chinese expert consensus on the perioperative management of cataracts in children (2022)

Cataract is the main cause of preventable visual impairment in children. Children requires special perioperative management because of their anatomical, physiological, behavioral, and developmental characteristics. In order to strengthen the standardized perioperative management of cataracts in children, the Chinese Cataract and Refractive Surgery Society has conducted a comprehensive discussion on the timing of surgery, surgical techniques, perioperative medications, and postoperative visual rehabilitation in children. The consensus has been reached to provide clinical guidance for Chinese ophthalmologists.

Evaluation of visual outcomes after pediatric cataract surgery in a Tertiary Eye Care Hospital in Western Maharashtra

Background: A review of pediatric cataract cases operated between January 2007 and May 2008 in a Tertiary Eye Care Hospital in Western Maharashtra was done. Aim: To evaluate postoperative visual status for distance and near after pediatric cataract surgery. Settings and Design: Retrospective and prospective medical record retrieval type of cohort study. Materials and Methods: The demographic data, preoperative, intraoperative, and postoperative details were noted. The surgical procedure included cataract extraction with intraocular lens implantation with primary posterior capsulorrhexis and anterior vitrectomy in most of the cases. The visual status of eyes was evaluated before and 6 weeks after surgery. Statistical Analysis: Univariate and multivariate type of statistical analysis using SPSS software. Results: Three hundred and sixteen eyes of 250 children were included in the study. Sixty-six children had bilateral, and 184 children had unilateral cataract. Most common were congenital cataracts seen in 124 eyes (39.2%). Distant vision following surgery was more than 6/60 in 86 eyes (49.1%). Aided near vision of N12 and above was seen in 75 eyes (68%). The common causes for noncompliance with spectacles were heavyweight, repeated breakage, and peer pressure. Conclusion: Early detection and management of cataract in children is the key to good visual outcomes. Postoperative care should include a special emphasis on near vision. Improved coordination is needed between parents, school teachers, and the pediatric eye care center to improve the compliance with spectacles.

Comprehensive management of pediatric cataract in Africa

Worldwide, childhood blindness is 0.75/1000 children giving an estimated number of 1.4 million suffering from blindness worldwide. Of the blind children worldwide, congenital cataract is the major cause in African countries. The management of cataract in children poses a challenge to the African ophthalmologist, and the earlier in life cataract develops, the more difficult it is to manage. A description of the common causes, clinical presentation, methods of modern surgical removal, and suggested typical postoperative management of this condition is given along with common complications and challenges that may be encountered.

Prevention and Management of Cataracts in Children with Juvenile Idiopathic Arthritis–Associated Uveitis

Juvenile idiopathic arthritis (JIA)-associated uveitis can be associated with vision-compromising complications such as cataracts, glaucoma, synechiae, and band keratopathy. Of these, cataracts are one of the most common sequelae of JIA-associated uveitis and can result in significant visual disability. Risk factors for cataracts include posterior synechiae and longstanding ocular inflammation. Prevention of cataract development is crucial through appropriate control of uveitis. However, not all preventive measures are successful, and further management consisting of medical and surgical techniques is often necessary. Various factors should be taken into consideration when deciding on cataract management, including timing of surgery and placement of an intraocular lens. Continued partnership between pediatric rheumatologists and pediatric ophthalmologists can help ensure favorable visual outcomes.

Challenges in the management of paediatric cataract in a developing country.

To review the management of cataract in children in a tertiary hospital in a developing country, and to highlight the challenges therein. The hospital records of children aged 15 years or less that had cataract surgery at University of Nigeria Teaching Hospital, Enugu from 2005 to 2008 were reviewed retrospectively. Information was obtained on bio-data, pre- and post-operative visual acuity (VA), biometry, and type of surgery, use of intraocular lens (IOL) and presence of co-morbidity. SPSS was used for data entry and analysis. The hospital records of 21 children (26 eyes) were analyzed. There were 12 males (57.1%) and 9 females (42.9%). Pre-operative VA could not be assessed in 11 eyes (42.3%), 14 eyes (53.9%) had VA <3/60 and 1 eye (3.8%) had VA 6/60. Biometry was done in only 5 eyes (19.2%). All eyes had standard extracapsular cataract extraction without primary posterior capsulectomy; 12 eyes (46.2%) had posterior chamber intraocular lens (PC-IOL) implant while 13 eyes (50.0%) had no IOL. After 12 weeks of follow up, vision assessment was available in only 15 eyes. With best correction, VA of 6/18 or better was achieved in only 5 eyes (33.3%). Inadequate facilities and inadequate follow up after surgery are some of the challenges in managing paediatric cataract in the developing countries. If these challenges are not addressed, cataract will remain a major cause of childhood blindness and low vision in Africa for many years. There should be collaboration between Paediatric Ophthalmology Centres in industrialized and developing countries to enhance skill transfer. Governmental and International Non-governmental Organizations can go a long way to facilitate this exchange.

Pediatric cataract surgery with an intraocular lens implant

Intraocular lens (IOL) implantation has become the standard of care for the optical rehabilitation of children with cataract from the toddler age group and up. However, the use of IOLs in infants remains controversial. Management of congenital and childhood cataracts is more challenging than cataract management in adults. The surgical techniques for children have evolved because of collaboration between pediatric ophthalmologists and adult cataract surgeons. Although pediatric surgical technique has evolved, IOL power calculation has not kept pace. Selection of IOL power is one of the remaining challenges of management of cataract in children. We discuss the issues and possible solutions for IOL implantation in children.

Surgical management of cataracts in children with juvenile rheumatoid arthritis-associated uveitis

Purpose To evaluate outcomes of cataract surgery with posterior chamber intraocular lens (IOL) implantation with or without trabeculectomy in children with juvenile rheumatoid arthritis (JRA)-associated uveitis. Design Interventional case series. Methods Retrospective chart review of five patients aged 12 years or younger with JRA-associated uveitis who underwent cataract surgery with posterior chamber IOL with or without trabeculectomy at the Cleveland Clinic Foundation from December 1995 to October 2001. Results Four female patients and one male patient ranging from age 7 to 12 years were identified. One patient had bilateral involvement; six eyes were included in the study. Three eyes underwent cataract extraction with posterior chamber IOL, and three underwent combined cataract surgery with posterior chamber IOL and trabeculectomy. Median age at surgery was 8.5 years, with a median follow-up of 43.5 months. Four of five children (five eyes) were on systemic methotrexate immunosuppressive therapy for a median length of 1.25 years before surgery. Two of five patients (three eyes) were also on additional systemic immunosuppressive or anti-inflammatory treatments. All eyes received frequent topical corticosteroid therapy for a median of 2 weeks preoperatively and 8.5 weeks postoperatively. A final postoperative Snellen visual acuity of 20/40 or better was achieved in all children. A median final visual acuity improvement of 7 Snellen lines was observed after cataract surgery. Conclusions With adequate long-term preoperative and postoperative control of intraocular inflammation with systemic immunosuppressive therapy in addition to intensive topical corticosteroid treatment, children with JRA-associated uveitis can demonstrate favorable surgical outcomes after cataract surgery with posterior chamber IOL.

Management of pediatric cataract and lens opacities.

The diagnosis and surgical management of cataracts in children has benefitted from improvements in microsurgical techniques. Intraocular lens placement has become standard in children 2 years of age and older. Initial experience with intraocular lens implantation in infants found a high rate of surgical complications. However, refinements in surgical techniques may lesson these complications. Posterior capsule opacification is a frequent postoperative problem after pediatric cataract surgery. Posterior continuous curvilinear capsulorhexis with anterior vitrectomy is an effective means to prevent opacification of the visual axis in children.

Management of cataracts in children

All children under 19 years of age who are candidates for cataract surgery must be approved by the FDA and have the pediatric protocol approved by the Investigational Review Committee. Twenty-three children who were approved by FDA received 29 Sinskey-style posterior chamber intraocular lenses. Twenty-four were primary and five were secondary posterior chamber implants. Two minor complications could be attributed to the intraocular lens. Five other complications such as an opacifying posterior capsule and one retinal detachment could have occurred in any cataract procedure. The results of this series of lens implantations in children differ from previously reported studies. This difference may be attributed to the selection of the patients (i.e., all over the age of 20 months) and to the surgery technique.

OUTCOME OF CATARACT SURGERY IN CHILDREN

Objectives: To evaluate the management and visual outcome of cataract surgery in children.&#x0D; Study design: Descriptive.&#x0D; Material and Methods: This study included one hundred pediatric patients having cataracts over a periodof two year, from Is' January 2005 to 31 st December 2006, at the Department of Ophthalmology, SaiduTeaching Hospital, Saidu Sharif, Swat.&#x0D; Results: Age range was fourteen years and below. Sixty five (65%) patients were males and thirty five (35%) females. Sixty three (63%) patients had congenital or developmental cataracts and thirty seven (37%) had traumatic cataracts. Extracapsular cataract extraction (aspiration) was performed on 150 eyes. Postoperative visual acuity was recordable in 112 eyes. Acorrected visual acuity of 6/18 or better was obtained in50 (44.64%) eyes. Forty one (36.6%) eyes obtained visual acuity of 6/24 to 6/60, while in 21 (18.75%) eyesthe visual acuity remained below 6/60. The most common postoperative complication was development ofthick posterior capsule, which occurred in 51 (34%) eyes and vitreous loss in 10 (6.6%) eyes. Pupil blockglaucoma developed in 4 (2.66%) eyes. No case developed endophthalmitis. Posterior chamber IOL wasimplanted in 9 (6%) eyes.&#x0D; Conclusions: Management of cataracts in children is still a problem and delayed presentation leads to poorvisual outcome. The public should be educated to seek early treatment for childhood cataracts. Paramedicsand doctors should be made aware of the problem and its management. Management of unilateral cataractsis still a difficult problem. Therefore search should continue for better surgical approach and better methodsof correction of aphakia so as to achieve better visual outcome.&#x0D; Key words: Childhood Cataracts, Congenital Cataracts and Traumatic Cataracts.