Posterior capsule opacification in children: comparison of posterior continuous curvilinear capsulorhexis alone and pars plana posterior capsulectomy with anterior vitrectomy.

The long-term outcomes of surgery for pediatric traumatic cataract are not well described; understanding these outcomes would inform parental expectations. To report visual acuity (VA) outcomes and cumulative incidence of ocular complications by 5 years following lensectomy for pediatric traumatic cataract. This prospective cohort study was conducted across 32 sites in the US and Canada among 75 children undergoing lensectomy from birth to less than 13 years of age for unilateral traumatic cataract. Of 75 children, 60 had primary intraocular lens (IOL) placement; 15 were left aphakic. Data were collected from August 2012 to February 2020. Data analysis was performed from October 2022 to May 2025. Lensectomy. The primary outcomes were best-corrected VA 5 years after lensectomy; period prevalence of strabismus and glaucoma (including cases diagnosed before lensectomy); surgery for visual axis opacification (VAO); and cumulative incidence of ocular complications by 5 years. Annual data collection was from medical record reviews through 5 years following lensectomy. Among 75 participants, 28 (37%) were female, and median (range) age at lensectomy was 7.4 years (0.1-13 years). Median (IQR) best-corrected VA at 5 years (available for 37 participants [49%]) was 20/63 (20/35-20/159) in pseudophakic eyes (n = 29; mean [SD] age at surgery, 7.2 [3.0] years) and 20/258 (20/56-<20/800) in aphakic eyes (n = 8; mean [SD] age at surgery, 5.5 [4.3] years). Age-normal VA was achieved by 6 pseudophakic eyes (21%; 95% CI, 10%-38%) and 1 aphakic eye (13%; 95% CI, 2%-47%). The 5-year period prevalence of glaucoma was 9% in pseudophakic eyes (95% CI, 1%-16%) and 9% in aphakic eyes (95% CI, 0%-24%). The 5-year cumulative incidence of surgery for VAO was 47% in pseudophakic eyes (95% CI, 31%-60%) and 13% in aphakic eyes (95% CI, 0%-28%). The risk was greater in eyes that did not undergo an anterior vitrectomy (84%; 95% CI, 55%-94%) vs eyes that did (15%; 95% CI, 2%-26%) (age-adjusted hazard ratio, 11.4; 95% CI, 4.6-33.1; P < .001). In this cohort study, while only half of the study participants had a 5-year follow-up visit, achieving age-normal VA was uncommon among the cohort in whom a best-corrected VA was determined. The prevalence of glaucoma at 5 years was low among those with 5-year follow-up, while nearly half of the pseudophakic eyes needed surgery for VAO supporting the need to monitor these children.

PurposeSocial networking sites are an increasingly popular source of health information and a natural place for connection and support among patients and their loved ones. This study analyzes the content of a Facebook support group for congenital cataracts to understand the concerns, informational needs, and support-seeking behaviors in this community.MethodsA qualitative evaluation was conducted on the Facebook group Children with Congenital Cataracts, the largest group for congenital cataracts on the platform. The most recent 150 discussion posts were selected for review. Posts were categorized into one of 5 themes: surgery, contact lens, disease related, tips/advice, and miscellaneous. Additional information recorded included the identity of the post’s author (caregiver/patient) and level of engagement. Two investigators reviewed the posts.ResultsThe majority of posters were mothers of children with congenital cataracts (142/150 or 94.67%), with two posts from adults with the condition. The average number of replies per post was 9 (range: 0–63). Posts with image attachments had more engagement in terms of reactions obtained compared to posts without images (p = <0.001). The majority of posts were questions, followed by news sharing. Discussion post topics fell under the following categories: tips/advice, surgery related, contact lens related, miscellaneous, and disease related. The most common topics within each category were questions regarding surgical complications (n=12, 8%), inserting and removing (usage of) contact lens (n=12, 8%), etiology of disease (n=3, 2%), and advice on patching (n=13, 8.67%) and glasses (n=13, 8.67%).ConclusionAwareness of the community and knowledge sharing in the online social space is important for pediatric cataract surgeons. Understanding parental knowledge gaps can help healthcare providers address concerns and improve patient education strategies. Community-driven resources, such as unused contact lens resale, highlight impressive grassroots efforts to assist in care.

Visual Axis Opacification after Pediatric Cataract Surgery in the IRIS® Registry (Intelligent Research in Sight).

Background: Pediatric cataract remains a major cause of childhood blindness worldwide, with visual axis opacification (VAO) representing a frequent and challenging postoperative complication. Objective: To evaluate the incidence and factors associated with VAO following pediatric cataract surgery at Kilimanjaro Christian Medical Centre from January 2013 to January 2023. Methods: We conducted a retrospective cohort study including 345 children (612 eyes) who underwent cataract surgery. Demographic and clinical data were extracted from medical records. Data analysis was performed using STATA version 17. Kaplan-Meier survival curves were used to estimate the probability of VAO over time. Poisson regression models identified factors associated with VAO, with statistical significance set at P&lt; 0.05. Results: Among 345 children, 189 (54.8%) were male, and 267 (77.4%) had bilateral cataracts. The median age at surgery was 28.5 months (range 9-72). The overall incidence of VAO was 19.9% (122/612), corresponding to an incidence rate of 0.251 events per eye-year, with a median follow-up duration of 1 year. Secondary surgeries were performed in 20.3% (124/612) of eyes. Postoperatively, 69.4% of eyes achieved no visual impairment, highlighting the overall success of surgical intervention when VAO is prevented. Significant factors associated with VAO included age at surgery &lt;60 months (AHR = 4.90; 95% CI: 2.77-8.70); P-value&lt;0.001), surgical technique involving lens washout without posterior capsulotomy or anterior vitrectomy (LWO+IOL) (AHR = 7.58; 95% CI: 3.85-14.91); P-value&lt;0.001), and postoperative acute fibrinous reaction (AHR = 5.91; 95% CI: 4.01-8.71); P-value&lt;0.001). Conclusion: The incidence of VAO at KCMC is consistent with global data. Early age at surgery, surgical technique without PPC and AV, and postoperative inflammation were significantly associated with VAO. Adoption of preventive strategies and enhanced postoperative care are critical for improving visual outcomes.

HighlightsWhat are the main findings?A proof-of-concept neural network model was developed to predict visual outcomes after secondary intraocular lens (IOL) implantation in children with congenital cataracts.The model demonstrated encouraging predictive performance across training, validation, and test sets, suggesting feasibility despite the limited dataset.What is the implication of the main finding?This work underscores the potential of machine learning to support clinical decision-making for secondary IOL implantation, an area currently lacking predictive tools.Broader, multi-center datasets and models restricted to preoperative variables will be essential to validate and translate this approach into clinical practice.Objectives: To develop a proof-of-concept machine learning (ML) neural network model to predict post-operative visual outcomes in children with congenital cataracts undergoing intraocular lens (IOL) implantation, thereby guiding the optimal timing for IOL insertion. Determining the ideal timing and predicting outcomes for IOL implantation in children remains clinically complex due to variability in eye development and measurement accuracy. Methods: Retrospective analysis using a publicly available dataset from 110 children diagnosed with congenital cataracts, who underwent IOL implantation at the Eye and ENT Hospital of Fudan University. A neural network model with a hidden layer of 10 nodes was developed in MATLAB 2024a using the scaled conjugate gradient algorithm. Input variables included demographic and clinical features; the target was achieving visual acuity greater than 20/40. Performance metrics were evaluated using cross-entropy loss, sensitivity, specificity, and accuracy. Results: Training completed after 14 epochs with the test set reaching the highest performance metrics: 88.2% accuracy, 88.9% sensitivity, and 87.5% specificity. ROC curve analysis showed AUC values of 0.942 (training), 0.920 (validation), 0.885 (test), and 0.917 (overall). Conclusions: The neural network effectively predicted post-operative visual outcomes, offering potential clinical utility in guiding IOL implantation decisions. Despite limitations in dataset diversity, this study lays the foundation for future development of personalized strategies in pediatric cataract care.

Background/AimsPediatric cataracts are considered a leading cause of visual impairment. While intraocular lens (IOL) implantation is mostly performed for children >2 years, its use in younger children remains contentious. This study assessed primary IOL in a unique pediatric population characterized by limited adherence to postoperative care, where primary IOL implantation was favored to minimize the risk of prolonged uncorrected aphakia.MethodsThis retrospective study examined primary IOL implantation outcomes in children across three age brackets: below 6 months, 6–12 months, and 1–18 years, focusing on best-corrected visual acuity (BCVA) and complications including glaucoma, toxic anterior segment syndrome (TASS), retinal detachment (RD), and yttrium-aluminum-garnet (YAG)/membranectomy.Results169 eyes from 119 patients were evaluated over a median follow-up period of 6.4 years. No significant differences were observed between age groups in terms of LogMAR visual acuity (p = 0.344) or the incidence of postoperative complications such as glaucoma (p = 0.244), retinal detachment (p = 0.244), or TASS (p = 0.960). The incidence of YAG capsulotomy/membranectomy was highest in the <6 months group (36%), compared to 22% in the 6–12 months group and 13% in the >1 year group (p = 0.020). Among unilateral cases, all 3 patients diagnosed before 6 months required YAG/membranectomy.ConclusionPrimary IOL implantation for pediatric cataracts resulted in comparable visual acuity and overall complication rates across all age groups. Although a higher incidence of YAG/membranectomy was observed in children under 6 months, particularly among unilateral cases, most patients still avoided the need for additional surgical intervention. These findings support primary IOL implantation as a valid option for selected patients.

Juvenile cataracts, though less common than congenital types, can cause irreversible visual impairment if diagnosis and treatment are delayed. We report a 10-year-old boy with progressive bilateral visual loss, photophobia, and leukocoria over three years, with a positive paternal history suggesting hereditary etiology. Examination revealed dense bilateral lens opacities and markedly reduced visual acuity. The patient underwent sequential aspiration–irrigation with posterior chamber intraocular lens implantation in both eyes. Surgeries were uneventful; however, postoperative vision in the right eye remained limited due to deprivation amblyopia, while the left eye achieved a better functional outcome. Final refraction showed mild residual error, and the patient was continued on visual rehabilitation and amblyopia therapy. This case highlights the importance of early detection and timely surgery in pediatric cataract to prevent permanent visual deficits and optimize outcomes. This report aims to illustrate the impact of delayed intervention on functional vision, daily activities, and educational performance in school-aged children within resource-limited settings.

Intraocular lens tilt and decentration and optical quality after primary intraocular lens implantation in pediatric cataract patients

&lt;p&gt;Cataracts are a prevalent eye disease in children, particularly in the congenital form. Its occurrence is the primary cause of avoidable blindness and visual impairment. Our study aimed to assess the epidemiological characteristics and spatiotemporal distribution of infantile cataracts in children from the Marrakech-Safi region. A retrospective study was carried out in the Mohammed VI University Hospital. Data collection, carried out between March 25, 2024, and April 26, 2024, was based on a review of the medical records of sick children aged between 0 and 15 years and having undergone surgery between 2019 and 2023. The findings revealed a high rate of cataract in boys (64.7%), with congenital cataract predominating (57.6%), followed by traumatic cataract (41.1%). In 2021, 81 cases of cataracts were reported, with 51.5% of cases being bilateral. Cataract development (42.4%) was attributed to postnatal and infantile factors, with the remaining 42.7% having an unknown etiological. The study revealed a significant association between cataract type and factors such as gender, age, residence area, age at onset of cataract, consanguinity, and family history. Efficient, high-quality care can prevent cataract complications. This can be achieved by implementing health strategies targeting all levels of prevention.&lt;/p&gt;

Long-Term Refractive Changes After Pediatric Cataract Surgery: An Average Follow-up of 15 Years.

Pediatric cataracts are a significant cause of childhood blindness, requiring long-term management. This study evaluated the economic burden of pediatric cataract surgery in South Korea and identified factors influencing the medical costs, particularly in patients with complications after cataract surgery. We used National Health Insurance Service claims data, covering the Korean population, including pediatric patients (aged ≤5 years) who underwent cataract surgery between 2004 and 2011. We measured healthcare resource utilization (outpatient, inpatient, and emergency department visits) and cataract-related medical costs over an 8-year follow-up after cataract surgery. We further explored factors influencing medical costs using a generalized linear model. A total of 1297 pediatric patients (mean age: 2.2 years, 56.8% male) were included. Over 8 years, patients had an average of 30 outpatient visits, 2.7 inpatient visits, and 3 emergency department visits. The total average medical cost over 8 years was $2,391 per patient, with significantly higher costs in those developed retinal detachment ($7729) or glaucoma ($8,821) developed after the surgery. Additionally, higher costs were associated with older age at surgery, higher income, the presence of postoperative complications, and multiple surgeries. Pediatric cataract surgery resulted in a considerable long-term economic burden, particularly when accompanied by postoperative complications. This study provides real-world evidence underscoring the need for improvement in pediatric cataract management to ensure optimal care for young patients at risk of vision impairment.

The purpose of this study was to assess large language models (LLMs) for enhancing the readability of online patient education materials (PEMs) on pediatric cataracts through multilingual adaptation, content retrieval, and prompt engineering. This study included 103 PEMs presented in different languages and retrieved from diverse resources. Three LLMs (ChatGPT-4o, Gemini 2.0, and DeepSeek-R1) were used for content improvement. Readability was assessed for both the original and converted PEMs with multiple formulas. Different prompt engineering strategies for LLMs were also tested in this study. The PEMs directly generated by LLMs exceeded a 10th grade reading level. Compared to a traditional Google search, LLMs' web browsing feature provided online PEMs with better characteristics and a higher reading level. Original PEMs from Google showed significantly improved readability after LLM conversion, with DeepSeek-R1 achieving the greatest reduction in reading level from 10.59 ± 2.20 to 7.01 ± 0.91 (P < 0.001). Prompt engineering also showed statistically significant results in their effects on LLM conversion, and Zero-shot-Cot (APE) successfully achieving target readability below the sixth grade reading level. Besides, the LLMs' simplified Chinese conversion, as well as the LLMs conversion of other original Chinese PEMs, both showed that they meet the recommended standards for reading levels in multiple dimensions. LLMs can significantly enhance the readability of multilingual online PEMs on pediatric cataract. Combining it with web browsing and prompt engineering can further optimize outcomes and advance patient education. This study links LLMs with patient education and demonstrates their potential to significantly improve the readability of online PEMs.

To investigate whether using an enhanced monofocal intraocular lens (IOL) in the pediatric age group can improve the visual performance at varying distances in comparison to standard monofocal lenses. Forty-five eyes of children aged 6 to 13 years with unilateral or bilateral cataract were prospectively randomized into two groups: the monofocal group (23 eyes) who had a standard monofocal aspheric lens (Tecnis Model ZCB00) implanted and the enhanced mono-focal group (22 eyes) who had an enhanced monofocal lens (Tecnis Eyhance ICB00) implanted (both Johnson & Johnson Vision). Target refraction was emmetropia. Visual acuity was measured at distance, intermediate, and near distance 3 months postoperatively. Defocus curves wearing distance correction were plotted. Unilateral cataract surgery with Eyhance and Tecnis monofocal implantation was performed in 10 and 9 patients, respectively. Thirteen children underwent bilateral surgery, 4 had an Eyhance IOL implanted in one eye and a Tecnis monofocal IOL in the other eye, 4 had bilateral Eyhance IOL implantation, and 5 had bilateral Tecnis mono-focal IOL implantation. Uncorrected and corrected distance, intermediate, and near visual acuity, and the power of near add were comparable between both groups (P > .05). Mean visual acuity through the defocus range was significantly better (P < .01) in the Eyhance group (0.30 vs 0.41). Use of an enhanced monofocal IOL improved visual performance at intermediate distances of greater than 1 meter but did not reduce the power of spectacles needed for distances of less than 1 meter.

Supplementary intraocular lenses (IOLs) are used to correct spherical and astigmatic refractive errors after cataract surgery. They provide patients with improved uncorrected visual acuity, resulting in ahigher degree of spectacle independence. For the implantation of supplementary IOLs two approaches are distinguished: the primary and secondary Duet procedures. Indications include extreme refractive errors, desire for reversible multifocality, residual refractive errors and pediatric cataract surgery. Monofocal, extended depth of focus (EDOF) and multifocal implants are available, some also as toric variants. Thanks to specialized IOL designs, supplementary IOLs have been optimized for implantation in the ciliary sulcus, making the procedure safe, effective and associated with minimal complications. Several studies have demonstrated the favorable safety profile, predictable refractive outcomes and improvement in uncorrected visual acuity. Continuous advancements in IOL design, including the availability of EDOF and multifocal implants, have further enhanced the benefits of supplementary IOLs. Through arelatively small, low-risk and quick procedure, individualized solutions can be provided for many patients, improving vision and reducing spectacle dependence.

Purpose: Pediatric cataract surgery requires mydriasis, typically achieved with eye drops. An intracameral mydriatic combining tropicamide 0.02%, phenylephrine 0.31%, and lidocaine 1% is established in adults, but not in children. We aimed to evaluate the safety profile of this intracameral mydriatic in children. Methods: We conducted a prospective observational cohort study on 40 patients, aged 8 weeks to 17 years, undergoing cataract surgery under general anesthesia (GA) and receiving 1 intracameral injection (0.1 mL) of the mydriatic. Thirteen patients underwent immediate sequential bilateral cataract surgery with a second injection to the second eye. We evaluated the incidence of hemodynamic adverse effects and assessed systemic exposure by quantification of plasma concentrations of phenylephrine and tropicamide at 4 fixed time points during the procedure. Results: The highest plasma concentrations of phenylephrine and tropicamide were detected in the youngest patients (age 8 weeks-1 year), with a significant increase from baseline (P = 0.008 and P = 0.023, respectively). In patients aged 1-6 years, significant changes were observed only in the plasma concentration of phenylephrine (P < 0.001). For patients aged 6-17 years, there was no significant rise in phenylephrine nor in tropicamide plasma concentration (P = 0.194 and P = 1.000). No clinically important changes in hemodynamic parameters occurred in any age group. Sequential bilateral administration did not result in an increase in plasma concentrations, nor in an increase of hemodynamic adverse effects. Conclusions: Intracameral mydriatic injection did not induce cardiovascular adverse events, and systemic exposure was minimal in this pediatric population undergoing cataract surgery under GA.

To identify primary suspect drugs potentially associated with pediatric cataracts by analyzing reports from the Food and Drug Administration Adverse Event Reporting System (FAERS). Database study. Retrospective observational pharmacovigilance study. FAERS reports submitted between 2004 and 2024 involving patients aged 18 years or younger with adverse events listed as cataract and its subtypes. Descriptive statistics summarized patient demographics and drug reporting frequencies. A signal detection analysis was conducted using 5 established data mining algorithms: proportional reporting ratio (PRR), chi-squared with Yates' correction (χ 2 ), reporting odds ratio (ROR), empirical Bayes geometric mean (EBGM), and information component (IC). Positive signals were defined using threshold criteria established in pharmacovigilance literature. The mean patient age was 9.39 ± 4.59 years. 91 drugs were listed as primary suspect drugs. The most frequently reported drugs were ivacaftor and prednisolone (n = 29, 7%), followed by methotrexate and adalimumab (n = 26, 6%). Topotecan demonstrated the strongest positive signal (n = 12, PRR = 47.34, χ 2 = 477.86, ROR 95% CI: 48.84 [27.15-87.86], EBGM [EBGM05]: 18.13 [9.8], IC [IC05]: 4.03 [3.11]), followed by ivacaftor (n = 29, PRR = 12.04, χ 2 = 281.28, ROR 95% CI: 12.95 [8.85-18.94], EBGM [EBGM05]: 5.46 [3.78], IC [IC05]: 3.33 [2.77]), and prednisolone (n = 29, PRR = 9.22, χ 2 = 204.17, ROR 95% CI: 9.89 [6.76-14.46], EBGM [EBGM05]: 3.39 [2.36], IC [IC05]: 3.01 [2.45]). 3 potential drug-adverse event pairs were identified for pediatric cataracts, including a previously infrequently described association with ivacaftor and topotecan. Prednisolone, consistent with known corticosteroid-induced cataractogenesis, also demonstrated a positive signal. These findings raise drug safety concerns and warrant further investigation.

Purpose: To assess the quality of life in pediatric patients who have undergone cataract surgery and identify clinical and demographic variables that influence visual recovery and QoL outcomes. Study Design: Descriptive observational. Place and Duration of Study: Jinnah Postgraduate Medical Center, Karachi. From March 2021 to March 2023 Methods: A total of 230 pediatric patients who had undergone cataract surgery between the ages of 6 months and 12 years were enrolled from a tertiary eye care center. To evaluate the impact of surgery on children’s quality of life, two validated instruments were used. The Pediatric Quality of Life Inventory (PedsQL) was employed to assess general health-related quality of life across physical, emotional, social, and school-related domains. Results: The mean post-operative best-corrected visual acuity (BCVA) improved from 1.20 ± 0.34 to 0.48 ± 0.29 logMAR (p &lt; 0.001). Over 68% of children achieved a BCVA of 0.5 logMAR or better. The mean total PedsQL score was 74.6 ± 12.5, with highest scores in physical functioning (81.2 ± 10.3). Children who underwent bilateral surgery, intraocular lens (IOL) implantation, and good compliance to amblyopia therapy reported higher QoL scores. Significant correlations were found between better visual outcomes and improved QoL (r = -0.61, p &lt; 0.001). Conclusion: Cataract surgery significantly improves both visual function and quality of life in children, especially when performed early and supported by proper rehabilitation. Clinical success should be evaluated not only by visual acuity but also through QoL outcomes. Keywords: Pediatric cataract, Visual acuity,Quality of Life, Amblyopia

BACKGROUND Pediatric cataract is a public health concern, and it causes long-term functional impairment and impacts the quality of life of the child with cataract. Visual impairment in children due to cataract has devastating consequences on their health, social life, and academic performance and places a socio-economic burden on the child’s family and society as a whole. Globally, pediatric cataract is a significant contributor to ocular morbidity and blindness. Findings from this study will help quantify the visual benefits of pediatric cataract surgical interventions and identify opportunities for improving pediatric cataract services. AIM To evaluate the visual acuity outcomes of children after cataract surgery. METHODS The study employed a retrospective electronic review of pediatric cataract surgeries from January 2019 to July 2021 at the pediatric unit of the eye department at Komfo Anokye Teaching Hospital (KATH), Ghana. Patient clinical data including demographics, cataract presentation, pre-operative and post-operative visual acuity, surgical procedure, postoperative complications, interventions and refraction were collected and analyzed using the Statistical Package and Service Solution. Pearson's χ 2 test and regression statistics were used to summarize data at a significance of P &lt; 0.05. RESULTS 163 children (257 eyes) underwent cataract surgery at KATH. The overall mean age was 3.81 ± 3.56 years. Congenital cataract was commonly observed (56.4%). All children underwent keratometry and phacoemulsification procedures. A few children (9.8%) experienced postoperative complications while 90.8% did not require further intervention after the surgery. After the surgery 27.0% of the children had refraction and the majority were corrected for myopia and near addition (12.9%). An analysis of the association of postoperative visual acuity and the type of cataract was statistically significant (P value &lt; 0.05). There was a significant improvement in the visual outcomes following cataract surgery. CONCLUSION Timely pediatric cataract surgery improves postoperative visual outcomes. Creating awareness and implementing screening programs is important to ensure that the prevalence of childhood blindness is reduced to the barest minimum.

Pediatric cataract surgery is very different from adult cataract surgery. Aprofound understanding of surgical technique, age at time of surgery, combined ocular and systemic diseases to be associated with long-term functional or morphological outcomes is important for planning and performing treatment of cataracts in children. Increased intra- and postoperative risk and individual amblyogenic risk mainly affect surgical versus nonsurgical treatment decisions. The most common long-term complication in children following congenital cataract surgery is aphakic glaucoma. It is well established that the single greatest risk factor for aphakic glaucoma is surgery during early infancy. Other risk factors include microphthalmos, fetal nuclear cataract, and persistent fetal vasculature. The following article provides an overview on important aspects of pediatric cataract treatment.