Pediatric Cataract Research Articles

Postoperative guidelines following pediatric cataract and glaucoma surgeries: a survey of preferred surgeon instructions.

Background Recommendations regarding long-term postoperative activity are intended to prevent adverse events, but no common policy or best practice exists among ophthalmologists for pediatric patients. We surveyed ophthalmologists on their postoperative guidelines after the one-month postoperative period following childhood cataract and glaucoma surgeries. Methods A 28-question anonymous Qualtrics survey was distributed via listservs and social media. The survey was designed to elicit respondents' preferred long-term postoperative guidelines (after month 1) for participation in five water-based activities, nine sports, and three other "high-risk" activities, according to type of surgery: primary cataract extraction with or without intraocular lens (IOL) implantation, angle-based glaucoma surgeries, glaucoma drainage device surgeries, and glaucoma filtering surgeries. Results A total of 49 responses were collected from June to August 2023. Most respondents reported no long-term postoperative restrictions for water-based activities (72%-84%), sports (47%-84%), or high-risk activities (72%-88%). Most respondents did not change their postoperative restrictions based on nuances of surgical technique or clinical examination, such as an "iris claw" IOL (79%), prior trauma (65%), contact lens removal (83%), eye pressure (86%-87%), or bleb appearance (80%). For glaucoma surgeries, although the majority allow complete participation, ophthalmologists were more likely to recommend complete restrictions than sports participation with protective eyewear. For cataract surgery, children with aphakia were more likely to be encouraged to wear safety glasses and less likely to have complete restriction of an activity than those with an IOL. Conclusions Most ophthalmologists do not impose long-term postoperative restrictions following childhood intraocular surgeries.

Association of neighborhood Child Opportunity Index with visual outcomes in children with unilateral pediatric cataract.

To demonstrate the association between neighborhood quality, using the Child Opportunity Index (COI), and the visual outcomes in children with unilateral pediatric cataract. We retrospectively reviewed the medical records of patients ≤18 years of age who presented at Boston Children's Hospital between 2000 and 2022 with unilateral cataracts and underwent cataract extraction. The collected data included patient demographics, residential addresses, the reason for the initial presentation, the age at presentation, the morphology of the cataract, and the final visual acuity. The COI was used as a metric of neighborhood quality. We analyzed the association between the COI scores and the final visual acuity. We included a total of 80 patients in the study. The mean age at presentation was 2.59 ± 2.97 years. The most common reason for the initial presentation was a failed vision screen (27.5%), followed by an abnormal red reflex (25.0%). Posterior cataract was the most common type of cataract (66.3%). In the adjusted analysis, we found that a lower overall COI (β = -0.17; 95% CI, -0.31 to -0.02; P = 0.023) was associated with higher logMAR visual acuity (ie, worse visual acuity) at the final follow-up visit. Lower education and health and environment COI subdomains were associated with higher logMAR visual acuity at the final follow-up visit (P = 0.011 and P = 0.020, resp.). Neighborhood environment quality is a potentially important variable for predicting visual outcomes in pediatric cataracts. Lower COI scores were associated with worse visual outcomes.

Factors associated with the time of glaucoma-related adverse events onset after pediatric cataract surgery and the preferred anti-glaucomatous surgical selection

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.

Exploring the safety and feasibility of intracameral Aprokam® (cefuroxime sodium) in pediatric cataract surgery.

To describe the safety and assess the feasibility of using intracameral cefuroxime sodium (Aprokam®) during congenital cataract surgery as a preventive measure for endophthalmitis. Monocentric, prospective, observational pilot study. San Giuseppe Hospital, University of Milan, Milan, Italy. Pediatric patients with a mean age of 21.4 ± 40.52weeks with congenital cataracts. 65 eyes from 65 patients, i.e. only one eye for each patient was included in the study. At the end of the surgery, patients received the administration of intracameral Aprokam. The efficacy endpoint was assessed by excluding postoperative intra-ocular infections, while the safety endpoint was assessed by recording vital signs (body temperature, heart rate, blood pressure, respiratory rate) and local effects (corneal edema, toxic anterior segment syndrome, presence of cells or fibrin formation in anterior chamber, intraocular pressure, conjunctival hyperemia) after the administration of the substance. Aprokam intracameral administration at the end of the cataract surgery prevented the occurrence of intraocular infection in all of our patients. Among the analyzed systemic parameters, breath frequency was the only one showing a statistically significant increase after the drug delivery (∆(post-pre) 0.4 breaths/minute ± 1.74; p = 0.022). Regarding the local adverse effects, a statistically significant increase of intraocular pressure has been detected from the first week (∆7days-1day: 0.9mmHg ± 2.28, p = 0.042), and remained constantly elevated in the first month. The presence of conjunctival hyperemia noticed in the first week after surgery showed a significant decrease over time, with a statistically significant reduction after one month (8 cases vs 0, p = 0.009). Intracameral administration of Aprokam in pediatric cataract surgery appears safe and promising as a preventive measure for post-operative endophthalmitis. It may be considered suitable for an optimal post-operative management of intra-ocular post-operative infections in congenital cataract surgery.

Effectivity of Posterior Optic Capture in Preventing Visual Axis Opacification Following Pediatric Cataract Surgery: A systematic review and meta-analysis

Common complication after pediatric cataract surgery is visual axis opacification (VAO). Current surgical approach commonly used today is posterior capsulotomy with anterior vitrectomy (AV), but posterior optic capturewithout AV, has been introduced as an alternative. This study reviews posterior optic capture in preventing VAO following pediatric cataract surgery.Literature searches through various databases and comprehensive analysis results in 5 selected articles. Selected studies state that optic capture is as effective as conventional methods in preventing VAO. Optic capture is a safer alternative for IOL implantation, as it results in fewer inflammatory complications and eliminates the need for AV. Hence, optic capture reduces the additional risks associated with AV.Posterior optic capture is comparable to the standard surgical approach in preventing VAO. Furthermore, it is safer in terms of inflammatory sequelae and lens epithelial cell proliferation. Optic capture presents an alluring alternative surgical approach to overcome the need for vitrectomy.

Study and management of pediatric cataracts

Study and management of pediatric cataracts

Real-world use of integrated intraoperative OCT in pediatric cataract.

To study the utility of integrated intraoperative OCT (i2OCT) in pediatric patients with cataracts in the real world. It was a retrospective case series. We included patients aged 0-12 years with unilateral or bilateral cataracts who underwent cataract surgery or membranectomy for visual axis opacification between July 2022 and December 2023, where intraoperative OCT was used. We matched the clinical data with i2OCT images and tried to identify any useful information i2OCT provided. Intraoperative notes were reviewed to analyze any changes in the surgical plan or steps after doing i2OCT. The mean age of the children undergoing surgery was 5.9 ± 2.4 years (range: 6 months-9 years). OCT provided valuable insights into the anterior, posterior capsule, and vitreolental surface morphology. The surgical decision was modified in 10 cases after doing the intraoperative OCT (31.3%). The study adds to the database of pediatric patients imaged using i2OCT in the real world. i2OCT complements the preoperative examination and aids intraoperative decision-making in cases of white cataracts with excellent real-time delineation of the vitreolental interface in children.

Association analyses of the measurements of the photopic negative response evoked by two ISCEV protocols.

To perform association analyses between the measurements of photopic negative response (PhNR) evoked by two ISCEV protocols. A total of 172 eyes from 72 post-operative pediatric cataract patients and 24 healthy children were enrolled. The amplitude and peak time of PhNR were analyzed in three eye groups, 1. healthy controls; 2. fellow eyes of unilaterally affected patients; 3. affected eyes. PhNR responses were measured with skin-electrodes and evoked by the ISCEV standard protocols of PhNR and light-adapted 3.0, referred to as PhNR1 and PhNR2. The correlation coefficients between PhNR1 and PhNR2 measurements were calculated. The generalized estimating equation (GEE) model of PhNR1, with PhNR2 as a predictor, was evaluated after adjusting for correlation between paired eyes. Both the amplitude (P = 0.025) and the peak time (P = 0.036) of PhNR1 showed a significant difference among the three eye groups, which was not observed in PhNR2. The four correlation coefficients (Pearson, Intraclass, Lin's and Kendall's) between z-score transformed PhNR1 and PhNR2 measurements were generally moderate: 0.52, 0.52, 0.52, 0.36 for amplitude (P < 0.001), and 0.57, 0.57, 0.57, 0.36 for peak time (P < 0.001). The amplitude of PhNR1 cannot be precisely predicted by PhNR2, with a mean absolute percentage error (MAPE) of 36.7%, while the peak time of PhNR1 can be precisely predicted with a MAPE of 3.9%. PhNR1 appears to be a more sensitive measure than PhNR2 for detecting eye group differences. Further research is needed to confirm this and explore its clinical applications. PhNR1 may not be entirely replaced by PhNR2 due to moderate correlation and low prediction precision in amplitude.

Associations of light-adapted electroretinogram in paediatric amblyopia.

The aim of this study was to investigate changes in the light-adapted (LA) electroretinogram (ERG) associated with paediatric amblyopia. A total of 220 eyes from 81 postoperative paediatric cataract patients and 29 healthy children were enrolled in four groups, namely controls, unilaterally amblyopic eyes, non-amblyopic fellow eyes and bilaterally affected eyes. Differences in LA ERG variables (peak time and amplitude of a- and b-waves and photopic negative response [PhNR]) were compared across groups, as well as their associations with visual acuity and changes in axial length. The peak time of both the a-wave (p < 0.001) and b-wave (p < 0.001), as well as the amplitude of the b-wave (p < 0.001) and the PhNR (p = 0.04) differed significantly across groups. Compared to controls, affected eyes in both unilateral and bilateral groups showed significantly lower b-wave amplitude and longer a- and b-wave peak times (p < 0.008, Bonferroni-corrected). Additionally, fellow eyes in the unilateral group exhibited significantly longer b-wave peak times (p = 0.008). For all eyes, poorer visual acuity was associated with a longer peak time for both the a- (p = 0.006) and b-waves (p = 0.003), as well as lower amplitudes of the b-wave (p = 0.006) and PhNR (p = 0.02). Changes in LA ERG components suggest alteration of retinal physiology in deprivation amblyopia. Thus, the LA ERG may provide additional information to help understand the mechanisms underlying deprivation amblyopia.

Clinical outcomes of triamcinolone acetonide in pediatric cataract surgery with intraocular lens implantation: A systematic review and meta-analysis

Clinical outcomes of triamcinolone acetonide in pediatric cataract surgery with intraocular lens implantation: A systematic review and meta-analysis

Case Finding and Management of Childhood Cataracts: The Role of a Child Eye Health Programme in Kaduna State, Nigeria.

To evaluate the output of a child eye health programme in terms of identification, referral, and volume of paediatric cataract surgeries in Kaduna State, Nigeria. This was a retrospective review of the North-West Nigeria Child Eye Health Initiative programme referral registers at primary, secondary and tertiary hospitals in Kaduna State. Theatre registers of children 0-16 years who had cataract surgery at National Eye Centre Kaduna between 2016 and 2019 were also reviewed. Information on numbers of children, age, sex, laterality of cataract and programme status were summarised as frequencies, percentages and mean ± standard deviation. The initial 2 years of the programme (2018-2019) were compared with the 2 years (2016-2017) preceding them. Between January 2018 and December 2019; primary health workers screened 41,552 children and referred 2,316 (5.6%). Of those referred 1772 (76.5%) presented at one of three zonal secondary hospitals where nurses identified 492 (27.8%) with leukocoria using torchlights and referred them to the tertiary hospital. At the tertiary hospital, 364 (74.0% of 492) attended and 262 (72.0% of 364) were confirmed to have operable cataracts after dilated slit lamp examination by ophthalmologists. Between 2016 and 2017 (pre-programme years), 201 children had cataract surgery compared to 352 in 2018 and 2019 (programme years) of whom 239 (67.9% of 352) were beneficiaries of the programme. The proportion of girls who had cataract surgery declined from 39.8% to 35.0%, while mean age increased from 5.7 ± 4.2 years to 7.5 ± 4.1 over 4 years. More children with unilateral cataracts (214 [60.8%]) presented during the programme years (Fishers exact test, P = 0.004), whereas unilateral cataract (207 [60.2%]) was significantly more common in males than females (Fisher's exact P = 0.017). The programme has resulted in improved case detection of childhood leukocoria at primary eye care level. additionally, the eye health referral system in Kaduna State has been strengthened with increasing numbers of children accessing services: majority boys, older children, and unilateral cataracts.

Aanpak van congenitaal cataract: een actueel overzicht

Current management of congenital cataract: an overview Congenital cataract, a congenital clouding of the lens of the eye, annually affects 20,000 to 40,000 neonates worldwide. An important clinical sign is complete or partial leukocoria, a white pupillary reflex, detected on a screening examination of the newborn in primary care or otherwise noticed by the parents. Congenital cataracts can occur uni- or bilaterally. Unilateral cataract is mostly due to a developmental disorder of the lens. Bilateral cataract is often isolated and caused by a genetic mutation, but can also be seen in an underlying syndrome, a metabolic disorder, a chromosomal disorder or a congenital infection, requiring further investigation by the pediatrician. It is crucial to recognize the condition and to refer the patient to a specialized center for pediatric cataract as early as possible to initiate an appropriate investigation and treatment. The mainstay of the therapy is cataract surgery. Its ideal timing varies individually, but in most cases the procedure is planned very early: ideally at the age of 6 to 8 weeks. Afterwards, an intensive and long-term treatment with contact lenses, glasses and often occlusion therapy is needed to stimulate the visual development. Lifelong follow-up is indicated. This literature review provides a comprehensive overview of the epidemiology, classification, diagnosis, treatment and prognosis of congenital cataract.

Morphological Aspect and Management of Pediatric Cataract in Treacher Collins Syndrome

The morphological aspect of lens opacification in a 13-year-old patient with Treacher Collins Syndrome was discussed. The outcome of the cataract surgical treatment was presented. Initial visual acuity was 20/200 at the right eye and 20/100 at the left eye. A lamellar opacification of the lens, as bananatree- leaves-shaped cataracts, were observed in both eyes. Phacoemulsification with intraocular lens implantation was performed. Final visual acuity was 20/30 in both eyes. Cataract is a rare feature in Treacher Collins Syndrome and the lens opacity morphology detected in this patient was very unique.

Cataract Epidemiology and Prevention: Strategies for Reducing Global Burden

Cataract, characterized by the clouding of the eye's clear lens, is the leading cause of blindness worldwide. To achieve optimal image quality on the retina, the human lens and cornea must first refract light accurately. With aging, the human lens undergoes physical, biochemical, and morphological changes, leading to opacification. The primary mechanisms of cataract formation involve the modification, aggregation, and precipitation of crystalline. While most cataracts result from age-related degeneration, they can also arise secondary to trauma or as a consequence of other diseases, though cataracts are rare in children. This review article provides an in-depth examination of the anatomy and physiology of the lens, different types of cataracts—including diabetic, pediatric, and age-related cataracts—and the management of cataracts through surgical and pharmacological treatments.

Histopathologic findings of the lens capsule and persistent hyperplastic primary vitreous in Korean pediatric cataract patients

This study aimed to measure lens capsule thickness and investigate histopathologic characteristics of persistent hyperplastic primary vitreous (PHPV) in Korean pediatric cataracts. We analyzed lens capsules from 116 eyes of 83 pediatric cataract patients treated between 2011 and 2015. The mean thickness of the anterior/posterior capsule was 7.21 ± 1.74/4.39 ± 1.41 μm. PHPV was observed in 11.2% (13/116) of eyes. Histologic examination revealed that PHPV is typically characterized by retrolenticular membranes with hypercellular membrane tissue comprising vascular structures and/or mesenchymal cells, seen in 69% of cases. Only 3 patients had hyaloid arteries and endothelium-lined blood vessels in the retrolenticular membranes, whereas six eyes showed only mesenchymal cells. Lens capsule thickness did not significantly vary with age or the presence of PHPV in Korean pediatric cataracts. The primary histological characteristic of PHPV was the presence of mesenchymal cells, with or without vascular structures, supporting the role of endothelial-mesenchymal transition as a key mechanism in vascular regression.

Changes and Influencing Factors of Corneal Endothelial Cells and Central Corneal Thickness after Pediatric Cataract Surgery

Introduction: This study aimed to examine the impact of cataract surgery on the corneal endothelium and central corneal thickness (CCT) in pediatric patients, and to identify the factors associated with corneal alterations. Methods: This retrospective study included consecutive children undergoing bilateral or unilateral cataract surgery and intraocular lens implantation at the Eye Hospital of Wenzhou Medical University, with or without posterior capsulorhexis and anterior vitrectomy, and an age-matched normal control group. This study aimed to assess whether changes in corneal parameters, including CCT, corneal endothelial cell density (CD), average cell area (AVE), standard deviation of size (SD), coefficient of variation (CV), percentage of hexagonal cells (6A) before and after surgery, and endothelial cell loss (ECL) differed among the bilateral cataract, unilateral cataract, and control groups. Furthermore, the potential effects of anterior vitrectomy, axial length, preoperative anterior chamber depth, surgical duration, horizontal corneal diameter, intraoperative pupil diameter (PD), and the number of corneal sutures on corneal endothelial parameters and CCT were investigated. Results: A total of 107 eyes from 107 children were included in the study. In the bilateral cataract group, CD significantly decreased, AVE and CCT significantly increased, and ECL was significantly higher than in the control group. The unilateral cataract group also exhibited a significant increase in CCT. Additionally, the number of corneal sutures was negatively correlated with CD, and PD was negatively correlated with CV in the unilateral cataract group. Conclusion: Cataract surgery in pediatric patients results in increased CCT, reduced CD, and morphological changes in corneal cells. A greater number of corneal sutures and a smaller PD increased the risk of CD reduction and elevated CV in the unilateral cataract group, underscoring the need for ophthalmologists to minimize corneal damage in these children.

A Review of the Utility and Limitations of Artificial Intelligence in Retinal Disorders and Pediatric Ophthalmology.

Artificial intelligence (AI) is reshaping ophthalmology by enhancing diagnostic precision and treatment strategies, particularly in retinal disorders and pediatric ophthalmology. This review examines AI's efficacy in diagnosing conditions such as diabetic retinopathy (DR) and age-related macular degeneration (AMD) using imaging techniques, such as optical coherence tomography (OCT) and fundus photography. AI also shows promise in pediatric care, aiding in the screening of retinopathy of prematurity (ROP) and the management of conditions, including pediatric cataracts and strabismus. However, the integration of AI in ophthalmology presents challenges, including ethical concerns regarding algorithm biases, privacy issues, and limitations in data set quality. Addressing these challenges is crucial to ensure AI's responsible and effective deployment in clinical settings. This review synthesizes current research, underscoring AI's transformative potential in ophthalmologywhile highlighting critical considerations for its ethical use and technological advancement.

Pediatric Diabetic Cataract Variations: Intumescence and Volume Loss

Pediatric Diabetic Cataract Variations: Intumescence and Volume Loss

Large language models: a new frontier in paediatric cataract patient education

Background/aimsThis was a cross-sectional comparative study. We evaluated the ability of three large language models (LLMs) (ChatGPT-3.5, ChatGPT-4, and Google Bard) to generate novel patient education materials (PEMs) and improve...

A case series on small incision cataract surgery + PMMA IOL with primary posterior capsulorrhexis: A safe and cheaper alternative in management of pediatric cataracts

Pediatric cataracts, a significant cause of childhood blindness, present pronounced challenges in low-income countries where conventional phacoemulsification with hydrophobic foldable IOLs may be economically unfeasible. In resource-limited settings, the conventional method of employing phacoemulsification with hydrophobic foldable IOLs is often impractical. This case series explores an economically pragmatic alternative, centering on Small-incision cataract surgery (SICS) paired with rigid polymethyl methacrylate (PMMA) intraocular lenses (IOLs). This study delves into the visual outcomes of SICS with in-the-bag PMMA IOLs, Primary Posterior Capsulorrhexis (PPC), and anterior vitrectomy to mitigate Posterior Capsule Opacification (PCO) formation in the Visual Axis (VA). The evaluation, conducted at specific postoperative intervals spanning from Post-op Day 01 to the 6th month, provides a comprehensive understanding of the efficacy and safety of this approach. Findings underscore PMMA IOLs as both durable and cost-effective substitutes, with an emphasis on SICS with PPC as a reliable technique for cataract removal. This research delivers a practical solution to enhance visual outcomes, tackling the distinct challenges confronted in resource-limited settings and contributing to the broader global endeavor to alleviate preventable childhood blindness.