Treatment Of Congenital Cataract Research Articles

Age as an important factor in the diagnosis and treatment of congenital cataract in children

The onset of congenital cataract is in the sensitive period of eyeball and visual development, and the pathogenic factors and clinical manifestations are diverse. The age of patients seeking medical treatment can range from the neonatal period to adolescence or even adulthood. However, minors are in continuous growth and development with various characteristics at different periods, which makes the diagnosis and treatment of congenital cataract complicated. In this article, the diagnosis and treatment strategies of congenital cataract are expounded according to the characteristics of the disease in infancy, early childhood, pre-school age and school age. It is pointed out that age is an important factor in the diagnosis and treatment of congenital cataract, which should be considered in related clinical work and scientific research.

Developing effective intervention strategies for congenital cataract to facilitate visual rehabilitation

Congenital cataract is a blinding condition that presents at birth. Form-deprivation amblyopia can be developed and has become the leading cause of childhood blindness in China. For the problems and challenges in the treatment of congenital cataract, this article discusses the surgical treatment and postoperative rehabilitation strategies and emphasizes the importance of developing effective intervention strategies to improve the visual outcomes in children with congenital cataract, providing valuable guidance for clinical treatment.

Atypical presentation and treatment of congenital cataract and temporal iridolenticular coloboma in a 43-year-old male

Ocular coloboma occurs due to incomplete closure of the embryonic fissure in the 5th or 6th week of intrauterine life. Iris coloboma is characterised by a keyhole-shaped defect in the iris, typically located in the inferonasal quadrant. Temporal iris coloboma is a rare occurrence. Temporal iridolenticular coloboma is an uncommon structural anomaly within the iris that is sometimes linked to other ocular disorders, such as congenital cataracts. We describe a case study of a 43-year-old male patient who had a congenital cataract with temporal iridolenticular coloboma, which is not a common presentation. The aim is to report favourable outcomes of cataract surgery in patients with congenital cataracts associated with temporal iris coloboma with temporal lens coloboma. Phacoemulsification with intraocular lens implantation was done without any complications. Significant improvements in subjective visual function and visual acuity were seen in the post-operative follow-up.

Rare micropupil secondary to congenital cataract surgery favoring the development of the affected eye: a case report

BackgroundCongenital microcoria has been extensively reported and usually leads to visual dysfunction or blindness. However, micropupil development secondary to cataract surgery has never been reported. Here, we describe a rare case of micropupil development in infancy that occurred secondary to combined cataract extraction and intraocular lens implantation for treatment of congenital cataract. When the patient reached adulthood, the affected eye not only gained good vision but also showed better ocular development and refractive status than the fellow eye.Case presentationA 17-year-old boy presented to our outpatient clinic with decreased vision in his left eye related to congenital cataract surgery at 6 months of age. The affected eye had exhibited a pinhole pupil since the third month postoperatively. The condition had been managed with observation and regular monocular occlusion treatment. Upon presentation to our clinic, the best-corrected visual acuity (BCVA) in his fellow eye was 0.0 logMAR(20/20) with a refraction of − 5.75 diopters cylinder/−2.25 diopters sphere, and the BCVA in his affected eye was 0.5 logMAR(20/40) with a refraction of 0.00 diopters. Ophthalmic examination of the affected eye revealed a pinhole pupil (approximately 0.5 mm) with high light reflex sensitivity but no response to pupil-dilating drugs. The patient underwent pupilloplasty of the affected eye under corneal surface anesthesia. Postoperative examination revealed better ocular development in the affected eye than in the fellow eye (axial length: 24.21 vs. 27.02 mm, respectively) as well as better refractive status in the affected eye (BCVA of 0.0 logMAR(20/20) with a refraction of − 2.23 diopters cylinder/−3.00 diopters sphere vs. 0logMAR(20/20) with a refraction of -5.75 diopters cylinder/-2.25 diopters sphere).ConclusionsWe have reported a rare case of micropupil development secondary to congenital cataract surgery, which is an uncommon complication, especially in children. However, unlike congenital microcoria, the secondary pinhole pupil may have reduced imaging haze and halos, possibly favoring the development of the affected eye. This case provides further insight into the treatment of congenital cataract.

Odległe wyniki leczenia dzieci chorych na zaćmę wrodzoną jednostronną i ze stożkiem tylnym soczewki

The studies conducted were aimed at showing the importance of early diagnosis and appropriate treatment of congenital cataracts in children. We can see that the treatment is multi-stage and often difficult not only for the performed surgical procedures but also for the further rehabilitation of eyesight. At the same time, we show how many benefits can be obtained by properly treated children. The study group consisted of patients treated at the Department of Pediatric Ophthalmology in Katowice in 2007–2014 with unilateral congenital cataract with posterior cone or unilateral congenital cataract and with simultaneous or secondary implantation of an artificial intraocular lens. 104 eyes were examined in 52 children at the age of 52 from 1 to 17 years of age.

Outcomes of surgical treatment of congenital cataract with microphthalmia in infancy

Objective: To examine the outcomes of surgical treatment for infants with congenital cataract and microphthalmia (CATM). Methods: It was a retrospective case series study. Data of 28 (55 eyes) CATM children who underwent cataract surgery at the Qingdao Eye Hospital of Shandong First Medical University and were followed up for more than 5 years between January 2010 and December 2014 under the age of 6 months. There were 15 male and 13 female children. The age at the time of surgery was (3.2±1.3) months, and the follow-up time was (8.2±1.7) years. The data included the basic information of the children, the ocular biological parameters before and after surgery and intraocular lens (IOL) implantation, and the occurrence of complications. Paired t-tests or Wilcoxon signed rank tests were used to compare groups, and logistic regression analysis was used to identify factors related to IOL implantation, secondary glaucoma, and visual axis opacification (VAO). Results: The mean preoperative axial length was (16.6±1.0) mm, and the mean horizontal corneal diameter was (9.5±0.9) mm. The axial growth rate within 2 years after the first stage of surgery was (1.4±0.8) mm/year. None of the children had an IOL implanted before the age of 2. Sixty percent of the eyes (33/55) received IOL implantation within 2 to 4 years after the first stage of surgery, while the remaining 40% (22/55) did not receive IOL implantation at the last follow-up. The axial growth rate was (0.9±0.7) mm/year within two years after the second stage of surgery. Postoperative secondary glaucoma occurred in 7 eyes (12.7%), and VAO occurred in 15 eyes (27.3%). IOL implantation was associated with preoperative axial length (OR=0.072, P<0.001) and age at the first stage of surgery (OR=7.270, P<0.001), but not with preoperative corneal diameter (P=0.735). The incidence of VAO was associated with preoperative corneal diameter (OR=4.124, P=0.011), but not with age at the first stage of surgery (P=0.489) or preoperative axial length (P=0.489). No factors related to the occurrence of secondary glaucoma were found. The best corrected visual acuity at the last follow-up after IOL implantation was (0.37±0.28) logMAR, which was better than that of children without IOL implantation (0.67±0.19) logMAR (U=49.50, P=0.003). Conclusions: Children with CATM can obtain the opportunity for IOL implantation through early surgery and ultimately achieve good visual outcomes. Properly selecting the timing for implanting IOL can keep the incidence of secondary glaucoma at an acceptable level.

Disruption of PIKFYVE causes congenital cataract in human and zebrafish.

Congenital cataract, an ocular disease predominantly occurring within the first decade of life, is one of the leading causes of blindness in children. However, the molecular mechanisms underlying the pathogenesis of congenital cataract remain incompletely defined. Through whole-exome sequencing of a Chinese family with congenital cataract, we identified a potential pathological variant (p.G1943E) in PIKFYVE, which is located in the PIP kinase domain of the PIKFYVE protein. We demonstrated that heterozygous/homozygous disruption of PIKFYVE kinase domain, instead of overexpression of PIKFYVEG1943E in zebrafish mimicked the cataract defect in human patients, suggesting that haploinsufficiency, rather than dominant-negative inhibition of PIKFYVE activity caused the disease. Phenotypical analysis of pikfyve zebrafish mutants revealed that loss of Pikfyve caused aberrant vacuolation (accumulation of Rab7+Lc3+ amphisomes) in lens cells, which was significantly alleviated by treatment with the V-ATPase inhibitor bafilomycin A1 (Baf-A1). Collectively, we identified PIKFYVE as a novel causative gene for congenital cataract and pinpointed the potential application of Baf-A1 for the treatment of congenital cataract caused by PIKFYVE deficiency.

25G lens resection combined with anterior vitrectomy in the treatment of congenital cataract

25G lens resection combined with anterior vitrectomy in the treatment of congenital cataract

The efficiency of congenital cataract management in children

Aim: This study aimed to analyze the results of congenital cataract treatment in children who underwent surgery in VP Vyhodcev Eye Hospital from 2015 to 2019 and to compare these data with global results.&#x0D; Material and methods: A retrospective analysis of electronic outpatient medical records of children who underwent surgery for congenital cataract during the period from 2015 to 2019 included the following parameters: age at the first admission to the Eye Hospital, delay between the first admission and cataract surgery, age at surgery, best corrected visual acuity at the end of follow-up, and presence of any eye comorbidities. To compare the obtained data with the results of similar studies worldwide, articles on this topic published during the past 5 years were searched.&#x0D; Results: This retrospective study analyzed 71 electronic outpatient medical records of children with congenital cataract (96 eyes). The age at the first admission was 33.5 [60.081.5] months. The best corrected visual acuity before surgery was 0.2 [0.10.4]. The delay between the first admission and cataract surgery was 5.0 [2.512.0] months; thus, children underwent surgery for congenital cataract at age 51 [14.594.5] months. In all patients, lens aspiration with intraocular lens implantation resulted in significant improvement of visual acuity to 0.4 [0.10.9]. The comparative analysis revealed a trend for earlier recognition and surgical treatment of congenital cataract in European countries, while a significant delay before surgery and worse visual outcomes are common in developing countries.&#x0D; Conclusion: The current state of ophthalmological care for children with congenital cataract in Russia allows achieving good visual outcomes comparable with published results in Europe. Nonetheless, further studies are required to determine reasons for later recognition and surgery of congenital cataract in children

Reflections on surgical treatment of congenital cataract

Congenital cataract is the first main cause of avoidable blindness in children. The manifestations of congenital cataract are diverse and complex, often associated with other ocular structural abnormalities. The infantile eyeballs are in the growth and development stage, the structure of eyeball wall is fragile, and the blood-ocular barrier is immature. Therefore, congenital cataract surgery features relatively higher surgical technical requirements with higher postoperative complications occurrence. Congenital cataract is not a miniature version of age-related cataract, which has its own unique surgical principles. In this article, issues including the preoperative characteristics of congenital cataract, surgical timing and techniques, and follow-up treatment, were discussed based on expert clinical experiences of Zhongshan Ophthalmic Center and relevant literatures. (Chin J Ophthalmol, 2021, 57: 11-16).

Наш опыт хирургического лечения врожденной катаракты

Aim. To present our experience and evaluate the results of surgical treatment of congenital cataracts. Methods. A clinical analysis of the results of congenital cataract aspiration in 16 children (22 eyes) aged 2 months to 5 years is performed. Bilateral cataract was determined in 6 children, unilateral – in 10. Preoperative examination of children aged 3–5 years was carried out in a standard way. Children younger than 3 years of age at the initial appointment underwent non-contact examination methods, the remaining studies were performed under general anesthesia in the operating room immediately before surgery. Congenital cataract phacoaspiration was performed under general anesthesia using the Stellaris microsurgical system (Bausch and Lomb, USA) through a 1.2-mm paracentesis in the lens irrigation-aspiration regime. Hydrophobic IOL models were implanted. The posterior lens capsule was preserved in all cases. Mandatory was the appointment of cycloplegics in drops in the early postoperative period. Results. An increase in visual acuity (from 0.03 to 0.7) occurred in all cases. However, presence of obscuration amblyopia of varying degrees required regular courses of pleoptic treatment. Conclusions. The effectiveness of congenital cataracts phacoaspiration is ensured by the fulfillment of federal clinical recommendations, however, sutureless surgery allows achieving high functional results in the treatment of this pathology. Key words: congenital cataract; phacoaspiration; intraocular lens.

Complications of various methods for implanting intraocular lenses in the surgical treatment of congenital cataract

Objective: Comparison of complications development rate in various methods for implanting intraocular lenses (IOLs) in the surgical treatment of congenital cataract.Methods: The results of surgical treatment of 16 children under 5 years old with bilat‑ eral congenital cataract were assessed. In each case, IOL was implanted according to the technique “optic capture” into one eye (the 1st group of study); the lens was implanted after capsulorrhexis and extraction of anterior segments of vitreous body into the second eye (the 2nd group of study).Results: Fibrinoplastic complications in the postoperative period were more often recorded in the 2nd group than in the 1st one (5 and 1 eyes, respectively). Epithelial proliferation in the 2nd group developed in 10, in the 1st group – in 5 eyes.Conclusions: In the surgical treatment of congenital cataract, implantation of IOLs according to the technique “optic capture” is an effective way of epithelial proliferation and opacity prevention reducing visual acuity in postoperative period. This method is safe regarding inflammatory fibrinoplastic reactions and allows maintaining normal anatomical position of the vitreoretinal structures of the growing eye.

The Case of the Congenital Cataract Development in a Child with Kabuki’s Makeup Syndrome

Kabuki makeup syndrome is a rare genetic disease. The features of the child’s face resemble the mask of the actors of the Japanese Kabuki theater. Accompanied by multiple anomalies of various organs and systems. Cases of congenital cataract (CC) are not described. Purpose: to describe a clinical case of diagnosis and treatment of congenital cataracts in a child with Kabuki syndrome. Material and methods. Child M.,15 years old with syndrome Kabuki make-up. At OD — zonular congenital cataract in 1-degree of turbidity, OS — zonular congenital cataract 3rd degree of turbidity Conducted a survey and phacoaspiration with IOL implantation HOYA 24,0 D at OS. Results. Visual acuity: OD = 0.6 s –1.0 D = 0.8–0.9; OS before surgery = 0.02 n/c, after surgery = 0.05 n/c (amblyopia obscuration). Lens OD-opacity disc, through which the Central parts of the fundus can be investiture with Ophthalmoscope. Lens OS-atypical disk with uneven opacity in the form of dark and light bands, the Central parts of the fundus can’t be investigated with ophthalmoscope, viewed only peripheral vessels. Ultrasound examination OU: single floating opacities in vitreous body, APA of eye = 22.7 mm. Electrophysiological examination-reduction of a number of indicators OS. Resume. 1. In children with the syndrome Kabuki make-up can be congenital zonular cataracts. 2. Taking into account the progressive nature of lens opacity, a dynamic examination with a wide pupil is necessary for timely referral to surgical treatment. 3. There is a risk of developing exudative proliferative reactions in the early postoperative period.

Refraction in pseudophakic eyes after surgical treatment of congenital cataracts

To evaluate the achieved refraction and its relation to the anterior-posterior axis of pseudophakic eyes after extraction of CC in children of up to one year of age. The study included 115 children (159 eyes) examined 1 to 11 years after the extraction of bilateral or unilateral CC at the age of 2-11 months. Optical power of the implanted IOL had been calculated using SRKII formula for hypercorrection to result in emmetropic or weak myopic refraction by the time the eye growth finishes. The subjects underwent autorefractometry on Retinomax K-Plus 3 device and ultrasonic biometry on Humphrey 835 A/B-scan system. The incidence of unplanned refraction in children aged 1 to 3 years was 61.2%, aged 3 years to 5 years 11 months - 24.4%, and in children of 6-11 years - 50.0%; it was associated with pronounced unplanned eye growth in 48.6% of cases with bilateral CC and in 27.3% of cases with unilateral CC. The main cause of unplanned refraction in pseudophakic eyes in children with CC is unpredictable increase of the length of anterior-posterior axis after surgery.

The Results of Morphometric Assessment of the Macular Zone in Congenital Cataract

Purpose:to study the morphological characteristics of the macular zone using optical coherence tomography to assess its development in congenital cataract.Patients and methods:a comprehensive ophthalmological examination was performed in 147 children (269 eyes) aged 1 to 15 years, including, along with traditional methods, optical coherence tomography on the Spectralis HRA + OCT instrument, Heidelberg Engineering. Of these, 193 eyes were with pseudophakia after the removal of congenital cataracts in children aged 2 months to 14 years, 18 eyes with aphakia after the removal of congenital cataracts in children aged 2 months to 11 years, 20 unoperated eyes with partial forms of congenital cataracts and 38 paired conditionally healthy eyes in children with unilateral congenital cataracts. Visual evaluation of linear tomograms, measurement of 5 parameters of the central zone of the fundus and calculation of the macular index were performed.Results:various features of the macular zone were revealed: changes in the macular contour, lamellar structure of the retina, thinning of the choroid, and elements of epiretinal fibrosis. Evaluation of retinal differentiation with the help of a macular index, calculated on the basis of morphometric characteristics, revealed its violations in 52.8 % of cases, which was not always revealed in the visual analysis of tomograms. The best morphometric parameters of the central zone of the fundus are noted in the eyes with pseudophakia in comparison with aphakia (p &lt; 0.05).Conclusion:there is a variability in the state of the macula. In patients with congenital cataracts. Better indicators of the central zone of the fundus in front of the eye with pseudophakia in comparison with aphakia justify the feasibility of performing surgical treatment of congenital cataracts simultaneously with the implantation of the intraocular lens, including in infants. Thinning of the choroid in the subfoveiolar zone with congenital cataract may indicate a violation of trophism and exert additional influence on the physiological development of the macular zone.

The Morphometric Status of the Macula in Children with Pseudophakia after Surgical Treatment of Congenital Cataracts

The Morphometric Status of the Macula in Children with Pseudophakia after Surgical Treatment of Congenital Cataracts

THE SURGICAL CORRECTION OF THE ANOMALIES OF THE POSTERIOR CAPSULE OF THE LENS

Aim. The objective of the present work was to describe the surgical strategy used for the correction of congenital cataract in the children presenting with the anomalies in the posterior capsule of the lens making possible intracapsular implantation of the IOL. Material and methods. The analysis of the surgical strategy for the removal of congenital cataract in the children presenting with the anomalies in the posterior capsule of the lens was performed based on the results of objective examination of its clinical and anatomical features in 40 patients (71 eyes) with the use of biomicroscopy, ophthalmoscopy, and ultrasound study. Results. The intact transparent posterior capsule of the lens was found in 28% of the examined children while 72% of them exhibited changes in the capsule in the form of thinning (33%), lenticone (25%), fibrous degeneration with the presence of calcificates (14%). The choice of the differential surgical treatment of the above anomalies was made on an individual basis. Implantation into the capsular bag proved successful in 81% of all the cases and into the ciliary furrow in 15%. Implantation of IOL was found impossible in $% of the patients. Due to a major defect of the capsular bag. Conclusion. The surgical treatment of congenital cataract with concomitant changes in the shape and transparency of the posterior capsule of the lens requires a differential approach in order to carry out intracapsular implantation of IOL even in the case of manifest posterior lenticone and avoid the development of intra- and postoperative complications.

Role of pterygopalatine blockade in the early rehabilitation program of children after congenital cataract surgery

Nowadays, the surgical treatment of congenital cataract is a small-incisions surgery (aspiration, in some cases ultrasound phacoemulsification). It corresponds to the Fast Track surgery principles, and as a quick recovery technology it requires optimization of pain control in the early postoperative period. &#x0D; Purpose. To estimate the efficiency of the pterygopalatine block as a component of an optimized Fast Track protocol in children after congenital cataract surgery.&#x0D; Materials and methods. 54 children operated for congenital cataract were included in the study. All patients were divided into 2 groups. In the first group (n = 26), a regional component of combined anesthesia on sevoflurane basis was carried out in combination with a pterygopalatine block; in the second group (n = 28), there was an implementation of a retrobulbar block. The efficiency of the methods was evaluated by a comparative analysis of hemodynamic parameters, the index of the vegetative system tension, the assessment of pain intensity by a verbal rating scale, as well as by the severity of ocular inflammatory reactions.&#x0D; Results. Obtained data show that the pterygopalatine ganglion block as a component of a combined anesthesia in congenital cataract surgery allows providing adequate anesthesia, creating prolonged pain control, reducing the inflammatory reaction in postoperative period during the first 24 hours.&#x0D; Conclusion. On the basis of our analysis, the possibility of a safe implementation of optimized (Fast-Track) protocol was proven.

Twenty-five-gauge sutureless lensectomy in infants with congenital cataract

To evaluate the incidence of intra- and postoperative complications of transconjunctival 25-gauge (25G) sutureless pars plicata lensectomy. The medical records of patients <12 months of age with congenital cataracts who underwent 25G sutureless lensectomy were reviewed retrospectively. Patients were evaluated at postoperative days 1, 7, 15, 30, 60, and 90 and every 3 months thereafter. Visual acuity outcomes and intra- and postoperative complications were described and analyzed. A total of 72 eyes of 44 infants were included; 28 patients (64%) had bilateral cataract. Median follow-up was 28 months (range, 12-93 months). In 47 eyes (81%) there was improved visual acuity after surgery. Intraoperative adverse events occurred in 9 eyes (13%). Postoperative complications occurred in 14 eyes (19%): 6 eyes (8%) had secondary visual axis opacification, 6 eyes (8%) had secondary glaucoma, 1 eye (1%) had posterior synechiae, and 1 eye (1.4%) had retinal detachment. Transconjunctival pars plicata 25G sutureless lensectomy is a minimally invasive technique for congenital cataract treatment. No postoperative complications were observed in 81% of eyes. Visual acuity improved in 81% of the operated eyes.

The comparative analysis of the effectiveness of implantation of toric, spherical and aspherical intraocular lenses for the surgical treatment of congenital cataract

Objective. The comparative analysis of the outcomes of the surgical treatment of the children presenting with congenital cataract and astigmatism following the implantation of toric, spherical, and aspherical intraocular lenses (IOLs). Materials and methods. A total of 97 children (127 eyes) presenting with congenital cataract were selected for the present study. Group 1 consisted of the patients suffering from corneal astigmatism of more than 1,0 D who had undergone toric IOLs implantation (25 children, 38 eyes). Group 2 was comprised of the patients with corneal astigmatism of more than 1,0 D who had undergone implantation of spherical and aspherical intraocular lenses (40 children, 48 eyes). Group 3 was composed of 32 children (41 eyes) with corneal astigmatism of less than 1,0 D who had undergone implantation of non-toric intraocular lenses. Lensectomy was performed with the use of the small (1,8 mm and 2,2 mm) incision technique. Various IOL models (Alcon, USA) were used for implantation. The vector analysis of astigmatic correction (Alpinus) was employed to evaluate the quality of astigmatism correction. Results. The patients of all groups experienced a significant improvement of postoperative non-correctable and maximally correctable visual acuity during the long-term follow-up period (over 3 years in duration). In the children comprising group 1, the estimated value of vector astigmatism (-0,72) was close to the actual postoperative value (-0,81). The TIA axis was 113,7 degrees and the SIA axis 92,6 degrees. The vector difference was 0,18 diopters which suggested the high precision of astigmatism correction. The correction index averaged 1,12 ± 0,14. The IOL index was 0,25 ± 0,16 in comparison with its ideal value of 0.0. In the children of group 2, the estimated value of vector astigmatism (-0,87) was significantly higher than the actual postoperative values (-0,56). The TIA axis was 134,3 degrees and the SIA axis 77,1 degrees (p