Pediatric cataract: challenges and future directions

Abstract

Cataract is a significant cause of visual disability in the pediatric population worldwide and can significantly impact the neurobiological development of a child. Early diagnosis and prompt surgical intervention is critical to prevent irreversible amblyopia. Thorough ocular evaluation, including the onset, duration, and morphology of a cataract, is essential to determine the timing for surgical intervention. Detailed assessment of the general health of the child, preferably in conjunction with a pediatrician, is helpful to rule out any associated systemic condition. Although pediatric cataracts have a diverse etiology, with the majority being idiopathic, genetic counseling and molecular testing should be undertaken with the help of a genetic counselor and/or geneticist in cases of hereditary cataracts. Advancement in surgical techniques and methods of optical rehabilitation has substantially improved the functional and anatomic outcomes of pediatric cataract surgeries in recent years. However, the phenomenon of refractive growth and the process of emmetropization have continued to puzzle pediatric ophthalmologists and highlight the need for future prospective studies. Posterior capsule opacification and secondary glaucoma are still the major postoperative complications necessitating long-term surveillance in children undergoing cataract surgery early in life. Successful management of pediatric cataracts depends on individualized care and experienced teamwork. We reviewed the etiology, preoperative evaluation including biometry, choice of intraocular lens, surgical techniques, and recent developments in the field of childhood cataract.

Keywords: aphakia; children; infantile cataract; pediatric cataract; pseudophakia.

Figure 1

Ultrasound biomicroscopy images. Notes: (A) Ultrasound biomicroscopy image depicting anterior segment structures in a normal eye. (B) Ultrasound biomicroscopy showing keratolenticular adhesion (arrow) with cataract in a case of Peter’s anomaly. The image demonstrates the utility of anterior segment imaging for pediatric cataract evaluation. Abbreviations: C, cornea; I, Iris; ACa, anterior capsule; L, lens.

Figure 2

Examination of family members. Notes: (A) Undilated exam that is apparently normal; (B) dilated exam of the same patient revealed punctate cortical opacities.

Figure 3

Total cataract with central anterior capsular plaque.

Figure 4

Anterior polar cataract. Notes: (A) Aniridia with dot-like anterior polar cataract (arrow); (B) pyramidal cataract.

Figure 5

Oil-droplet cataract in galactosemia.

Figure 6

Subluxated lens in a child with Marfan’s syndrome.

Figure 7

The technique of two-incision push–pull anterior capsulorhexis. Notes: (A) Two stab incisions are made approximately 4.5–5.0 mm apart in the anterior capsule with a microvitreoretinal blade (arrowheads). (B) Grasping the distal flap of the proximal anterior capsule with capsulorhexis forceps and pushing toward the distal stab incision, making a semicircular rhexis; (C) similarly, the proximal flap of the distal stab incision is then grasped and pulled toward the proximal stab incision. (D) Complete continuous curvilinear capsulorhexis. (E) Anterior (arrow) and posterior two-incision push–pull rhexis (arrowheads) under retroillumination.