Pediatric cataract

Abstract

Pediatric cataract is a leading cause of childhood blindness. Untreated cataracts in children lead to tremendous social, economical, and emotional burden to the child, family, and society. Blindness related to pediatric cataract can be treated with early identification and appropriate management. Most cases are diagnosed on routine screening whereas some may be diagnosed after the parents have noticed leukocoria or strabismus. Etiology of pediatric cataract is varied and diagnosis of specific etiology aids in prognostication and effective management. Pediatric cataract surgery has evolved over years, and with improving knowledge of myopic shift and axial length growth, outcomes of these patients have become more predictable. Favorable outcomes depend not only on effective surgery, but also on meticulous postoperative care and visual rehabilitation. Hence, it is the combined effort of parents, surgeons, anesthesiologists, pediatricians, and optometrists that can make all the difference.

Figure 1

A 4-month-old child with congenital rubella syndrome presenting with (a) Membranous cataract. (b) Salt and pepper retinopathy

Figure 2

Anterior-segment dysgenesis. (a) A 4-month-old baby with Peter's type 2 anomaly with image showing central corneal opacity with cataractous lens displaced in the anterior chamber. (b) Ultrasound biomicroscopy of the same patient showing keratolenticular touch

Figure 3

Preexisting posterior capsular defect. (a) Image showing posterior capsular plaque with multiple white dots in the surrounding areas. (b) Ultrasound biomicroscopy showing partially absorbed cataract with large posterior capsular defect

Figure 4

Persistent fetal vasculature. (a) Anterior persistent hyperplastic primary vitreous with prominent ciliary processes and vessels over the lens. (b) Posterior persistent hyperplastic primary vitreous with ultrasonography showing stalk of persistent hyperplastic primary vitreous

Figure 5

Traumatic and complicated cataracts. (a) Rosette cataract. (b) Traumatic cataract with posterior synechiae and iridodialysis. (c) Festooned pupil in a uveitic patient with complicated cataract. (d) Uveitic cataract with 360° posterior synechiae

Figure 6

Morphology of pediatric cataract. (a) Zonular cataract with riders. (b) Cataract pulverulenta. (c). Anterior polar cataract (plaque type). (d) Anterior polar cataract (pyramidal type). (e) Posterior lenticonus showing oil droplet sign. (f) Posterior polar cataract. (g) Sutural cataract. (h) Morgagnian cataract

Figure 7

Visual axis opacification. (a) A 6-month-old child with 1-mm pupil with pupillary membrane. (b) Ultrasound biomicroscopy showing membrane only anterior to intraocular lens which was tackled with anterior route surgery. (c) A 2-year-old child with thick posterior capsular opacification. (d) Ultrasound biomicroscopy showing thick membrane behind the intraocular lens which was removed using pars plana membranectomy