Pediatric cataract surgery: challenges

Abstract

This review examines pediatric cataract surgery via the challenges and complications that must be considered by the treating physician. The following is structured to examine challenges in clinically relevant categories, each with a brief background, philosophy, incidence and/or outcomes when available, and an overview of interventions and treatment modalities. The latter part of each segment contains a summary of data and/or comments published from the infant aphakia treatment study, a prospective, randomized controlled trial that compared primary intraocular lens implantation to aphakia corrected with a contact lens when operating for unilateral cataract from 1 to 7 months of age. The infant aphakia treatment study authors have published clinical data out to 5 years of age in their study cohort.

Keywords:

• aphakia
• congenital cataract
• glaucoma
• infant aphakia treatment study
• intraocular lens
• pediatric cataract
• primary IOL
• pseudophakia
• secondary IOL

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• The efforts of Vision 2020 aim to address the leading causes of preventable blindness by increasing access to subspecialty care.

• Cataract extraction is only the initial step in a long-term rehabilitation process that can include surgical complications, amblyopia, and strabismus.

• Cataract surgery in very early infancy carries increased risks when compared to surgery on eyes beyond 1 year of age.

• Unilateral disease carries a statistically poorer overall acuity in afflicted eyes than bilateral disease.

• Visual acuity has not shown a significant difference between primary management of monocular congenital cataract at ages 1–7 months with contact lens or intraocular lens with a follow-up of 4.5 years of age.

• Modern surgical techniques and technology combine with visual rehabilitation regimens to maximize useful visual acuity.

• Glaucoma remains a prominent, enduring risk after infantile surgery often requiring medical and/or surgical therapy.

• Retinal detachment also represents an enduring risk, typically representing a 3–7% risk, which is further stratified into sub-groups.

• Refractive error management after cataract extraction utilizes intraocular lens (primary or secondary), contact lens, and/or spectacles.

• Visual axis opacification after surgery remains the highest complication; and it is necessary to clear the recurrent opacity in order to enhance visual rehabilitation.