The greatest concern in children with cataracts is irreversible visual loss. The timing of congenital cataract surgery is critical for the visual rehabilitation. Cataract surgery in children remains complex and challenging. The incidence of complications during or after operation is higher in children than adults. Some complications could be avoided by meticulous attention to surgical technique and postoperative care, and others were caused by more exuberant inflammatory response associated with surgery on an immature eye or the intrinsic eyes abnormalities. Utilizing of advanced techniques and timely applying topical corticosteroids and cycloplegic agents can reduce the occurrence of visual axis opacification. Operation on children with strabismus or nystagmus, and applying occlusion therapy on amblyopic eyes can balance the visual inputs to the two eyes. Diagnosis of glaucoma following congenital cataract surgery requires lifelong surveillance and continuous assessment of the problem. So cataract surgeries in children are not the end of journey, but one step on the long road to visual rehabilitation. This paper describes recent evidence from the literature regarding the advance of management after congenital cataract surgery.

PurposeTo evaluate the visual outcomes of dense pediatric cataract surgery in eastern China.MethodsMedical records of children who underwent surgery for dense unilateral or bilateral pediatric cataract in Shandong Provincial Hospital between January 2007 and December 2012 were collected. Patients who cooperated with optical correction and aggressive patching of the sound eye and who had a minimum postoperative follow-up of more than 2 years were included. Risk factors for poor visual outcomes were analyzed.ResultsOf the 105 eligible patients (181 eyes), 76 had bilateral cataract, and 29 unilateral. With a mean follow up of 46.77 mo (range 24.0~96.0 mo), the final best corrected visual acuity (BCVA) of 158 eyes were recorded, and 4.43% (7/158) achieved 0.1 logarithm of the minimum angle of resolution (logMAR) or better; 15.19% (24/158) obtained a BCVA between 0.1 logMAR and 0.3 logMAR; 18.99%, (30/158) between 0.3 logMAR and 0.5 logMAR; 46.84% (74/158), between 0.5 logMAR and 1 logMAR; 14.55%, worse than 1 logMAR. The mean BCVA of the patients who underwent lensectomy before 3 months of age was significantly better than that of patients who underwent lensectomy between 3 and 12 months (p = 0.001). In the same lensectomy age groups, the final BCVA of the children in the bilateral and unilateral groups did not differ significantly (P>0.05). Lensectomy after 3 months of age, postoperative complications, strabismus and nystagmus were shown to be risk factors for poor visual outcomes.ConclusionsLensectomy before 3 months of age, IOL implantation, proper managing of postoperative complications, early optical correction and aggressive postoperative patching of the sound eye would increase the final BCVA for patients with dense pediatric cataract.