Paediatric cataract surgery

Abstract

. Bilateral congenital cataract is the most common cause of treatable childhood blindness. Nuclear cataract is usually present at birth and is non‐progressive, while lamellar cataract usually develops later and is progressive. Prompt surgery has to be performed in cases with dense congenital cataract: if nystagmus has developed, the amblyopia is unfortunately irreversible. A treatment regime based on surgery within 2 months of life, combined with prompt optical correction of the aphakia and occlusion therapy with frequent follow‐up, have been successful in both unilateral and bilateral cases. The surgery ought to include anterior and posterior capsulorexis in all children at the present time. Intraocular lens implantation has been safely performed below the age of 1 year and has also been successfully performed in bilateral cases. Anterior dry vitrectomy should be performed in preschool children to avoid visual axis opacification. Visual axis opacification is the most common complication found after cataract surgery in children. Secondary glaucoma is by far the most sight‐threatening complication and is, unfortunately, common in the newborn so lifelong follow‐up is essential in these cases.

Treatment of Congenital Aniridia Associated with Subluxated Infantile Cataract

“…Posterior capsulotomy although indicated (14, 16, 17) was not performed due to instability of the capsular bag. Anterior vitrectomy through pars plana approach was not indicated since the patient is 5.5 years old and because of potential adverse effects of additional trauma to the eye (14, 17). Due to instability of the capsular bag, CTR was introduced and three-piece mono focal acrylic IOL was implanted.…”

“…Due to instability of the capsular bag, CTR was introduced and three-piece mono focal acrylic IOL was implanted. Hydrophobic acrylic IOL are reported to have lower incidence of posterior capsule opacification (PCO) (14, 16, 17). Instead of calculated 23D IOL, hyperopic 24D IOL was used due to expected later myopic shift (14, 16, 17).…”

“…Hydrophobic acrylic IOL are reported to have lower incidence of posterior capsule opacification (PCO) (14, 16, 17). Instead of calculated 23D IOL, hyperopic 24D IOL was used due to expected later myopic shift (14, 16, 17). Because of patient’s age, questionable stability of the capsular bag and constant pupil diameter of the Artificial Iris implant, mono focal and not multifocal IOL was used.…”

HSF4 Mutation p.Arg116His Found in Age-Related Cataracts and in Normal Populations Produces Childhood Lamellar Cataract in Transgenic Mice

“…Up to half of all congenital cataracts are inherited and most of these are catalogued as autosomal dominant [Francis and Moore 2004; Shiels and Hejtmancik 2013; Zetterstrom and Kugelberg 2007]. Light deprivation of the developing eye due to the cataracts in the ocular lens, during infancy, impedes the brain development of the child [Blakemore and Cooper 1970; Kalia et al, 2014].…”

“…1D shows the ophthalmoscope images of the lamellar cataract phenotype in the transgenic mouse lens. The pathology is bilateral as is known for the human population [Zetterstrom and Kugelberg 2007]. It is typically punctate and appears as dots or specks, very much confined to the nucleus just like the known early childhood lamellar cataract [Francis et al, 2000; Marner et al 1989].…”