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.

Posterior Capsular Opacification in Preschool- and School-Age Patients after Pediatric Cataract Surgery without Posterior Capsulotomy

“…The development (for pediatric eyes) of medical antagonists against factors leading to PCO or capsule washing substances that reduce the speed and severity of lens epithelial cell proliferation would solve this problem. 14 …”

Dual function of TGFβ in lens epithelial cell fate: implications for secondary cataract

“…, 2010) and a much higher prevalence in certain other populations (e.g., very young children; Medsinge and Nischal, 2015). The only standard treatment for PCO is YAG capsulotomy, in which an externally applied laser is used to ablate the posterior lens capsule and any associated cells.…”

Molecular Genetics of Cataract

“…7 Under slit-lamp examination, pediatric cataract exhibits considerable phenotypic variability with respect to location, size, shape, density, age at onset, rate of progression, and even color of opacities within the lens. There is no universally accepted classification system for pediatric cataract.…”