Update on congenital cataract surgery management

Lim, Maria E.; Buckley, Edward G.; Prakalapakorn, S. Grace

doi:10.1097/icu.0000000000000324

Cited by 58 publications

(55 citation statements)

References 50 publications

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“…us, first of all, the surgeon must be highly skilled for both cataract surgery and anterior vitrectomy. Secondly, transcorneal 23G lensectomy was preferred instead of phacoaspiration for the small incision size, anterior chamber stability, and hand piece rigidity [29].…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Surgical Safety in Congenital Cataract Eyes with Three Pathological Types of Posterior Capsule Abnormalities

Ding

Xiang

Wang

et al. 2020

Journal of Ophthalmology

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Purpose. To observe the clinical characteristics of 3 pathological types of posterior capsule abnormalities (PCAs) in congenital cataracts (CCs) and evaluate the surgical safety in these eyes. Methods. This study involved 239 children (367 eyes) with CC who underwent cataract surgery at the Eye Hospital of Wenzhou Medical University. All surgery videos were collected for detailed reviews. Intraoperative and postoperative complications (within 3 months) were all recorded. Results. The 3 pathological types of PCAs, namely, persistent fetal vasculature (PFV), posterior capsule defect (PCD), and posterior lenticonus (PLC), presented in 129 (35.1%) CC eyes, while 238 (64.9%) eyes were recorded as CC without PCA. The percentages of PFV, PCD, and PLC were 10.9%, 26.7%, and 5.4% in CC eyes (n = 367), respectively. The most common concomitant of PFV eyes was PCD (42.5%), and PFV was the most frequent (17.3%) one in PCD eyes. PLC was only associated with PFV (15%) and PCD (50%). The occurrence rates of surgical complications ranged from 0 to 5.4%, and no statistical difference was found between the eyes with and without PCA (all P>0.05). Conclusions. PFV, PCD, and PLC play a very important role in the CCs. The effect of fetal vessels in PFV eyes might be an abnormally strong attachment on the posterior capsule, leading to PLC and PCD. Even in PCA patients, severe surgical complication can also be avoided with well-designed and skilled operation. This trial is registered with NCT03905044 at http://ClinicalTrials.gov.

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Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Surgical Safety in Congenital Cataract Eyes with Three Pathological Types of Posterior Capsule Abnormalities

Ding

Xiang

Wang

et al. 2020

Journal of Ophthalmology

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“…The age of primary IOL implantation in pediatric cataract surgery is an on-going debate, with the general consensus being 2 years old, and the feasibility of IOL implantation in children under 2 years old remains debatable 4,10,11 . In this study, 2-6-year-old children were included.…”

Section: Discussionmentioning

confidence: 99%

Study on the Enlargement Index of Femtosecond Laser-Assisted Capsulorhexis in 2–6-Year-Old Patients With Congenital Cataract

Liao¹,

Guo²,

Liao³

et al. 2020

Preprint

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Background: To identify the capsule enlargement index after femtosecond laser-assisted anterior capsulorhexis in 2–6-year-old children who underwent congenital cataract surgery. Methods: In this prospective case series study, femtosecond laser-assisted anterior capsulorhexis was performed in patients with congenital cataract, aged 2–6 years. The actual achieved capsulorhexis diameters were measured with Digimizer version 4.2.6. Correlation coefficient (r) and multiple linear regression analysis were used to evaluate the variables that could potentially influence anterior capsulorhexis enlargement index (E). Results: This prospective study enrolled 28 eyes of 22 patients with congenital cataract. The mean age of the patients at surgery was 4.67 years ± 1.54 (standard deviation [SD]). “E” of the 28 cases was 1.211±0.039 (SD). Correlation analysis showed that “E” correlated significantly with the anterior chamber depth (ACD) (r=−0.469, p=0.021) and axial length (AL) (r=0.452, p=0.027). The following formula was developed by using multivariable linear regression analysis: Predicted E=1.177−0.052×ACD +0.009×AL, R2=0.346 (F=4.396, p=0.046).Conclusions: The anterior capsulorhexis enlargement index and its calculation formula could help to set up an accurate programmed capsulorhexis diameter for femtosecond laser-assisted congenital cataract surgery in children aged 2–6 years. Thus, an appropriate actual capsulorhexis diameter could be achieved

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“…There are several therapeutic options for infant patients with congenital cataract after cataract extraction surgery, including primary IOL implantation and short-term aphakia followed by secondary IOL implantation. With the improved biocompatibility of IOLs and advances in surgical instruments, the most commonly recommended treatment for children over 2 years of age is a combined surgery, i.e., cataract extraction plus primary IOL implantation, but it remains a controversial procedure for IOL implantation in children below the age of 2 years [24]. Both methods are safe and effective to prevent the onset of deprivation amblyopia [25].…”

Section: Discussionmentioning

confidence: 99%

The role of primary intraocular lens implantation in the risk of secondary glaucoma following congenital cataract surgery: A systematic review and meta-analysis

Zhang

Wang

et al. 2019

PLoS ONE

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This meta-analysis aims to evaluate the incidence of secondary glaucoma in patients under the age of 2 years who underwent congenital cataract surgery with or without primary intraocular lens (IOL) implantation. Methods An electronic literature search was performed in Medline, EMBASE, and Web of Science databases to retrieve studies between January 2011 and November 2018. Patients with congenital cataract who did primary IOL implantation, aphakia, or secondary IOL implantation followed by receiving extraction surgery were included in this study. Relevant studies meeting defined eligibility criteria were selected and reviewed systematically by meta-analysis. Long-term incidences of secondary glaucoma, which developed at least one year after cataract surgery, were considered and discussed as clinical outcomes in each cohort. The pooled data were analyzed according to a random effects model. Results Eight publications involving 892 eyes were included in the current meta-analysis. In the general population of eyes with congenital cataract, the long-term incidence of secondary glaucoma was lower (P = 0.06) in eyes with primary IOL (9.5%) than in eyes without primary IOL (15.1%), including aphakia and secondary IOL. The pooled risk ratio (RR) favors primary IOL implantation in all patients (RR = 0.63). For bilateral congenital cataract, the incidence was 6.7% in eyes with primary IOL implantation, which is significantly lower than the 16.7%

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Update on congenital cataract surgery management

Abstract: We review updates in the management of congenital cataract, which remains a major cause of preventable childhood blindness.

Cited by 58 publications

References 50 publications

Clinical Characteristics and Surgical Safety in Congenital Cataract Eyes with Three Pathological Types of Posterior Capsule Abnormalities

Clinical Characteristics and Surgical Safety in Congenital Cataract Eyes with Three Pathological Types of Posterior Capsule Abnormalities

Study on the Enlargement Index of Femtosecond Laser-Assisted Capsulorhexis in 2–6-Year-Old Patients With Congenital Cataract

The role of primary intraocular lens implantation in the risk of secondary glaucoma following congenital cataract surgery: A systematic review and meta-analysis

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