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Updated: Aug 10, 2026
Rotating the Intraocular Lens to Prevent Posterior Capsular Opacification in Cataract Surgeries
Published on: July 7, 2023
Pediatric cataracts
1Division of Ophthalmology, Cleveland Clinic Foundation, OH 44195, USA.
Insights
Posterior chamber intraocular lenses are effective for treating aphakia in children over 2 years old. Management of unilateral congenital cataracts is evolving, with part-time occlusion showing promise for better visual outcomes.
Area of Science:
- Ophthalmology
- Pediatric ophthalmology
Background:
- Posterior chamber intraocular lenses (PCIOLs) are standard for aphakia in children aged 2+.
- Infants typically receive contact lenses due to significant axial eye elongation.
- Intraocular lens use in juvenile rheumatoid arthritis-associated cataracts is debated, though recent studies show promise.
Purpose of the Study:
- To review current practices and evolving strategies in pediatric aphakia and cataract management.
- To discuss the efficacy of intraocular lenses versus contact lenses in pediatric aphakia.
- To evaluate the changing paradigms in amblyopia management for unilateral congenital cataracts.
Main Methods:
- Literature review of pediatric intraocular lens implantation and cataract management.
- Analysis of treatment outcomes for aphakia in children.
- Examination of evolving amblyopia treatment protocols, including occlusion therapy.
Main Results:
- PCIOLs are increasingly preferred for aphakia in children over two years old.
- Part-time occlusion therapy for unilateral congenital cataracts shows improved outcomes compared to historical full-time occlusion.
- Better development of binocular vision and stereopsis is achievable with updated amblyopia management.
Conclusions:
- PCIOLs are a viable and often preferred option for pediatric aphakia.
- Modern amblyopia management, particularly part-time occlusion, offers improved functional vision and reduced strabismus in unilateral congenital cataracts.
- Continued research is vital for optimizing visual outcomes in challenging pediatric ophthalmic conditions.
Abstract:
Posterior chamber intraocular lenses are a well-accepted treatment of aphakia in children 2 years of age and older, with many now considering them as the treatment of choice. Infants, however, are usually treated with contact lens, rather than intraocular lens implantation, as the infant eye undergoes significant axial elongation. The use of intraocular lenses in children with cataracts associated with juvenile rheumatoid arthritis remains controversial, but a recent article [9] describes good results in these patients, who historically have a poor prognosis. The management of amblyopia associated with unilateral congenital cataracts is evolving. In the 1970s and 1980s, full-time occlusion of the sound eye was advocated for infants with unilateral congenital cataracts. It was also taught that binocular fusion was impossible to obtain, and children with unilateral cataracts inevitably develop strabismus. Recent studies have shown that part-time occlusion may in fact yield better results, allowing the development of binocular vision and stereopsis and reducing the incidence of strabismus.
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