Update on pediatric cataract surgery

Cataracts in infants and children are comparatively rare, but they remain an important cause of potentially lifelong visual impairment, largely because of associated deprivation amblyopia. This is particularly seen in children missed by screening programs and thus presenting late for treatment. However, advances in diagnosis, surgical techniques and amblyopia management have improved the prognosis for most children seen with this condition. This comprehensive review focuses on all aspects of the care required to optimize outcomes. It covers modern genetic investigations, performed to precisely determine underlying cataract etiology, and discusses the use of outcome-based evidence to guide the timing of surgical intervention. The paper also outlines the options available to clinicians for post-operative refractive error correction and compares indications, risks and benefits for the use of contact lenses, spectacles and intraocular lenses (IOL). The challenge of choosing the most appropriate dioptric power of IOL to implant into a growing eye is discussed, as is consideration of types of IOLs that can be considered and the surgical techniques needed. Evidence-based approaches to the clinical management of amblyopia, glaucoma and visual axis opacification, the three most common complications seen following pediatric cataract surgery, are reviewed. Two specific conditions associated with pediatric cataract are discussed in detail--persistent fetal vasculature and ocular trauma. Strategies for assessment, management and surgical treatment of these conditions are reviewed.