Abstract
Pediatric cataracts are common and represent one of the most treatable causes of lifelong visual impairment in children. Management of childhood cataract is more challenging than cataract management in adults. Although cataract surgery in children has incorporated many innovations that started in adult surgery, unique features of children’s eyes have required many modifications of the adult procedure. Challenges remain for surgery in the pediatric population, and these include anatomical differences, timing of surgery, how to avoid and/or treat amblyopia, how to prevent and treat visual axis opacification, and how to determine the optimum model and power of intraocular lens (IOL).
In this chapter, we focus on surgical techniques and outcomes of cataract surgery in children. Presently, the treatment for a cataract is the surgical removal of the opaque lens. This is often followed by implantation of an IOL, either at the time of surgery or as a secondary procedure later in childhood. Primary IOL implantation during the first 6 months of life appears to increase the risk of reoperations, but primary IOL implantation is usually considered for children above 6 months of age. Postoperative complications occur more commonly after infantile than adult cataract surgery, and many of these complications do not develop until years later. As a result, it is critical that children be followed closely on a long-term basis after cataract surgery.
Similar content being viewed by others
References
Wilson ME, Trivedi RH. Pediatric cataract surgery: operative and postoperative issues. In: Wilson ME, Saunders RA, Trivedi RH, editors. Pediatric ophthalmology: current thought and a practical guide. Heidelberg: Springer; 2009. p. 326–43.
Birch EE, Stager DR. The critical period for surgical treatment of dense congenital unilateral cataract. Investig Ophthalmol Vis Sci. 1996;37(8):1532–8.
Birch EE, Cheng C, Stager DR Jr, Weakley DR Jr, Stager DR Sr. The critical period for surgical treatment of dense congenital bilateral cataracts. J AAPOS. 2009;13(1):67–71.
Wilson ME Jr, Trivedi RH, Hoxie JP, Bartholomew LR. Treatment outcomes of congenital monocular cataracts: the effects of surgical timing and patching compliance. J Pediatr Ophthalmol Strabismus. 2003;40(6):323–9.
Koo EB, VanderVeen DK, Lambert SR. Global practice patterns in the management of infantile cataracts. Eye Contact Lens. 2018;44(Suppl 2):S292–s6.
Serafino M, Trivedi RH, Levin AV, Wilson ME, Nucci P, Lambert SR, et al. Use of the Delphi process in paediatric cataract management. Br J Ophthalmol. 2016;100(5):611–5.
Nallasamy S, Davidson SL, Kuhn I, Mills MD, Forbes BJ, Anninger WV, et al. Simultaneous bilateral intraocular surgery in children. J AAPOS. 2010;14(1):15–9.
Wilson ME, Trivedi RH. Multicenter randomized controlled clinical trial in pediatric cataract surgery: efficacy and effectiveness. Am J Ophthalmol. 2007;144(4):616–7.
McAnena L, McCreery K, Brosnahan D. Migration to aphakia and contact lens treatment is the trend in the management of unilateral congenital cataract in Britain and Ireland. Ir J Med Sci. 2018;
Poole ZB, Trivedi RH, Wilson ME. Primary IOL implantation in children: the effect of the Infant Aphakia Treatment Study on practice patterns. J AAPOS. 2019;23(4):228.
Bothun ED, Wilson ME, Traboulsi EI, Diehl NN, Plager DA, Vanderveen DK, et al. Outcomes of unilateral cataracts in infants and toddlers 7 to 24 months of age: Toddler Aphakia and Pseudophakia Study (TAPS). Ophthalmology. 2019;126(8):1189–95.
Vasavada AR, Vasavada V, Shah SK, Praveen MR, Vasavada VA, Trivedi RH, et al. Five-year postoperative outcomes of bilateral aphakia and pseudophakia in children up to 2 years of age: a randomized clinical trial. Am J Ophthalmol. 2018;193:33–44.
Repka MX, Dean TW, Lazar EL, Yen KG, Lenhart PD, Freedman SF, et al. Cataract surgery in children from birth to less than 13 years of age: baseline characteristics of the cohort. Ophthalmology. 2016;123(12):2462–73.
Lambert SR, Aakalu VK, Hutchinson AK, Pineles SL, Galvin JA, Heidary G, et al. Intraocular lens implantation during early childhood: a report by the American Academy of Ophthalmology. Ophthalmology. 2019;126(10):1454–61.
Trivedi RH, Wilson ME. Pediatric cataract: preoperative issues and considerations. In: Wilson ME, Saunders RA, Trivedi RH, editors. Pediatric ophthalmology: current thought and a practical guide. Heidelberg: Springer; 2009. p. 311–24.
Gochnauer AC, Trivedi RH, Hill EG, Wilson ME. Interocular axial length difference as a predictor of postoperative visual acuity after unilateral pediatric cataract extraction with primary IOL implantation. J AAPOS. 2010;14(1):20–4.
Musleh M, Hall G, Lloyd IC, Gillespie RL, Waller S, Douzgou S, et al. Diagnosing the cause of bilateral paediatric cataracts: comparison of standard testing with a next-generation sequencing approach. Eye (Lond). 2016;30(9):1175–81.
Trivedi RH, Wilson ME. Axial length measurements by contact and immersion techniques in pediatric eyes with cataract. Ophthalmology. 2011;118(3):498–502.
Trivedi RH, Wilson ME. Prediction error after pediatric cataract surgery with intraocular lens implantation: contact versus immersion A-scan biometry. J Cataract Refract Surg. 2011;37(3):501–5.
Trivedi RH, Barnwell E, Wolf B, Wilson ME. A model to predict postoperative axial length in children undergoing bilateral cataract surgery with primary IOL implantation. Am J Ophthalmol. 2019;206:228.
Wilson ME Jr, Trivedi RH, Bartholomew LR, Pershing S. Comparison of anterior vitrectorhexis and continuous curvilinear capsulorhexis in pediatric cataract and intraocular lens implantation surgery: a 10-year analysis. J AAPOS. 2007;11(5):443–6.
Nischal KK. Two-incision push-pull capsulorhexis for pediatric cataract surgery. J Cataract Refract Surg. 2002;28(4):593–5.
Dick HB, Schultz T. Femtosecond laser-assisted cataract surgery in infants. J Cataract Refract Surg. 2013;39(5):665–8.
Dick HB, Schelenz D, Schultz T. Femtosecond laser-assisted pediatric cataract surgery: Bochum formula. J Cataract Refract Surg. 2015;41(4):821–6.
Wilson ME Jr, Trivedi RH, Mistr S. Pediatric intraoperative floppy-iris syndrome. J Cataract Refract Surg. 2007;33(7):1325–7.
Bayramlar H, Totan Y, Borazan M. Heparin in the intraocular irrigating solution in pediatric cataract surgery. J Cataract Refract Surg. 2004;30(10):2163–9.
Dada T. Intracameral heparin in pediatric cataract surgery. J Cataract Refract Surg. 2003;29(6):1056.
Wilson ME Jr, Trivedi RH. Low molecular-weight heparin in the intraocular irrigating solution in pediatric cataract and intraocular lens surgery. Am J Ophthalmol. 2006;141(3):537–8.
Shah SK, Vasavada V, Praveen MR, Vasavada AR, Trivedi RH, Dixit NV. Triamcinolone-assisted vitrectomy in pediatric cataract surgery. J Cataract Refract Surg. 2009;35(2):230–2.
Dixit NV, Shah SK, Vasavada V, Vasavada VA, Praveen MR, Vasavada AR, et al. Outcomes of cataract surgery and intraocular lens implantation with and without intracameral triamcinolone in pediatric eyes. J Cataract Refract Surg. 2010;36(9):1494–8.
Cleary CA, Lanigan B, O’Keeffe M. Intracameral triamcinolone acetonide after pediatric cataract surgery. J Cataract Refract Surg. 2010;36(10):1676–81.
You C, Wu X, Ying L, Xie L. Ultrasound biomicroscopy imaging of sclerotomy in children with cataract undergoing 25-gauge sutureless pars plana anterior vitrectomy. Eur J Ophthalmol. 2010;20(6):1053–8.
Lam DS, Chua JK, Leung AT, Fan DS, Ng JS, Rao SK. Sutureless pars plana anterior vitrectomy through self-sealing sclerotomies in children. Arch Ophthalmol. 2000;118(6):850–1.
Vasavada AR, Trivedi RH. Role of optic capture in congenital cataract and intraocular lens surgery in children. J Cataract Refract Surg. 2000;26(6):824–31.
Trivedi RH, Wilson ME. Selection of an initial contact lens power for infantile cataract surgery without primary intraocular lens implantation. Ophthalmology. 2013;120(10):1973–6.
Drews-Botsch C, Celano M, Cotsonis G, DuBois L, Lambert SR. Parenting stress and adherence to occlusion therapy in the Infant Aphakia Treatment Study: a secondary analysis of a randomized clinical trial. Transl Vis Sci Technol. 2019;8(1):3.
Lambert SR, DuBois L, Cotsonis G, Hartmann EE, Drews-Botsch C. Spectacle adherence among four-year-old children in the Infant Aphakia Treatment study. Am J Ophthalmol. 2019;200:26–33.
Wilson ME Jr, Trivedi RH, Buckley EG, Granet DB, Lambert SR, Plager DA, et al. ASCRS white paper. Hydrophobic acrylic intraocular lenses in children. J Cataract Refract Surg. 2007;33(11):1966–73.
Stager DR Jr, Wang X, Weakley DR Jr, Felius J. The effectiveness of Nd:YAG laser capsulotomy for the treatment of posterior capsule opacification in children with acrylic intraocular lenses. J AAPOS. 2006;10(2):159–63.
Vasavada AR, Trivedi RH, Nath VC. Visual axis opacification after AcrySof intraocular lens implantation in children. J Cataract Refract Surg. 2004;30(5):1073–81.
Trivedi RH, Wilson ME Jr, Golub RL. Incidence and risk factors for glaucoma after pediatric cataract surgery with and without intraocular lens implantation. J AAPOS. 2006;10(2):117–23.
Infant Aphakia Treatment Study Group, Lambert SR, Lynn MJ, Hartmann EE, DuBois L, Drews-Botsch C, et al. Comparison of contact lens and intraocular lens correction of monocular aphakia during infancy: a randomized clinical trial of HOTV optotype acuity at age 4.5 years and clinical findings at age 5 years. JAMA Ophthalmol. 2014;132(6):676–82.
Freedman SF, Lynn MJ, Beck AD, Bothun ED, Orge FH, Lambert SR. Glaucoma-related adverse events in the first 5 years after unilateral cataract removal in the Infant Aphakia Treatment study. JAMA Ophthalmol. 2015;133(8):907–14.
Kraus CL, Trivedi RH, Wilson ME. Intraocular pressure control with echothiophate iodide in children’s eyes with glaucoma after cataract extraction. J AAPOS. 2015;19(2):116–8.e1.
Agarkar S, Gokhale VV, Raman R, Bhende M, Swaminathan G, Jain M. Incidence, risk factors, and outcomes of retinal detachment after pediatric cataract surgery. Ophthalmology. 2018;125(1):36–42.
Ledoux DM, Trivedi RH, Wilson ME Jr, Payne JF. Pediatric cataract extraction with intraocular lens implantation: visual acuity outcome when measured at age four years and older. J AAPOS. 2007;11(3):218–24.
Bonaparte LA, Trivedi RH, Ramakrishnan V, Wilson ME. Visual acuity and its predictors after surgery for bilateral cataracts in children. Eye (Lond). 2016;30(9):1229–33.
American Academy of Ophthalmology. Amblyopia, preferred practice pattern. San Francisco: American Academy of Ophthalmology; 2017.
Infant Aphakia Treatment Study Group, Lambert SR, Buckley EG, Drews-Botsch C, DuBois L, Hartmann E, et al. The infant aphakia treatment study: design and clinical measures at enrollment. Arch Ophthalmol. 2010;128(1):21–7.
Gimbel HV, Marzouk HA. Haptic tuck for reverse optic capture of a single-piece acrylic toric or other single-piece acrylic intraocular lenses. J Cataract Refract Surg. 2019;45(2):125–9.
Van Looveren J, Vael A, Ideler N, Sillen H, Mathysen D, Tassignon MJ. Influence of the vitreolenticular interface in pediatric cataract surgery. J Cataract Refract Surg. 2018;44(10):1203–10.
Dick HB, Schultz T. Influence of the vitreolenticular interface in pediatric cataract surgery. J Cataract Refract Surg. 2019;45(3):388.
Wilson ME Jr, Englert JA, Greenwald MJ. In-the-bag secondary intraocular lens implantation in children. J AAPOS. 1999;3(6):350–5.
Trivedi RH, Wilson ME Jr, Facciani J. Secondary intraocular lens implantation for pediatric aphakia. J AAPOS. 2005;9(4):346–52.
Trivedi RH, Wilson ME. Posterior capsule opacification in pediatric eyes with and without traumatic cataract. J Cataract Refract Surg. 2015;41(7):1461–4.
Warren N, Trivedi RH, Wilson ME. Persistent fetal vasculature with elongated ciliary processes in children. Am J Ophthalmol. 2019;198:25–9.
Anfuso T, Wilson ME. Nanophthalmos. In: Johnson SM, editor. Cataract surgery in the glaucoma patients. Heidelberg: Springer; 2009. p. 221–6.
Lambert SR, Capone A Jr, Cingle KA, Drack AV. Cataract and phthisis bulbi after laser photoablation for threshold retinopathy of prematurity. Am J Ophthalmol. 2000;129(5):585–91.
Trivedi RH, Wilson ME. Aniridia and cataracts. In: Wilson ME, Trivedi RH, Pandey SK, editors. Pediatric cataract surgery: techniques, complications, and management. Philadelphia: Lippincott, Williams & Wilkins; 2005. p. 199–202.
Honavar SG, Shields CL, Shields JA, Demirci H, Naduvilath TJ. Intraocular surgery after treatment of retinoblastoma. Arch Ophthalmol. 2001;119(11):1613–21.
Trivedi RH, Wilson ME. Cataract surgery in eyes treated for retinoblastoma. In: Wilson ME, Trivedi RH, Pandey SK, editors. Pediatric cataract surgery: techniques, complications, and management. Philadelphia: Lippincott, Williams & Wilkins; 2005. p. 184–8.
Payne JF, Hutchinson AK, Hubbard GB, 3rd, Lambert SR. Outcomes of cataract surgery following radiation treatment for retinoblastoma. J AAPOS. 2009;13(5):454.e3-458.e3.
Wilson ME Jr, Trivedi RH, Biber JM, Golub R. Anterior capsule rupture and subsequent cataract formation in Alport syndrome. J AAPOS. 2006;10(2):182–3.
Trivedi RH, Wilson ME. Anterior lenticonus in Alport syndrome. In: Wilson ME, Trivedi RH, Pandey SK, editors. Pediatric cataract surgery: techniques, complications, and management. Philadelphia: Lippincott, Williams & Wilkins; 2005. p. 194–8.
Tassignon MJ, De Veuster I, Godts D, Kosec D, Van den Dooren K, Gobin L. Bag-in-the-lens intraocular lens implantation in the pediatric eye. J Cataract Refract Surg. 2007;33(4):611–7.
Van Looveren J, Ni Dhubhghaill S, Godts D, Bakker E, De Veuster I, Mathysen DG, et al. Pediatric bag-in-the-lens intraocular lens implantation: long-term follow-up. J Cataract Refract Surg. 2015;41(8):1685–92.
Wilson ME, Trivedi RH, Burger BM. Eye growth in the second decade of life: implications for the implantation of a multifocal intraocular lens. Trans Am Ophthalmol Soc. 2009;107:120–4.
Nischal KK. Who needs a reversibly adjustable intraocular lens? Arch Ophthalmol. 2007;125(7):961–2.
Lin H, Ouyang H, Zhu J, Huang S, Liu Z, Chen S, et al. Lens regeneration using endogenous stem cells with gain of visual function. Nature. 2016;531(7594):323–8.
Solebo AL, Hammond CJ, Rahi JS. Improving outcomes in congenital cataract. Nature. 2018;556(7699):E1–e2.
Vavvas DG, Dryja TP, Wilson ME, Olsen TW, Shah A, Jurkunas U, et al. Lens regeneration in children. Nature. 2018;556(7699):E2–e3.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Section Editor information
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this entry
Cite this entry
Wilson, M.E., Trivedi, R.H. (2020). Pediatric Cataract Surgery. In: Albert, D., Miller, J., Azar, D., Young, L. (eds) Albert and Jakobiec's Principles and Practice of Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-319-90495-5_197-1
Download citation
DOI: https://doi.org/10.1007/978-3-319-90495-5_197-1
Received:
Accepted:
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-90495-5
Online ISBN: 978-3-319-90495-5
eBook Packages: Springer Reference MedicineReference Module Medicine