Pediatric cataracts

Pediatric cataracts causes 

✍️ Idiopathic

✍️ Inherited/genetic 

✍️ Infection (transplacental)
TORCH (Toxoplasmosis,Rubella, Cytomegalovirus and Herpes)

✍️ Iatrogenic: Steroid 

✍️ Irradiation

✍️ Injury blunt or penetrating injury

✍️ electrical 

✍️ Inflammatory (Uveitis) 

✅ When to operate Pediatric cataracts:
✍️ Cataract greater than 3 mm in size

✍️ Posterior location (close to nodal point)

✍️ In the pupillary area

✍️ Inability to see the disc and macula with direct ophthalmoscope especially in undilated pupil

✍️ Reduced near vision, significant glare and a drop in stereopsis attributable to cataract

✍️ One has to search for causes like anisometropia especially if the cataract is visually insignificant but there is a reduced visual acuity.

Surgical notes on pediatric cataract

 Contraindications for 1ry Intraocular Lens or 2ry Intraocular Lens implant for Pediatric cataracts

✍️ Age less than 6 months✍️ Recurrent and uncontrolled chronic uveitis ✍️ Severe pars planitis✍️ Microcornea✍️ Very poor vision (for secondary IOL).

 Time of Surgery for Pediatric cataracts

✍️ Cataract surgery is planned after 6 weeks of age and if the child is fit for general anesthesia.

 ✍️ Surgery earlier than 6 weeks of age has been shown to have a higher risk of developing glaucoma. 

Time Interval between 2 eyes  Surgeries for Pediatric cataracts

✍️ do not plan bilateral simultaneous cataract surgery( unless necessary)

✍️ Pediatric cataract surgery without IOL implantation• Infants: Second eye is operated on the third postoperative day after the first eye is operated• Simultaneous bilateral cataract surgery is performed in high-risk patients for general anesthesia

✍️ Pediatric cataract surgery with IOL implantation:• One week to One month interval• In the presence of strabismus, the second eye surgery is delayed till the first eye takes up fixation• Simultaneous bilateral IOL implantation is not performed • If there are siblings to be operated for pediatric cataract, they are not operated on the same day to reduce the risk of infection during and after surgery (cross infections due to instillation of medications by parents).

 Timing of Secondary Posterior Chamber Intraocular Lens Implantation for Pediatric cataracts:

✍️ 3–4 years of age 

✍️ Planned earlier in:• Unilateral cataract• Poor compliance with glasses• Contact lens intolerance

✍️ The second eye surgery can be delayed if there is amblyopia of the first operated eye. The child is given pseudophakic correction for the amblyopic eye and secondary IOL is delayed for the other eye, so that child is forced to use the amblyopic eye. It works well especially if child is not compliant to patching. It is similar to optical penalization

 Surgical Options for Pediatric cataracts

✍️ The surgical options depend on • the age of the child • the decision on IOL implantation. Extracapsular cataract extraction (ECCE) ECCE + primary posterior capsulorhexis (PPC) + anterior vitrectomy (AV) ECCE with posterior chamber intraocular lens implantation (PCIOL) ECCE + PCIOL + PPC + AV Lensectomy: Limbal and pars

✍️ PPC is performed under the following situations • Intraocular lens is implanted in children with bilateral cataract above 2 years of age • children with unilateral cataract slightly earlier (14–18 months of age). It is combined with PPC and anterior vitrectomy

Pediatric Cataract