Management of pediatric cataract

P. Vassileva, M. Proinova, D. Efremova

Introduction: Cataract in children represents very important problem because of necessity for early diagnosis and surgery for prevention of amblyopia. There are still controversies regarding the best and most appropriate methodology for cataract operation in children: surgical technique, size and power calculation of IOL, prevention of comlications.

Patients and methods: A retrospective study was conducted on 32 children (altogether 52 eyes) with cataract, between 2 months and 14 years of age (average 7 years), treated at the eye department for a period of three years (1996 - 1999), with a mean follow-up of 18 months. Different types of cataract were diagnosed: hereditary - 8 children, congenital - 12 children, traumatic in 8 eyes, and complicated - 4 eyes. Following surgeries were performed: ECCE - 8 eyes, ECCE&IOL - 26 eyes, secondary PC IOL implantaion - 2 eyes, and ECCE&IOL&PPC - 16 eyes. Manual technique with anterior chamber maintainer was used in all cases. Complication rates and visual results were studied.

Results: Recorded observations demonstrate low rate of complication. A radial tear (3 eyes - 5,7%) and unadverted opening of posterior capsule (4 eyes - 7,6%) were documented during surgery. Most frequent postoperative complications were fibrinous reaction - 12 eyes (23%), and posterior capsule opacification - 20 eyes (38%). YAG capsulotomy was performed in 10 eyes, and increased intraocular pressure was observed in 3 eyes (5,7%). Visual acuity of 0,5 and better had 36 eyes (70%), between 0,1 - 0,5 - 7 eyes (14%), and less than 0,1 - 3 eyes (5,7%). Amblyopia was the main cause for vision restriction.

Conclusion: Cataract in children is common cause of blindness and visual impairment mostly because of coexisting amblyopia. Screening of new born is necessary for detection of cataract and early surgery in dense opacities. Many and varied factors determine the successful outcome in children with cataract. Data in the literature and our experiences indicate that implantation of PC IOL’s in children is effective and safe, with low rate of complications. Postrerior capsulotomy was performed on selected cases and is recommended for younger children (<7 years) as secondary cataract was rarely observed in older age. Control of postoperative inflammation and precise IOL power calculation are of critical importance for good visual results.

Eye Department, University Hospital "St.Anna", Evgeni Pavlovski 1, 1709 Sofia, Bulgaria

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