Current management of infantile cataracts

• Type of Material: Article
• Authors: Phoebe Lenhart, Emory University; Scott R Lambert, Stanford University
• Language: English
• Date: 2022-08-12
• Publisher: ELSEVIER SCIENCE INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2022 Elsevier Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.survophthal.2022.03.005
• Title of Journal or Parent Work: SURVEY OF OPHTHALMOLOGY
• Volume: 67
• Issue: 5
• Start Page: 1476
• End Page: 1505
• Grant/Funding Information: Research to Prevent Blindness, New York, NY. This work was supported in part by NIH Core Grant for Vision Research P30 EY006360.
• Keywords: MIRAJ PEDIATRIC CATARACT; RANDOMIZED CLINICAL-TRIAL; INTRAOCULAR-LENS IMPLANTATION; Life Sciences & Biomedicine; ANTERIOR SEGMENT SYNDROME; Ophthalmology; RED REFLEX EXAMINATION; Infantile cataract; HEALTH TERTIARY FACILITIES; CENTRAL CORNEAL THICKNESS; congenital cataract; POSTERIOR OPTIC CAPTURE; NDYAG LASER CAPSULOTOMY; POWER CALCULATION FORMULAS; Science & Technology

Abstract

Infantile cataracts remain one of the most treatable causes of lifelong visual impairment. While the chance of improving vision for children with infantile cataracts has never been better, significant global and socioeconomic disparities still exist in their early management. Recent epidemiological studies reveal a stable prevalence of infantile cataracts in high-income countries and highlight challenges in determining the prevalence of infantile cataracts in low-income countries. Detailed descriptions of cataract morphology may inform us as to etiology, provide guidance with regards to surgical approach, and have prognostic value. Molecular genetics is providing new insights into the hereditary bases and potential systemic associations of infantile cataracts. For visually significant infantile cataracts requiring surgery to clear the visual axis, surgical techniques continue to evolve based on the experiences and research efforts of skilled teams worldwide. The most common complications of cataract surgery performed in infancy are visual axis opacification and, in about a third of patients, the long-term development of glaucoma. Children with unilateral cataracts generally see well given the presence of a healthy fellow eye. Better visual outcomes in operated eyes, however, are achieved in the setting of early presentation, bilateral infantile cataracts, absence of nystagmus or strabismus, and consistent amblyopia therapy. While intraocular lenses for infants less than 6 months can result in good visual outcomes, contact lenses may be preferred in situations in which they are available and practical. Many studies have demonstrated the benefits of early surgery for infantile cataract. We must strive for the continued evolution of technologies and strategies that have the potential to further improve these outcomes.