The Literature Review on Cataract Management in Children - Phdassistance
                     THE LITERATURE 
 REVIEW ON  
CATARACT  
MANAGEMENT  
IN CHILDREN
An Academic presentation by
Dr. Nancy Agnes, Head, Technical Operations, 
Phdassistance  Group www.phdassistance.com
Email: [email protected]
Today's Discussion
Introduction
Clinical Tip
Diagnostic workflow for children with 
CC  During surgery
After surgery 
 Summary
Congenital and childhood  
cataracts are uncommon ;  
however, most paediatric  
ophthalmology units in the  
UK see them regularly.
They're frequently linked to  
severe vision loss, and a   
vast percentage have a   
genetic cause, with some  
having extra-ocular severe  
comorbidities.
In most cases, opt imal diagnosis and treatment necessitate close  
coordination across multidisciplinary teams. Surgery is still the most  
communal  form of therapy.
Many surgical procedures, intervention dates, and optical correction  
choices have been promoted, making care seem compl icated to those  
who regularly encounter affected children.
This report summarises the outcomes of two recent RCOphth child  
cataract study days, Offers a  Literature Review, and discusses the current  
state of play' in paediatric cataract  therapy in the United Kingdom.

Introduction
Congenital cataract (CC) affects  
between 2.2 and 13.6 people  
worldwide.
The difference in frequency amongst  
 populations is likely owing to higher 
 detection rates in countries with  
screening programmes (for both  
cataracts and problems related to  
cataracts), lower rubella vaccination 
 rates, and population genetic  
differences.
Treatment is also different depending on whether you have thick  
cataracts at  birth, partial cataracts at  birth, or developmental  
cataracts  that develop during childhood.
Early recognition, diagnosis, and proper treatment are critical for  
attaining the best possible results.
A team of healthcare earners is often involved in the best management   
of children with cataracts, and clinical networks and well-established  
referral pipelines are crucial for achieving the best results.
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Clinical Tip
The optimal time to operate on a   
newborn with a  visually significant  
cataract is within the first few  
weeks of life.
As a  result, babies detected with  
potential CC by non-special ist  
screening measures should be sent 
 to specialists as soon as feasible 
to  confirm the diagnosis.
Referra l to a specialised paed ia tric cata ract service should be trea ted 
 with the same urgency.
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Diagnostic workflow 
for  children with CC
While early detection and surgical intervention are critical For Preserving  
Vision In Newborns And Children, proper diagnosis is vital.
CC is a  condition with a  wide range of symptoms linked to various systemic 
 disorders. Trauma, maternal  TORCHS infection (toxoplasmosis, rubella, 
CMV,  herpes simplex, and syphilis), intrauterine chemical or drug exposure,  
metabol ic imbalance,  and genetic variation are possible causes  
(chromosomal  abnormalit ies or single gene mutat ion associated disorders).
Even with clinical algorithms, determining a  diagnosis is difficult and t ime-   
consuming. Traditionally, doctors have pursued biochemical, genetic,  
clinical, and imaging studies sequentially or iteratively.
This method relies on accurate clinical phenotyping, entails many  clinical  
professionals and appointments, and comes at  a  high expense to patients  
and healthcare providers, all while yielding a  low diagnosis rate.
During surgery
BASIC SURGICAL TECHNIQUES
A general anaesthetic is required  
for cataract surgery in children, 
and  it should be preceded by a  
similar  anaesthetic examination 
of both  eyes (EUA).
The child's age determines the surgical procedure and whether an IOL is  
implanted.
A vitrectomy cutter can nearly always aspirate or remove the lens, and this 
 is followed by a  cefuroxime intracameral injection and a  subconjunctival  
or  intracameral steroid injection.
Some surgeons leave a  CL in place after surgery to rectify the aphakic  
refractive defect. CLs in the best shape 1–2 weeks after surgery.
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After surgery
POST- OPERATIVEEYEDROP
REGIMES  IN PAEDIATRIC CATARACT 
SURGERY
Young children's post-operative 
 inf lammatory reactions are  
more intense than those of 
older  children and adults, and 
they  are influential in 
newborns and  those with 
uveitic cataracts.
This can result in discomfort, creating the pupil lary membrane and  
posterior synechiae, pupi l -block glaucoma,  and IOL deposits and  
decentration.
In youngsters, post-operative endophthalmit is  has a  bad  prognosis.
Using post-operat ive drops after cataract surgery in children aims to  
minimise inf lammation and infection risk in combinat ion with intraoperative 
 antibiotics.
 RISK FACTORS
Clinical studies have revealed that surgery at  a  younger age increases the  
risk of glaucoma.
According to some studies, g laucoma is four t imes more likely if surgery is  
performed before the period of four weeks, with g laucoma occurring only if 
 surgery is performed between the ages of six and nine months, with a  2%  
reduction in risk for each additional  week of age at  surgery.
 MANAGEMENT
Medical therapy can keep GFCS under control for years, and it's more likely 
 to keep surgery off the table in later-onset instances.
A safe, non-overburdening, and cost-effective treatment regimen should  
be adopted.
Except for Latanoprost, most glaucoma drugs are not approved for use in  
children, and this should be discussed with parents before prescription and 
 the rationale for the pharmaceutical  decision.
There are many  sensible topical t reatment combinations.  A  
reasonable topical treatment escalation, with progression to the next 
 step in the context of inadequate pressures, is given here:
(i) Latanoprost or t imolol 0.25% monotherapy.
(ii) Combination dorzolamide/t imolol  preparation.
(iii) Dorzolamide/timolol combinat ion plus latanoprost.
 CLINICAL TIP: Although technically challenging, there is now a  range  
of surgical options available for secondary IOL implantat ion in  
children enabling successful long- term optical and visual  
rehabilitation.
Considering IOL implantat ion in aphakic children, mainly those  
intolerant of CL wear or glasses, is an option at  any age after early  
infancy.
Summary
Paediatric cataracts (CC) are a  
 prevalent and severe cause of  
l ifetime vision loss in children.
Affected newborns should be  
handled by specialised services 
 with the necessary 
competence  and infrastructure.
The way children with CC are evaluated and treated has altered  
thanks to advances in genetics substantially, and early intervention is 
 typically the key to achieving the best possible results for these  
children.
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