Surgical Issues

Prompt clearing of the visual axis with immediate optical correction offers the best chance for visual recovery in pediat-ric patients with unilateral or bilateral cataracts. The surgical procedure recommended depends on the patient's age, risk of amblyopia and expected ocular growth, and reactivity to surgery. In patients younger than 6 months to 2 years old, the best option is to clear the visual axis and have it remain clear throughout the critical period of vision development with a lensectomy-vitrectomy procedure and 6-mm posterior capsulectomy with anterior vitrectomy. This procedure eliminates reopacification of the posterior capsule, which occurs in more than 90% of pediatric patients younger than 2 years. In children older than 2 years, lensectomy with vit-rectomy and a 4-mm posterior capsulectomy are performed. Most of these children can be fitted with contact lenses, although an intraocular lens is indicated for some traumatic cataract patients. Traumatic unilateral cataracts present the least controversial situation in which intraocular lenses are considered in young children. Advances in intraocular lenses and surgical techniques have afforded significant improvements in pediatric cataract management.

The prognosis for children with monocular and binocular congenital and pediatric cataracts has improved markedly. Ongoing clinical studies will determine the best indications and procedures for use in pediatric cataract patients.

KEY TREATMENT

The decision for cataract surgery with intraocular lens implantation depends on the degree of vision loss and potential for amblyopia. Among newborns and infants with cataracts, visually significant cataracts should be removed and corrected with intraocular lens, aphakic contact lens, or aphakic spectacles (AAPOS, 2007) (SOR: C).

The decision for cataract surgery with intraocular lens implantation in older children depends on the degree of vision loss, comorbidities, and systemic disease (AAPOS, 2007) (SOR: C).

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