Cataract in children
- Kathryn M McCreery, FRCOphth, FRCSI, MRCPI
Kathryn M McCreery, FRCOphth, FRCSI, MRCPI
- Consultant Ophthalmic Surgeon
- Our Lady's Hospital for Sick Children, Dublin
A cataract is an opacity of the lens of the eye that causes partial or total blindness (picture 1). Cataracts are a common and frequently curable cause of blindness in children. Early detection and prompt intervention are critical for a good visual outcome, particularly in newborns.
Cataracts in infants and children will be reviewed here. Lens dislocation in children and cataracts in adults are discussed separately. (See "Ectopia lentis (dislocated lens) in children" and "Cataract in adults".)
The reported prevalence of childhood cataracts ranges from 1 to 15 per 10,000 children. The wide range reflects differences in populations, age groups, methods of ascertainment, and case definitions . The prevalence of congenital cataract in developed countries is 1 to 3 per 10,000 [1-4].
The crystalline lens consists of five major structures: embryonic nucleus, fetal nucleus, cortex, lens epithelium, and lens capsule . The crystalline lens focuses light rays onto the retina . Relaxation or contraction of the ciliary body changes the shape of the lens to permit focus of light rays from objects at distant and near fixation (figure 1). Contraction of the ciliary body to permit focus at near fixation is referred to as "accommodation."
- Foster A, Gilbert C, Rahi J. Epidemiology of cataract in childhood: a global perspective. J Cataract Refract Surg 1997; 23 Suppl 1:601.
- Zetterström C, Lundvall A, Kugelberg M. Cataracts in children. J Cataract Refract Surg 2005; 31:824.
- Abrahamsson M, Magnusson G, Sjöström A, et al. The occurrence of congenital cataract in western Sweden. Acta Ophthalmol Scand 1999; 77:578.
- Rahi JS, Dezateux C, British Congenital Cataract Interest Group. Measuring and interpreting the incidence of congenital ocular anomalies: lessons from a national study of congenital cataract in the UK. Invest Ophthalmol Vis Sci 2001; 42:1444.
- Tesser RA, Hess DB, Buckley EG. Pediatric cataracts and lens anomalies. In: Harley's Pediatric Ophthalmology, 5th ed, Nelson LB, Olitsky SE (Eds), Lippincott Williams & Wilkins, Philadelphia 2005. p.255.
- Calhoun JH. Cataracts in children. Pediatr Clin North Am 1983; 30:1061.
- Lambert SR. Controversies in the management of infantile cataract. In: Pediatric Ophthalmology, Neuro-Ophthalmology, Genetics, Lorenz B, Moore AT (Eds), Springer, New York 2006. p.81.
- Jaafar MS, Robb RM. Congenital anterior polar cataract: a review of 63 cases. Ophthalmology 1984; 91:249.
- Nelson LB, Calhoun JH, Simon JH, Harley RD. Progression of congenital anterior polar cataracts in childhood. Arch Ophthalmol 1985; 103:1842.
- Müllner-Eidenböck A, Amon M, Moser E, Klebermass N. Persistent fetal vasculature and minimal fetal vascular remnants: a frequent cause of unilateral congenital cataracts. Ophthalmology 2004; 111:906.
- Paysse EA, McCreery KM, Coats DK. Surgical management of the lens and retrolenticular fibrotic membranes associated with persistent fetal vasculature. J Cataract Refract Surg 2002; 28:816.
- Wright KW, Kohn T, Matsumoto E. Lens abnormalities. In: Pediatric Ophthalmology, Wright KW (Ed), Mosby, St. Louis 1995. p.367.
- Wilson ME, Trivedi RH, Pandey SK. Miscellaneous issues and views. In: Pediatric Cataract Surgery, Wilson ME, Trivedi RH, Pandey SK (Eds), Lippincott Williams & Wilkins, Philadelphia 2005. p.293.
- Wilson ME, Trivedi RH, Pandey SK. Etiology and morphology of pediatric cataracts. In: Pediatric Cataract Surgery, Wilson ME, Trivedi RH, Pandey SK (Eds), Lippincott Williams & Wilkins, Philadelphia 2005. p.1.
- Taylor JB, Young WO, Rutar T. Posterior subcapsular cataracts in children receiving adrenocorticotropic hormone (ACTH) for infantile spasms. J Child Neurol 2010; 25:1017.
- Radiational injuries, Part 2: Non-mechanical injury. In: System of Ophthalmology, Duke-Elder S (Ed), CV Mosby, St. Louis 1972. Vol XIV, p.878.
- Hall P, Granath F, Lundell M, et al. Lenticular opacities in individuals exposed to ionizing radiation in infancy. Radiat Res 1999; 152:190.
- Tongue AC, Cibis GW. Brückner test. Ophthalmology 1981; 88:1041.
- Lambert SR, Lynn MJ, Reeves R, et al. Is there a latent period for the surgical treatment of children with dense bilateral congenital cataracts? J AAPOS 2006; 10:30.
- Wilson ME, Trivedi RH, Pandey SK. Preoperative workup. In: Pediatric Cataract Surgery, Wilson ME, Trivedi RH, Pandey SK (Eds), Lippincott Williams & Wilkins, Philadelphia 2005. p.23.
- Wiesel TN, Hubel DH. Comparison of the effects of unilateral and bilateral eye closure on cortical unit responses in kittens. J Neurophysiol 1965; 28:1029.
- Wiesel TN, Hubel DH. Extent of recovery from the effects of visual deprivation in kittens. J Neurophysiol 1965; 28:1060.
- Lambert SR, Taylor D, Kriss A, et al. Ocular manifestations of the congenital varicella syndrome. Arch Ophthalmol 1989; 107:52.
- Wolff SM. The ocular manifestations of congenital rubella. Trans Am Ophthalmol Soc 1972; 70:577.
- Good WV. Cataract surgery in young children. Br J Ophthalmol 2001; 85:254.
- Crawford JS. Conservative management of cataracts. Int Ophthalmol Clin 1977; 17:31.
- Lambert SR, Plager DA, Lynn MJ, Wilson ME. Visual outcome following the reduction or cessation of patching therapy after early unilateral cataract surgery. Arch Ophthalmol 2008; 126:1071.
- Hiles DA, Biglan AW. Indications for infantile cataract surgery. Int Ophthalmol Clin 1977; 17:39.
- Cheng KP, Hiles DA, Biglan AW, Pettapiece MC. Visual results after early surgical treatment of unilateral congenital cataracts. Ophthalmology 1991; 98:903.
- Drummond GT, Scott WE, Keech RV. Management of monocular congenital cataracts. Arch Ophthalmol 1989; 107:45.
- Ahmadieh H, Ja'farinasab MR. Postoperative medications and follow-up. In: Pediatric Cataract Surgery, Wilson ME, Trivedi RH, Pandey SK (Eds), Lippincott Williams & Wilkins, Philadelphia 2005. p.105.
- Hiles DA. Visual rehabilitation of aphakic children. III. Intraocular lenses. Surv Ophthalmol 1990; 34:371.
- Wilson ME, Bluestein EC, Wang XH. Current trends in the use of intraocular lenses in children. J Cataract Refract Surg 1994; 20:579.
- Infant Aphakia Treatment Study Group, Lambert SR, Lynn MJ, et al. Comparison of contact lens and intraocular lens correction of monocular aphakia during infancy: a randomized clinical trial of HOTV optotype acuity at age 4.5 years and clinical findings at age 5 years. JAMA Ophthalmol 2014; 132:676.
- Infant Aphakia Treatment Study Group, Lambert SR, Buckley EG, et al. A randomized clinical trial comparing contact lens with intraocular lens correction of monocular aphakia during infancy: grating acuity and adverse events at age 1 year. Arch Ophthalmol 2010; 128:810.
- Hartmann EE, Stout AU, Lynn MJ, et al. Stereopsis results at 4.5 years of age in the infant aphakia treatment study. Am J Ophthalmol 2015; 159:64.
- Larsen JS. The sagittal growth of the eye. 3. Ultrasonic measurement of the posterior segment (axial length of the vitreous) from birth to puberty. Acta Ophthalmol (Copenh) 1971; 49:441.
- SORSBY A, SHERIDAN M. The eye at birth: measurement of the principal diameters in forty-eight cadavers. J Anat 1960; 94:192.
- Spierer A, Desatnik H, Blumenthal M. Refractive status in children after long-term follow up of cataract surgery with intraocular lens implantation. J Pediatr Ophthalmol Strabismus 1999; 36:25.
- Gordon RA, Donzis PB. Refractive development of the human eye. Arch Ophthalmol 1985; 103:785.
- Greenwald MJ, Glaser SR. Visual outcomes after surgery for unilateral cataract in children more than two years old: posterior chamber intraocular lens implantation versus contact lens correction of aphakia. J AAPOS 1998; 2:168.
- BenEzra D, Cohen E, Rose L. Traumatic cataract in children: correction of aphakia by contact lens or intraocular lens. Am J Ophthalmol 1997; 123:773.
- Jensen AA, Basti S, Greenwald MJ, Mets MB. When may the posterior capsule be preserved in pediatric intraocular lens surgery? Ophthalmology 2002; 109:324.
- Kohnen T. Visual axis opacification after pediatric intraocular lens implantation. J Cataract Refract Surg 2001; 27:1141.
- Apple DJ, Solomon KD, Tetz MR, et al. Posterior capsule opacification. Surv Ophthalmol 1992; 37:73.
- Hosal BM, Biglan AW. Risk factors for secondary membrane formation after removal of pediatric cataract. J Cataract Refract Surg 2002; 28:302.
- Brady KM, Atkinson CS, Kilty LA, Hiles DA. Cataract surgery and intraocular lens implantation in children. Am J Ophthalmol 1995; 120:1.
- Beck AD, Freedman SF, Lynn MJ, et al. Glaucoma-related adverse events in the Infant Aphakia Treatment Study: 1-year results. Arch Ophthalmol 2012; 130:300.
- Bothun ED, Cleveland J, Lynn MJ, et al. One-year strabismus outcomes in the Infant Aphakia Treatment Study. Ophthalmology 2013; 120:1227.
- Chrousos GA, Parks MM, O'Neill JF. Incidence of chronic glaucoma, retinal detachment and secondary membrane surgery in pediatric aphakic patients. Ophthalmology 1984; 91:1238.
- Endophthalmitis Study Group, European Society of Cataract & Refractive Surgeons. Prophylaxis of postoperative endophthalmitis following cataract surgery: results of the ESCRS multicenter study and identification of risk factors. J Cataract Refract Surg 2007; 33:978.
- Lane SS, Osher RH, Masket S, Belani S. Evaluation of the safety of prophylactic intracameral moxifloxacin in cataract surgery. J Cataract Refract Surg 2008; 34:1451.
- Peterseim MW, Wilson ME. Bilateral intraocular lens implantation in the pediatric population. Ophthalmology 2000; 107:1261.
- Mistr SK, Trivedi RH, Wilson ME. Preoperative considerations and outcomes of primary intraocular lens implantation in children with posterior polar and posterior lentiglobus cataract. J AAPOS 2008; 12:58.
- Spierer A, Desatnik H, Rosner M, Blumenthal M. Congenital cataract surgery in children with cataract as an isolated defect and in children with a systemic syndrome: a comparative study. J Pediatr Ophthalmol Strabismus 1998; 35:281.
- Ocular trauma
- Ionizing radiation
- CLINICAL FEATURES
- Natural history
- Laboratory evaluation
- Referral indications
- DIFFERENTIAL DIAGNOSIS
- Cataract extraction
- Post-operative care
- Optical and visual rehabilitation
- - Aphakic contact lens
- - Intraocular lens
- POST-OPERATIVE COMPLICATIONS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS
- Clinical features and evaluation
- Management and outcome