1. THE LITERATURE
REVIEW ON
CATARACT
MANAGEMENT
IN CHILDREN
An Academic presentation by
Dr. Nancy Agnes, Head, Technical Operations, Phdassistance
Group www.phdassistance.com
Email: info@phdassistance.com

2. Introduction
Clinical Tip
Diagnostic workflow for children with CC
During surgery
After surgery
Summary
Today's Discussion

3. 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.

4. In most cases, optimal 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 complicated 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.

6. 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.

7. 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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9. 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-specialist
screening measures should be sent
to specialists as soon as feasible to
confirm the diagnosis.

10. Referral to a specialised paediatric cataract service should be treated
with the same urgency.
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11. 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,
metabolic imbalance, and genetic variation are possible causes
(chromosomal abnormalities or single gene mutation associated disorders).
Diagnostic workflow for
children with CC

12. Even with clinical algorithms, determining a diagnosis is difficult and time-
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.

13. During surgery
A general anaesthetic is required
for cataract surgery in children, and
it should be preceded by a similar
anaesthetic examination of both
eyes (EUA).
BASIC SURGICAL TECHNIQUES

14. 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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15. After surgery
Young children's post-operative
inflammatory reactions are
more intense than those of older
children and adults, and they
are influential in newborns and
those with uveitic cataracts.
POST-OPERATIVE EYEDROP REGIMES
IN PAEDIATRIC CATARACT SURGERY

16. This can result in discomfort, creating the pupillary membrane and
posterior synechiae, pupil-block glaucoma, and IOL deposits and
decentration.
In youngsters, post-operative endophthalmitis has a bad prognosis.
Using post-operative drops after cataract surgery in children aims to
minimise inflammation and infection risk in combination with intraoperative
antibiotics.

17. Clinical studies have revealed that surgery at a younger age increases the
risk of glaucoma.
According to some studies, glaucoma is four times more likely if surgery is
performed before the period of four weeks, with glaucoma 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.
RISK FACTORS

18. 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.
MANAGEMENT

19. There are many sensible topical treatment combinations. A
reasonable topical treatment escalation, with progression to the next
step in the context of inadequate pressures, is given here:
(i) Latanoprost or timolol 0.25% monotherapy.
(ii) Combination dorzolamide/timolol preparation.
(iii) Dorzolamide/timolol combination plus latanoprost.

20. CLINICAL TIP: Although technically challenging, there is now a range
of surgical options available for secondary IOL implantation in
children enabling successful long-term optical and visual
rehabilitation.
Considering IOL implantation in aphakic children, mainly those
intolerant of CL wear or glasses, is an option at any age after early
infancy.

21. Summary
Paediatric cataracts (CC) are a
prevalent and severe cause of
lifetime vision loss in children.
Affected newborns should be
handled by specialised services
with the necessary competence
and infrastructure.

22. 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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