Pediatric cataract surgery

Published on 08/03/2015 by admin

Filed under Opthalmology

Last modified 08/03/2015

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CHAPTER 17 Pediatric cataract surgery

Clinical features, diagnosis, and differential diagnosis

Five components are needed to define a cataract: when they appear, the degree to which the opacity occupies the capsular bag, anatomically where in the lens the opacity lies, its etiology, and morphology. Cataracts may present at birth (congenital) or develop through the first few years of life (developmental); they may be total or partial; they may be nuclear (fetal or embryonal), sutural, lamellar, capsular (usually anterior) or subcapsular (usually posterior), or polar (posterior or anterior); they may be inherited or sporadic with the latter including the acquired variety such as infectious (in utero TORCH infections), metabolic (e.g. galactosemia, Lowe syndrome, galactokinase deficiency) or secondary to other ocular conditions (e.g. persistent fetal vasculature, PFV). Morphology of cataracts includes descriptions such as anterior pyramidal, membranous, pulverulent, blue dot, and other specific entities such as anterior or posterior lenticonus. Such specifications sometimes help with systemic diagnoses (e.g. anterior lenticonus should alert the surgeon to the possibility of Alport syndrome) while pyramidal cataracts are often associated with corneal astigmatism1.

It is very important that the parents of all children with cataracts are also examined with dilation of the eyes to exclude an inherited opacity. It is worth noting that an autosomal dominant cataract may express itself phenotypically differently in the same family pedigree.

The differential diagnosis of a pediatric cataract is that of leukocoria. In infants and toddlers this differential includes retinoblastoma, total retinal detachment (stage V retinopathy of prematurity, Norrie disease, and incontinentia pigmentii), large retinochoroidal colobomas, Coats disease and rarely Toxocara granulomas.

Fundamental principles and goals of surgery

There are three important fundamental principles for successful pediatric cataract surgery:

Indications for surgery

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