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Introduction: This study aimed to examine the impact of cataract surgery on the corneal endothelium and central corneal thickness (CCT) in pediatric patients, and to identify the factors associated with corneal alterations. Methods: This retrospective study included consecutive children undergoing bilateral or unilateral cataract surgery and intraocular lens implantation at the Eye Hospital of Wenzhou Medical University, with or without posterior capsulorhexis and anterior vitrectomy, and an age-matched normal control group. This study aimed to assess whether changes in corneal parameters, including CCT, corneal endothelial cell density (CD), average cell area (AVE), standard deviation of size (SD), coefficient of variation (CV), percentage of hexagonal cells (6A) before and after surgery, and endothelial cell loss (ECL) differed among the bilateral cataract, unilateral cataract, and control groups. Furthermore, the potential effects of anterior vitrectomy, axial length, preoperative anterior chamber depth, surgical duration, horizontal corneal diameter, intraoperative pupil diameter (PD), and the number of corneal sutures on corneal endothelial parameters and CCT were investigated. Results: A total of 107 eyes from 107 children were included in the study. In the bilateral cataract group, CD significantly decreased, AVE and CCT significantly increased, and ECL was significantly higher than in the control group. The unilateral cataract group also exhibited a significant increase in CCT. Additionally, the number of corneal sutures was negatively correlated with CD, and PD was negatively correlated with CV in the unilateral cataract group. Conclusion: Cataract surgery in pediatric patients results in increased CCT, reduced CD, and morphological changes in corneal cells. A greater number of corneal sutures and a smaller PD increased the risk of CD reduction and elevated CV in the unilateral cataract group, underscoring the need for ophthalmologists to minimize corneal damage in these children. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to provide a comprehensive analysis of ocular biometric parameters in pediatric patients with cataracts to optimize surgical outcomes. By evaluating various biometric data, we seek to enhance the decision-making process for intraocular lens (IOL) placement, particularly with advanced technologies like femtosecond lasers. Methods: This retrospective comparative study included pediatric patients with cataracts who underwent ocular biometric measurements and cataract extraction with anterior vitrectomy at the Medical University of Vienna between January 2019 and December 2021. Parameters measured included corneal diameter (CD), axial length (AL), corneal thickness (CT) and flat and steep keratometry (Kf and Ks). The study explored the correlations between these parameters and IOL placement. Results: A total of 136 eyes from 68 pediatric patients were included in the study. Significant positive correlations were found between corneal diameter, age and AL. The mean CD was 11.4 mm, mean AL was 19.5 mm, CT was 581.2 ± 51.8 µm, Kf was 7.76 ± 0.55 mm and Ks 7.41 ± 0.59 mm, respectively. Older pediatric patients with larger corneal diameters and longer ALs were more likely to receive in-the-bag IOL implantation. Conversely, younger patients often required alternative IOL placements or remained aphakic. Our data indicated that over 95% of the study population and all patients aged one year and older had a corneal diameter of 10 mm or larger. Conclusions: Detailed ocular biometric analysis is crucial for optimizing both surgical outcomes and postoperative care in pediatric cataract patients. The positive correlations between CD, age and AL underline the importance of individualized surgical planning tailored to each patient's unique anatomical features. Additionally, our findings suggest that the use of a femtosecond laser is both feasible and safe for pediatric patients aged one year and older, potentially offering enhanced surgical precision and improved outcomes. [ABSTRACT FROM AUTHOR]

Mawaddah Sabr,1,&ast; Valmore A Semidey,2 Marcos J Rubio-Caso,2 Renad Aljuhani Jnr,3 Gorka Sesma1,&ast; 1Pediatric Ophthalmology and Strabismus Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 2Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 3Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia&ast;These authors contributed equally to this workCorrespondence: Gorka Sesma, Pediatric Ophthalmology and Strabismus Division, King Khaled Eye Specialist Hospital, Al Urubah Branche Road, West Building 2nd Floor, Riyadh, 11462, Saudi Arabia, Tel +966114849700, Fax +966114821908, Email gsesma@kkesh.med.saBackground: Retinal detachment is a major postsurgical threat in pediatric cataract surgery; however, the effect of axial length remains unclear. This study aimed to assess the relationship between axial length and detachment risk in vulnerable patients.Methods: This retrospective cohort study analyzed 132 eyes of 84 pediatric cataract surgery patients aged < 20 years old. Axial length was measured preoperatively, and the incidence of retinal detachment was recorded over a median follow-up of 4 years. Logistic regression analysis was used to examine the axial length-detachment relationship.Results: Twenty eyes had postoperative retinal detachments. The median axial length was longer in the detachment group (23.6 mm) than in the non-detachment group (21.6 mm). Eyes with axial length ≤ 23.4 mm had 0.55-fold decreased odds of detachment compared to longer eyes. Preexisting myopia and glaucoma confer heightened risk. Approximately half of the patients retained some detachment risk eight years postoperatively.Conclusion: Shorter eyes (axial length ≤ 23.4 mm) appear to be protected against pediatric retinal detachment after cataract surgery, whereas myopia, glaucoma, and axial elongation > 23.4 mm elevate the postoperative risk. Understanding these anatomical risk profiles requires surgical planning and follow-up care of children undergoing lensectomy.Plain language Summary: This study investigated the protective role of a shorter axial length in preventing retinal detachment after pediatric cataract surgery. This highlights the correlation between smaller eye sizes and reduced detachment risk, emphasizing the need for careful consideration of anatomical factors in surgical planning and patient monitoring, particularly for patients with preexisting myopia or postoperative glaucoma. Keywords: pediatric cataract surgery, axial length, retinal detachment, myopia, congenital glaucoma, congenital cataract

AIM: To evaluate morphological changes in the iridocorneal angle after pediatric cataract surgery. METHODS: Children who underwent primary infantile cataract surgery were included and 64 eyes from 41 children, including 18 with unilateral cataracts (18 eyes) and 23 with bilateral cataracts (46 eyes) were examined. All patients underwent two gonioscopic examinations to evaluate the iridocorneal angle, before the primary lens removal and before the secondary intraocular lens implantation. The anatomical changes in the iridocorneal angle and the relationship between intraocular pressure (IOP) and iridocorneal angle changes were also analyzed. RESULTS: The iridocorneal angle was wide in 64 eyes before and after surgery. The trabecular meshwork pigmentation, number of iris processes in every quadrant of the iridocorneal angle, and the width of the ciliary body band in the superior and inferior quadrants at the second gonioscopic examination were significantly increased compared to those at the first examination (P

AIM: To evaluate the ophthalmic and anesthesiologic management of cataract surgery in children with Lowe syndrome receiving lens removal, the development and management of secondary glaucoma. METHODS: This retrospective case series included 12 eyes of 6 children with genetically verified Lowe syndrome receiving cataract removal. Information regarding the type and duration of surgery and total anesthesia time were recorded. Additionally, intra- and postoperative complications were noted as well as clinical examinations such as visual acuity and funduscopy. RESULTS: All children received simultaneous bilateral cataract surgery at the mean age of 8.98±3.58wk. Lensectomy combined with posterior capsulotomy and anterior vitrectomy was performed in all children. The mean time for cataract surgery per eye was 35.83±8.86min, whereas the total time of surgery was 153.33±22.11min. The mean extubation time and duration at recovery room was 42.33±22.60min and 130.00±64.37min, respectively. During surgery, a decrease of oxygen saturation below 93% was found in only one child. During the postoperative follow-up, nystagmus (6 children) and strabismus (5 children) was commonly found in contrast to no case of visual axis opacification. Secondary glaucoma developed in five eyes of three children, which was treated with topical eye drops in only one child. A trabeculectomy was performed in both eyes of one child, whereas removal of syechia and an iridectomy in one eye of one child. CONCLUSION: Bilateral simultaneous cataract surgery under general anesthesia is a safe surgical procedure in Lowe syndrome children. The glaucoma screening with intraocular pressure measurements is crucial in the postoperative management of Lowe syndrome patients to avoid additional visual impairment.

Purpose: To present a panoramic review of childhood cataract knowledge networks, hotspots and trends. Methods: The Web of Science Core Collection was used to retrieve the global literature on childhood cataract published between 2012 and 2021. Scientometric data were analyzed and visualized using VOSviewer and CiteSpace for metrics including publication count, citation count, country, journal, author, cited reference, subject category and their temporal trends. Results: A total of 3395 analyzed publications showed an inconsistent annual increasing trend. The USA (n = 939) was the leading contributor among countries. The Journal of American Association for Pediatric Ophthalmology and Strabismus (n = 113) had the highest number of publications among journals. Eight clusters of author collaboration network including 183 authors were identified. Gene mutation, cataract surgery management, intraocular lens implantation complications, prevalence, and glaucoma were identified as the research hotspots. Pediatric cataract surgery, new mutations, artificial intelligence, and cerebrotendinous xanthomatosis were identified as frontier research topics. “Biochemistry and molecular biology”, “neurosciences”, and “radiology, nuclear medicine and medical imaging” had the highest betweenness centrality values (0.38, 0.32, and 0.22). Multidisciplinary (burst years: 2020 to 2021; strength = 4.32) had the greatest strength as of 2021. Conclusions: Childhood cataract research intensely focuses on revealing the genetic background and pheno-spectrum of the diseases, innovating and/or optimizing surgical techniques, and preventing and treating postoperative complications. Artificial intelligence has shed light on the diagnosis and treatment of childhood cataracts. The advance in the research on molecular mechanisms of childhood cataracts depends on multidisciplinary cooperation.

Purpose: To determine the cumulative incidence of strabismus surgery after pediatric cataract surgery and identify the associated risk factors. Design: US population-based insurance claims retrospective cohort study. Participants: Patients ≤ 18 years old who underwent cataract surgery in 2 large databases: Optum Clinformatics Data Mart (2003–2021) and IBM MarketScan (2007–2016). Methods: Individuals with at least 6 months of prior enrollment were included, and those with a history of strabismus surgery were excluded. The primary outcome was strabismus surgery within 5 years of cataract surgery. The risk factors investigated included age, sex, persistent fetal vasculature (PFV), intraocular lens (IOL) placement, nystagmus and strabismus diagnoses before cataract surgery, and cataract surgery laterality. Main Outcome Measures: Kaplan–Meier estimated cumulative incidence of strabismus surgery 5 years after cataract surgery and hazard ratios (HRs) with 95% confidence intervals (CIs) from multivariable Cox proportional hazards regression models. Results: Strabismus surgery was performed on 271/5822 children included in this study. The cumulative incidence of strabismus surgery within 5 years after cataract surgery was 9.6% (95% CI, 8.3%–10.9%). Children who underwent strabismus surgery were more likely to be of younger age at the time of cataract surgery, of female sex, have a history of PFV or nystagmus, have a pre-existing strabismus diagnosis, and less likely to have an IOL placed (all P < 0.001). Factors associated with strabismus surgery in the multivariable analysis included age 1 to 4 years (HR, 0.50; 95% CI, 0.36–0.69; P < 0.001) and age > 5 years (HR, 0.13; 95% CI, 0.09–0.18; P

Purpose: Prolonged postoperative topical corticosteroids are commonly given after pediatric cataract surgery to control inflammation. This study was undertaken to compare the efficacy, safety, and compliance of postoperative topical steroids and adjunctive intracameral (I/C) triamcinolone acetonide (tricort) and posterior subtenon (PST) triamcinolone in modulating postoperative inflammation after surgery. Methods: Forty-eight eyes of children with pediatric cataract between the ages of 5 and 10 years were randomized into three equal groups (T, I, S) before surgery. Group T received postoperative topical 1% prednisolone tapered over 4 weeks; Group I received adjunctive intraoperative I/C 1.2 mg/0.03 ml tricort and topical 1% prednisolone for 2 weeks postoperatively, and Group S received a single 0.5 ml (40 mg/ml) PST tricort without topical steroids. Signs of inflammation, intraocular pressure (IOP), and central corneal thickness were assessed at day 1, week 1, week 3, week 6, and week 12 postoperatively with optical coherence tomography (OCT) macula to rule out cystoid macular edema at the sixth and 12th weeks postoperatively. Results: Posterior synechiae were present in two eyes out of 16 in groups T and I, which resolved. Severe anterior chamber cells were present in four eyes out of 16 in group T, in two eyes in group I, and in one eye in group S, which resolved. All groups had comparable pre- and postoperative IOP. Conclusion: In pediatric cataracts, outcomes were better with PST tricort and the adjunctive I/C tricort compared to postoperative topical prednisolone, for modulating postoperative inflammation. [ABSTRACT FROM AUTHOR]

Purpose: Evaluation for systemic diagnosis is an important part of pediatric cataract management. While there are reports on associated systemic and ocular associations in children with infantile cataracts, reports specifying associations in large cohorts of children undergoing cataract surgery are lacking. Methods: Retrospective chart review of consecutive patients undergoing cataract surgery at a pediatric tertiary referral center during 30-year period was performed. Associated systemic and ocular associations were recorded. The etiologies were analyzed depending on laterality, age, and gender. Results: Seven-hundred twenty-seven patients (1135 eyes) were included for analysis: 408 (56%) with bilateral and 319 (44%) with unilateral cataract. An identifiable cause for cataract was identified in 66% (270/408) bilateral and 55% (176/319) unilateral cataract patients. Hereditary cataract accounted for 22% of bilateral cataracts. An underlying syndrome or genetic diagnosis was found in 24% bilateral (97/408, 86 genetic/syndromic, 11 metabolic) but only in 2% of unilateral cases (5/319). Cataracts were the result of treatment for cancer, or other systemic conditions requiring steroids, in 60/408 bilateral (15%) and 15/319 (5%) unilateral cataract patients. In contrast, unilateral cataracts had higher ocular associations (49%, 156/319) than bilateral cataracts (6%, 23/408) primarily ocular trauma (20%, 64/319) and persistent fetal vasculature (20%, 62/319). Conclusion: Clinicians should be aware of potential systemic and ocular associations among children with visually significant cataracts. Those with no family history of juvenile cataract should be evaluated for systemic associations, and referral to genetics may be warranted in select cases. [ABSTRACT FROM AUTHOR]

Abstract Background Bilateral cataract is a significant cause of blindness in children in Ethiopia. This study aimed to identify the resources available for cataract surgery in children, and to assess current surgical practices, surgical output and factors affecting the outcome of surgery in Ethiopia. Methods A Google Forms mobile phone questionnaire was emailed to nine ophthalmologists known to perform cataract surgery in young children (0–5 years). Results All nine responded. All but one had received either 12- or 3–5-month’s training in pediatric ophthalmology with hands-on surgical training. The other surgeon had received informal training from an experienced colleague and visiting ophthalmologists. The surgeons were based in seven health facilities: five in the capital (Addis Ababa) and eight in six public referral hospitals and one private center. Over 12 months (2017–2018) 508 children (592 eyes) aged 0–18 years (most 5 years were operated by other surgeons. There were substantially fewer surgeons per million population (nine for 115 million population) than recommended by the World Health Organization and they were unevenly distributed across the country. Methylcellulose and rigid intraocular lenses were generally available but less than 50% of facilities had a sharp vitrectomy cutter and cohesive viscoelastic. Mean travel time outside Addis Ababa to a facility offering pediatric cataract surgery was 10 h. Conclusion Despite the high number of cases per surgeon, the output for bilateral cataracts was far lower than required. More well-equipped pediatric ophthalmology teams are urgently required, with deployment to under-served areas.

Objective: To compare the rate of refractive growth (RRG3) of the crystalline lens (“lens”) versus the eye excluding the lens (“globe”) for the fellow, noncataractous eyes of participants in the Infant Aphakia Treatment Study. Design: Retrospective cohort study. Subjects: A total of 114 children who had unilateral cataract surgery as infants were recruited. Biometric and refraction data were obtained from the normal eyes at surgery and at 1, 5, and 10 years. Subjects were included if complete data (axial length [AL], corneal power, and refraction) were available at surgery and at 10 years of age. Methods: At surgery and at 1, 5, and 10 years, AL, corneal power, and cycloplegic refraction were measured in the normal eyes. For each eye, the RRG3 was defined by linear regression of refraction at the intraocular lens (IOL) plane against log10 (age + 0.6 years). The RRG3 for the globe was based on IOL power for emmetropia; the RRG3 for the lens was based on IOL power calculated to give the observed refractions. Intraocular lens powers were calculated with the Holladay 1 formula. The means were compared with a paired 2-tailed t test, and linear regression was used to look for a correlation between RRG3 of the lens globe. Main Outcome Measures: The RRG3 of the lens and globe. Results: Complete data were available for 107 normal eyes. The mean RRG3 of the lenses was −12.0 ± 2.5 diopters (D) and the mean RRG3 of the globes was −14.1 ± 2.7 D (P < 0.001). The RRG3 of the lens correlated with the RRG3 of the globe (R2 = 0.25, P < 0.001). Conclusions: The RRG3 was 2 D more negative in globes compared with lenses in normal eyes. Globes with a greater rate of growth tended to have lenses with a greater rate of growth.

Purpose: To determine the cumulative incidence of retinal detachment (RD) repair following pediatric cataract surgery and identify the associated risk factors. Design: US population-based insurance claims retrospective cohort study. Participants: Patients ≤ 18 years old who underwent cataract surgery in 2 large databases: Optum Clinformatics (2003–2021) and IBM MarketScan (2007–2016). Methods: Individuals with ≥ 6 months of prior enrollment were included, and those with a history of RD, RD repair, traumatic cataract, spherophakia, or ectopia lentis were excluded. The primary outcome was time between initial cataract surgery and RD repair. The risk factors investigated included age, sex, persistent fetal vasculature (PFV), prematurity, intraocular lens (IOL) placement, and pars plana lensectomy approach. Main Outcome Measures: Kaplan–Meier estimated cumulative incidence of RD repair 5 years after cataract surgery and hazard ratios (HRs) with 95% confidence intervals (CIs) from multivariable Cox proportional hazards regression models. Results: Retinal detachment repair was performed on 47 of 3289 children included in this study. The cumulative incidence of RD repair within 5 years of cataract surgery was 2.0% (95% CI, 1.3%–2.6%). Children requiring RD repair were more likely to have a history of prematurity or PFV and less likely to have an IOL placed (all P

To assess the time course of secondary visual axis opacification (VAO) leading to additional surgery after primary intraocular lens (IOL) implantation in children and to describe further surgical outcomes. Comparison of lens types. Single-center, retrospective analysis of children aged 1 to 14 years who underwent cataract surgery with primary IOL implantation. The surgical technique was either in-bag IOL placement with primary posterior capsulotomy and anterior vitrectomy or bag-in-lens IOL placement. We excluded eyes with visually significant ocular comorbidities. Total of 135 eyes of 95 children. Of these, 64 had received an acrylic 3-piece IOL, 51 had an acrylic single-piece IOL, and 20 had an acrylic single-piece bag-in-lens IOL. The median ages at surgery were 53 months (interquartile range [IQR], 35–75), 52 months (27–65), and 60 months (40–84) in the 3-piece, 1-piece, and bag-in-lens groups, respectively. Analysis of medical records. We used the Kaplan–Meier method and a Cox proportional hazards model with predefined adjustments for age at surgery, year of surgery, and the German Index of Socioeconomic Deprivation (score by postal code) to analyze VAO-free survival by lens type. Patients were invited to attend a clinical visit to achieve longer follow-ups. The rate of survival without VAO that required clearing of the visual axis after cataract surgery with primary IOL implantation. Any other surgical complications. The overall median follow-up was 19 months (IQR, 3–58). There were 13 cases of VAO, occurring at a median of 10 months (IQR, 10–12) after surgery. Of these, 1 eye had a 3-piece in-bag IOL, 10 eyes had 1-piece in-bag IOLs, and 2 eyes had bag-in-lens IOLs. The adjusted hazard ratio was 32.8 (95% confidence interval [CI], 3.3–327, P = 0.003) for 1-piece acrylic IOLs and 19.6 (CI, 1.22–316, P = 0.036) for bag-in-lens IOLs, compared with 3-piece acrylic in-bag IOLs. Two eyes with bag-in-lens surgery (10%) had an iris capture. There was 1 case of endophthalmitis. We found no cases of postoperative retinal detachment or new glaucoma. Children with secondary VAO who required a procedure to clear the visual axis generally presented within 15 months. Opacification rates were lowest when a 3-piece acrylic IOL was used. [ABSTRACT FROM AUTHOR]

Purpose: To assess the accuracy of the Kane formula for intraocular lens (IOL) power calculation in the pediatric population. Methods: The charts of pediatric patients who underwent cataract surgery with in-the-bag IOL implantation with one of two IOL models (SA60AT or MA60AC) between 2012 and 2018 in The Hospital for Sick Children, Toronto, Ontario, CanFada, were retrospectively reviewed. The accuracy of IOL power calculation with the Kane formula was evaluated in comparison with the Barrett Universal II (BUII), Haigis, Hoffer Q, Holladay 1, and Sanders-Retzlaff-Kraff Theoretical (SRK/T) formulas. Results: Sixty-two eyes of 62 patients aged 6.2 (IQR 3.2–9.2) years were included. The SD values of the prediction error obtained by Kane (1.38) were comparable with those by BUII (1.34), Hoffer Q (1.37), SRK/T (1.40), Holaday 1 (1.41), and Haigis (1.50), all p > 0.05. A significant difference was observed between the Hoffer Q and Haigis formulas (p = 0.039). No differences in the median and mean absolute errors were found between the Kane formula (0.54 D and 0.91 ± 1.04 D) and BUII (0.50 D and 0.88 ± 1.00 D), Hoffer Q (0.48 D and 0.88 ± 1.05 D), SRK/T (0.72 D and 0.97 ± 1.00 D), Holladay 1 (0.63 D and 0.94 ± 1.05 D), and Haigis (0.57 D and 0.98 ± 1.13 D), p = 0.099. Conclusion: This is the first study to investigate the Kane formula in pediatric cataract surgery. Our results place the Kane among the noteworthy IOL power calculation formulas in this age group, offering an additional means for improving IOL calculation in pediatric cataract surgery. The heteroscedastic statistical method was first implemented to evaluate formulas' predictability in children. [ABSTRACT FROM AUTHOR]

Purpose: To report the etiology, clinical presentation, and morphology of congenital cataract in a tertiary care center. Methods: It is a prospective cohort study conducted at L V Prasad Eye Institute, Hyderabad. All children with congenital cataract ≤ 12 months of age that required surgical intervention between August 2015 and July 2016 were included in the study. 109 such patients were subjected to meticulous history taking, pedigree charting, ocular, and systemic examination, B-scan, TORCH testing, clinical photographs, pediatrician consult and blood tests, which included serum calcium, serum phosphorous and urine for reducing sugars. Results: The mean age of presentation was 4.1 months (±2.6 months) and both the genders were equally affected (P = 0.49). Eighty-five patients (77.9%) presented with bilateral cataracts while 24 patients had a unilateral presentation (22.1%). The common morphological presentation was either a total or a nuclear cataract, both variants noticed in 47 patients (43.1%). TORCH infections were responsible for a maximum (37 patients, 33.4%) number of cases followed by familial (20 patients, 18%) and developmental anomalies (11 patients, 10.1%) while the total number of idiopathic cases were 24% (27 patients). Eighteen patients (16.5%) had congenital heart defects and the majority (16 patients, 88.9%) of these had positive TORCH titres. Conclusion: Familial cataract and those possibly due to TORCH are still the predominant cause of congenital cataract in this series-highlighting the role of vaccination and preventive measures.

Purpose: To assess the outcome of under-correction of intraocular lens (IOL) power in pediatric cataract surgery. Methods: We collected clinical data of 103 patients (181 eyes), all aged ≤15 years, who had undergone cataract surgery by a surgeon during 2006–2016. The mean duration of follow-up was 73 ± 38 months (range: 24–108). IOL power was calculated by Hoffer Q formula in axial length (AL) 10 years old. Results: The mean age of all children at surgery time was 5.85 ± 4.56 years (range: 1–178 months). There was a mean myopic shift of −6.379 D in the ≤1 year, −5.532 in the 1–3, −3.194 in the 3–5, −2.301 in the 5–7, −1.06 in the 7–9, −1.567 in the 9–10, and 0.114 in the >10-year-old age group. In 125 eyes (69.1%) of 181, the final SE was between −2 and +2 D, and 21 eyes (11.6%) achieved the goal of emmetropization. Mean best-corrected visual acuity logarithm of the minimum angle of the resolution was 0.30 in children ≤1 year, 0.39 in 1–3, 0.21 in 3–5, 0.18 in 5–7, 0.14 in 7–9, 0.16 in 9–10, and 0.11 in children >10 years old. Conclusion: This study shows a larger myopic shift in younger children. Using our approach, all age groups could finally achieve acceptable final refraction.

AimTo investigate the change of posterior capsular outcomes of pediatric cataract surgery with primary in-the-bag intraocular lens (IOL) implantation.MethodsWe conducted a case series of pediatric cataract children who underwent cataract extraction with primary in-the-bag IOL implantation, posterior capsulorhexis or vitrectorhexis, and limited anterior vitrectomy at the Eye Hospital of Wenzhou Medical University between 2016 and 2019. Digital retro-illumination photographs of pediatric eyes were obtained at baseline and 6 months, 12 months, and the last visit postoperatively. Capsular outcomes of the posterior capsular opening area (PCOA) and lens reprolifration area at those time points were compared. Correlations between the PCOA and influential factors, such as age at surgery, axial growth, and follow-up duration, were analyzed. The study was registered at register.clinicaltrials.gov (NCT04803097).ResultsData of 23 patients (27 eyes) were used in the final analysis. During follow-up, the PCOA enlarged at a rate of 0.29–0.32 mm2/month during the first six months postoperatively and 0.05–0.08 mm2/month over the next 1–2 years. Six months postoperatively, the PCOA enlargement statistically and positively correlated with the follow-up duration and axial growth. The area of lens reprolifration was 0.46 ± 1.00 mm2 at six months postoperatively and then remained stable.ConclusionThe PCOA enlarged rapidly within the first six months after the pediatric cataract surgery with primary IOL implantation. Six months postoperatively, the enlargement of PCOA was positively correlated with follow-up duration and axial growth. Posterior capsulorhexis or capsulectomy should be performed with a diameter of 3.0 to 4.0 mm for good visual axis transparency and the protection of in-the-bag IOL.

Background: Following penetrating keratoplasty, cataract surgery warrants certain modifications to ensure maximum survival of the graft. Purpose: To emphasize the intraoperative challenges and surgical manipulations to be followed. Synopsis: The surgeon makes a superior sclerocorneal tunnel avoiding the graft host junction. Dispersive viscoelastic is used. Continuous curvilinear capsulorhexis is done. Cataractous lens aspirated with a low flow rate. The intraocular lens is placed in the bag. Superior peripheral iridectomy and primary posterior capsulorhexis are done. The wound closed with two interrupted 10–0 nylon sutures. Graft host junction integrity is maintained. Highlights: Ensure 1. Good intraoperative corneal visibility, 2. Avoid graft host junction for main port incision 3. Generous dispersive viscoelastic use/soft shell technique to protect the corneal endothelium, 4. Avoid phaco energy in case of soft cataracts/low phaco energy and flow rates, 5. Phaco probe to be meticulously oriented away from corneal endothelium, 6. Primary posterior capsulorhexis to be done as in any pediatric cataract surgery, 7. Make sure of the graft host junction integrity at the end of the surgery, 8. Restrict to a single port whenever possible. Video link: https://youtu.be/tu4R5JangYs

Background: Bilateral cataract is a significant cause of blindness in children in Ethiopia. This study aimed to identify the resources available for cataract surgery in children, and to assess current surgical practices, surgical output and factors affecting the outcome of surgery in Ethiopia. Methods: A Google Forms mobile phone questionnaire was emailed to nine ophthalmologists known to perform cataract surgery in young children (0-5 years). Results: All nine responded. All but one had received either 12- or 3-5-month's training in pediatric ophthalmology with hands-on surgical training. The other surgeon had received informal training from an experienced colleague and visiting ophthalmologists. The surgeons were based in seven health facilities: five in the capital (Addis Ababa) and eight in six public referral hospitals and one private center. Over 12 months (2017-2018) 508 children (592 eyes) aged 0-18 years (most < 15 years) were operated by these surgeons. 84 (17%) had bilateral cataract, and 424 (83%) had unilateral cataract mainly following trauma. A mean of 66 (range 18-145) eyes were operated per surgeon. Seventy-one additional children aged > 5 years were operated by other surgeons. There were substantially fewer surgeons per million population (nine for 115 million population) than recommended by the World Health Organization and they were unevenly distributed across the country. Methylcellulose and rigid intraocular lenses were generally available but less than 50% of facilities had a sharp vitrectomy cutter and cohesive viscoelastic. Mean travel time outside Addis Ababa to a facility offering pediatric cataract surgery was 10 h. Conclusion: Despite the high number of cases per surgeon, the output for bilateral cataracts was far lower than required. More well-equipped pediatric ophthalmology teams are urgently required, with deployment to underserved areas. [ABSTRACT FROM AUTHOR]

Purpose: To assess the outcome of under-correction of intraocular lens (IOL) power in pediatric cataract surgery.Methods: We collected clinical data of 103 patients (181 eyes), all aged ≤15 years, who had undergone cataract surgery by a surgeon during 2006-2016. The mean duration of follow-up was 73 ± 38 months (range: 24-108). IOL power was calculated by Hoffer Q formula in axial length (AL) <21 mm and SRKT formula in AL ≥21 mm and then modified based on this approach: 7D initial inductive hypermetropization in children ≤1-year-old, 5D in 1-3, 3.5D in 3-5, 2.5D in 5-7, 1.5D in 7-9, 1D in 9-10, and 0 in children >10 years old.Results: The mean age of all children at surgery time was 5.85 ± 4.56 years (range: 1-178 months). There was a mean myopic shift of -6.379 D in the ≤1 year, -5.532 in the 1-3, -3.194 in the 3-5, -2.301 in the 5-7, -1.06 in the 7-9, -1.567 in the 9-10, and 0.114 in the >10-year-old age group. In 125 eyes (69.1%) of 181, the final SE was between -2 and +2 D, and 21 eyes (11.6%) achieved the goal of emmetropization. Mean best-corrected visual acuity logarithm of the minimum angle of the resolution was 0.30 in children ≤1 year, 0.39 in 1-3, 0.21 in 3-5, 0.18 in 5-7, 0.14 in 7-9, 0.16 in 9-10, and 0.11 in children >10 years old.Conclusion: This study shows a larger myopic shift in younger children. Using our approach, all age groups could finally achieve acceptable final refraction. [ABSTRACT FROM AUTHOR]

Purpose: To report the etiology, clinical presentation, and morphology of congenital cataract in a tertiary care center.Methods: It is a prospective cohort study conducted at L V Prasad Eye Institute, Hyderabad. All children with congenital cataract ≤ 12 months of age that required surgical intervention between August 2015 and July 2016 were included in the study. 109 such patients were subjected to meticulous history taking, pedigree charting, ocular, and systemic examination, B-scan, TORCH testing, clinical photographs, pediatrician consult and blood tests, which included serum calcium, serum phosphorous and urine for reducing sugars.Results: The mean age of presentation was 4.1 months (±2.6 months) and both the genders were equally affected (P = 0.49). Eighty-five patients (77.9%) presented with bilateral cataracts while 24 patients had a unilateral presentation (22.1%). The common morphological presentation was either a total or a nuclear cataract, both variants noticed in 47 patients (43.1%). TORCH infections were responsible for a maximum (37 patients, 33.4%) number of cases followed by familial (20 patients, 18%) and developmental anomalies (11 patients, 10.1%) while the total number of idiopathic cases were 24% (27 patients). Eighteen patients (16.5%) had congenital heart defects and the majority (16 patients, 88.9%) of these had positive TORCH titres.Conclusion: Familial cataract and those possibly due to TORCH are still the predominant cause of congenital cataract in this series-highlighting the role of vaccination and preventive measures. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate the outcomes of pediatric developmental cataract surgery with primary intraocular lens (IOL) implantation. Materials and Methods: Patients between 2 and 16 years old who underwent cataract surgery with primary IOL implantation were retrospectively evaluated. Age at time of surgery, pre- and postoperative best corrected visual acuities, postoperative ocular complications, and any accompanying ocular pathologies were obtained from the patients’ charts. Mean refractive changes and degree of myopic shift were analyzed according to the age groups. Operated eyes were also compared with the fellow eyes in unilateral cases. Results: A total of 101 eyes of 65 patients were included. The average age at time of surgery was 76±40 months and the average follow-up period was 44±30 months. Among the 78 eyes that could be assessed for visual acuity improvement, 66 (84.6%) of them showed ≥2 lines of improvement. The difference in the mean refractive change between the 2-5 years old and 8-16 years old age groups was found to be statistically significant. However, the mean refractive change per year was not found to be significant between the same age groups. In unilateral cases, the operated eyes showed a greater myopic change than the fellow eyes, with no statistically significant difference. The most common postoperative complication was visual axis opacity. Conclusion: Good visual outcomes can be achieved following pediatric cataract surgery with primary IOL implantation. Optic axis opacities were the most common postoperative complications. Overall, refractive changes following surgery are inevitable, and more prominent in younger age groups.

Purpose: The purpose of the study is to compare the efficiency as well as the rate and type of suture-related complications between 10-0 monofilament nylon (Aurolab Nylon Sutures, double arm, Aurolab) and 10-0 polyglactin 910 sutures (Vicryl, single arm, Aurolab) for pediatric cataract surgery. Methods: It is a prospective, comparative study performed in children who underwent surgery for congenital or developmental cataract from March 2013 to February 2016. Patients underwent suturing with either nylon or Vicryl in unilateral cases, but in most bilateral surgeries, one eye received Vicryl sutures while the other eye received nylon. The sutures were compared for their complications and the need for suture removal. Results: Forty-one children (72 eyes) were included in the study, of which 31 children (62 eyes) underwent bilateral surgery while 10 (10 eyes) underwent unilateral surgery. Sixty-four nylon sutures were placed in 32 children (34 eyes), of which 22 (34.4%) were removed due to suture-related complications, whereas 14 (19.7%) (P = 0.03) of the 71 Vicryl sutures placed in 32 children (38 eyes) needed suture removal at an average of 2.9 weeks with the earliest at 6 days postoperatively. The odds of Vicryl suture being removed was 0.42 times with respect to nylon. The most common reason encountered for suture removal in both the materials was sutures becoming loose (16.3%), followed by vascularization (14.1%), infiltration (1.5%), and opacification (4.4%). Conclusion: Absorbable suture such as 10-0 Vicryl is preferred over nonabsorbable suture 10-0 nylon for suturing incisions in pediatric cataract surgery, to avoid subjecting the child to repeated anesthesia.

Purpose: The aim of this study is to evaluate the efficacy of intracameral preservative-free triamcinolone acetonide (TA) on reducing inflammatory reactions after pediatric cataract surgery. Methods: Researches were comprehensively searched in PubMed, Embase, and the Cochrane Central Register of Controlled Trials up to 30 November, 2019. Data of interest were extracted and analyzed by Review Manager 5.2. The primary outcome was cell deposits. The secondary outcomes included posterior synechias, fibrinous anterior chamber reaction, visual axis obscuration, and posterior capsule opacification. The odds ratio (OR), weight mean difference (WMD), and their 95% confidence intervals (95% CI) were used to assess the strength of the association. Results: In total, 45 articles were obtained. Finally, 5 studies with a total of 308 eyes were enrolled in this meta-analysis. Among these, 134 eyes underwent intracameral TA treatment and 174 eyes did not. In intracameral TA treatment group, the incidence of cell deposits (OR = 0.35, 95% CI 0.16–0.76, P = 0.008), posterior synechias (OR = 0.44, 95% CI 0.23–0.86, P = 0.02), and fibrinous anterior chamber reaction (OR = 0.12, 95% CI 0.01–1.05, P = 0.05) were lower compared to those in patients without intracameral TA treatment. Meanwhile, the incidence of visual axis obscuration (OR = 0.10, 95% CI 0.01–0.85, P = 0.04) and posterior capsule opacification (OR = 0.09, 95% CI 0.02–0.55, P = 0.009) were also reduced significantly. The intraocular pressure (IOP) was evaluated at the first month postoperatively (WMD = 0.84 mmHg, 95% CI 0.14–1.53, P = 0.02), but within the normal range. There was no difference of IOP between two groups at 6 months or above after operation (P = 0.93). Conclusions: The intracameral preservative-free TA in pediatric cataract surgery contributed to much less inflammatory reaction with the normal IOP range. [ABSTRACT FROM AUTHOR]

"AIM: To compare visual prognoses and postoperative adverse events of congenital cataract surgery performed at different times and using different surgical approaches. METHODS: In this prospective, randomized controlled trial, we recruited congenital cataract patients aged 3mo or younger before cataract surgery. Sixty-one eligible patients were randomly assigned to two groups according to surgical timing: a 3-month-old group and a 6-month-old group. Each eye underwent one of three randomly assigned surgical procedures, as follows: surgery A, lens aspiration (I/A); surgery B, lens aspiration with posterior continuous curvilinear capsulorhexis (I/A+PCCC); and surgery C, lens aspiration with posterior continuous curvilinear capsulorhexis and anterior vitrectomy (I/A+PCCC+A-Vit). The long-term best-corrected visual acuity (BCVA) and the incidence of complications in the different groups were compared and analyzed. RESULTS: A total of 57 participants (114 eyes) with a mean follow-up period of 48.7mo were included in the final analysis. The overall logMAR BCVA in the 6-month-old group was better than that in the 3-month-old group (0.81±0.28 vs 0.96±0.30; P=0.02). The overall logMAR BCVA scores in the surgery B group were lower than the scores in the A and C groups (A: 0.80±0.29, B: 1.02±0.28, and C: 0.84±0.28; P=0.007). A multivariate linear regression revealed no significant relationships between the incidence of complications and long-term BCVA. CONCLUSION: It might be safer and more beneficial for bilateral total congenital cataract patients to undergo surgery at 6mo of age than 3mo. Moreover, with rigorous follow-up and timely intervention, the postoperative complications in these patients are treatable and do not compromise visual outcomes."

A 6-month-old baby was referred to our clinic for visually significant cataract in the left eye. Dens posterior lens opacity with hemorrhage was evident in the anterior segment evaluation. B-scan ultrasonography of the eye showed anechoic posterior segment. During the cataract surgery vascular remnants became evident after irrigation of the cloth in the anterior chamber. Histopathological examination of the vascular structure and cataract revealed fibrin formation, reactive lens epithelial hyperplasia and vascular endothelium, which were though to be remnants of tunica vasculosa lentis. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate the long-term outcomes of primary pediatric cataract surgery and to identify determinants of success and recommendations to improve the care of patients with pediatric cataracts., Methods: A cohort, retrospective study of cases who were operated as primary pediatric cataract surgery at King Khaled Eye Specialist Hospital. Patients who are 4 years old or younger and underwent primary cataract surgery with at least 3-year follow-up were enrolled in this study. Preoperative and postoperative evaluations were performed to determine the surgery outcomes., Results: Two hundred and two eyes of 119 patients were enrolled in the study. Seventy percentage of the patients were diagnosed with bilateral cataracts and 30% with unilateral cataracts. Postoperative evaluation showed that 20% of the patients had best corrected visual acuity of 20/30 or better, 25% had 20/40-20/50, 20% had 20/60-20/80, and 29% had 20/100 or less, 6% as fixate and follow. In addition, the mean spherical equivalent was 1.50D. Amblyopia was present in 120 eyes. Fourteen percentage showed a significant myopic shift of more than -4.00D and it was more in eyes with primary intraocular lens (IOL) implantation. Glaucoma was reported in 19% of the patients., Conclusion: There was a significant postoperative myopic shift and it was more in eyes with primary IOL implantation. Glaucoma was the most common reported postoperative complication. The presence of strabismus and nystagmus may affect the visual outcomes. Early intervention might reduce the incidence of amblyopia., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Saudi Journal of Ophthalmology.)

Purpose: The purpose of the study is to compare the efficiency as well as the rate and type of suture-related complications between 10-0 monofilament nylon (Aurolab Nylon Sutures, double arm, Aurolab) and 10-0 polyglactin 910 sutures (Vicryl, single arm, Aurolab) for pediatric cataract surgery.Methods: It is a prospective, comparative study performed in children who underwent surgery for congenital or developmental cataract from March 2013 to February 2016. Patients underwent suturing with either nylon or Vicryl in unilateral cases, but in most bilateral surgeries, one eye received Vicryl sutures while the other eye received nylon. The sutures were compared for their complications and the need for suture removal.Results: Forty-one children (72 eyes) were included in the study, of which 31 children (62 eyes) underwent bilateral surgery while 10 (10 eyes) underwent unilateral surgery. Sixty-four nylon sutures were placed in 32 children (34 eyes), of which 22 (34.4%) were removed due to suture-related complications, whereas 14 (19.7%) (P = 0.03) of the 71 Vicryl sutures placed in 32 children (38 eyes) needed suture removal at an average of 2.9 weeks with the earliest at 6 days postoperatively. The odds of Vicryl suture being removed was 0.42 times with respect to nylon. The most common reason encountered for suture removal in both the materials was sutures becoming loose (16.3%), followed by vascularization (14.1%), infiltration (1.5%), and opacification (4.4%).Conclusion: Absorbable suture such as 10-0 Vicryl is preferred over nonabsorbable suture 10-0 nylon for suturing incisions in pediatric cataract surgery, to avoid subjecting the child to repeated anesthesia. [ABSTRACT FROM AUTHOR]

Children cataracts are among the most common causes of treatable blindness and are estimated in about 7-20% of blindness among children. Early detection and timely treatment of congenital cataract is important to prevent the severe forms of amblyopia. Opacification of the lens that is peripheral and does not affect the sharpness of the visual acquity does not need to be operated immediately, but requires careful monitoring. When cataract formation is central and does not allow adequate vision development, operative lens removal is obligated. After removing the natural lens, rehabilitation of visual acuity can be achieved with glasses, contact lenses and with primary or delayed intraocular lens implantation. Recent technological achievements have enabled increased intraocular lens implantation in cataract surgery. Posterior lens capsule obscures in 100% of cases after cataract surgery in children up to 8 years and it is recommended to do the posterior capsulorexis in pediatric cataract surgery. New research will need to introduce clear guidelines since authors are not uniformed in accurate age of ongoing capsulorexis. Amblyopia is the most common complication determined after surgery and it affects most children to a greater or lesser extent. In patients with congenital cataracts, more effective visual rehabilitation is caused by improved screening, better surgical technique and with use of intraocular lenses. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate the outcomes of pediatric developmental cataract surgery with primary intraocular lens (IOL) implantation. Materials and Methods: Patients between 2 and 16 years old who underwent cataract surgery with primary IOL implantation were retrospectively evaluated. Age at time of surgery, pre- and postoperative best corrected visual acuities, postoperative ocular complications, and any accompanying ocular pathologies were obtained from the patients' charts. Mean refractive changes and degree of myopic shift were analyzed according to the age groups. Operated eyes were also compared with the fellow eyes in unilateral cases. Results: A total of 101 eyes of 65 patients were included. The average age at time of surgery was 76±40 months and the average follow-up period was 44±30 months. Among the 78 eyes that could be assessed for visual acuity improvement, 66 (84.6%) of them showed ≥2 lines of improvement. The difference in the mean refractive change between the 2-5 years old and 8-16 years old age groups was found to be statistically significant. However, the mean refractive change per year was not found to be significant between the same age groups. In unilateral cases, the operated eyes showed a greater myopic change than the fellow eyes, with no statistically significant difference. The most common postoperative complication was visual axis opacity. Conclusion: Good visual outcomes can be achieved following pediatric cataract surgery with primary IOL implantation. Optic axis opacities were the most common postoperative complications. Overall, refractive changes following surgery are inevitable, and more prominent in younger age groups. [ABSTRACT FROM AUTHOR]

Background: Following penetrating keratoplasty, cataract surgery warrants certain modifications to ensure maximum survival of the graft. Purpose: To emphasize the intraoperative challenges and surgical manipulations to be followed. Synopsis: The surgeon makes a superior sclerocorneal tunnel avoiding the graft host junction. Dispersive viscoelastic is used. Continuous curvilinear capsulorhexis is done. Cataractous lens aspirated with a low flow rate. The intraocular lens is placed in the bag. Superior peripheral iridectomy and primary posterior capsulorhexis are done. The wound closed with two interrupted 10-0 nylon sutures. Graft host junction integrity is maintained. Highlights: Ensure 1. Good intraoperative corneal visibility, 2. Avoid graft host junction for main port incision 3. Generous dispersive viscoelastic use/soft shell technique to protect the corneal endothelium, 4. Avoid phaco energy in case of soft cataracts/low phaco energy and flow rates, 5. Phaco probe to be meticulously oriented away from corneal endothelium, 6. Primary posterior capsulorhexis to be done as in any pediatric cataract surgery, 7. Make sure of the graft host junction integrity at the end of the surgery, 8. Restrict to a single port whenever possible. [ABSTRACT FROM AUTHOR]

Multifocal and toric intraocular lenses (IOLs) or the so-called premium IOLs are currently widely used in adult patients as a one-step refractive solution following cataract surgery. However, the decision to implant a premium IOL in a pediatric patient involves multiple factors affecting the child's visual development and is associated with several dilemmas and surgical challenges. The purpose of this review is to summarize these factors and analyse the influence of each of them on the visual outcomes following premium IOL implantation. A review of literature was conducted using the relevant keywords from various databases until 31 st January 2022. All pertinent studies with multifocal or toric IOL implantation in children were reviewed, and relevant articles were studied in detail for age, IOL power calculation, visual outcomes (refractive outcomes, contrast sensitivity and stereopsis) and complications such as dysphotic phenomena and others. A total of 17 relevant studies (10 case series/interventional studies and 7 case reports) on the subject were included. All studies showed a favourable refractive outcome; however, the data available was significantly less. Studies with earlier models of multifocal IOLs showed a higher incidence of IOL decentration and posterior capsule opacification; however, more recent studies with newer IOL models showed much better safety profiles. Toric IOLs showed promising results in all the studies evaluated. Premium IOLs have shown promising results in the pediatric age group. However, their long-term outcomes specifically concerning refractive shift, capsular contraction and role in the management of amblyopia needs to be explored further.

Purpose: To present a panoramic review of childhood cataract knowledge networks, hotspots and trends., Methods: The Web of Science Core Collection was used to retrieve the global literature on childhood cataract published between 2012 and 2021. Scientometric data were analyzed and visualized using VOSviewer and CiteSpace for metrics including publication count, citation count, country, journal, author, cited reference, subject category and their temporal trends., Results: A total of 3395 analyzed publications showed an inconsistent annual increasing trend. The USA (n = 939) was the leading contributor among countries. The Journal of American Association for Pediatric Ophthalmology and Strabismus (n = 113) had the highest number of publications among journals. Eight clusters of author collaboration network including 183 authors were identified. Gene mutation, cataract surgery management, intraocular lens implantation complications, prevalence, and glaucoma were identified as the research hotspots. Pediatric cataract surgery, new mutations, artificial intelligence, and cerebrotendinous xanthomatosis were identified as frontier research topics. "Biochemistry and molecular biology", "neurosciences", and "radiology, nuclear medicine and medical imaging" had the highest betweenness centrality values (0.38, 0.32, and 0.22). Multidisciplinary (burst years: 2020 to 2021; strength = 4.32) had the greatest strength as of 2021., Conclusions: Childhood cataract research intensely focuses on revealing the genetic background and pheno-spectrum of the diseases, innovating and/or optimizing surgical techniques, and preventing and treating postoperative complications. Artificial intelligence has shed light on the diagnosis and treatment of childhood cataracts. The advance in the research on molecular mechanisms of childhood cataracts depends on multidisciplinary cooperation., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 Published by Elsevier Ltd.)

This study reports the short-term functional and anatomical outcome of Boston Type 1 keratoprosthesis (Boston Kpro) implantation for bilateral limbal stem cell deficiency (LCSD). Retrospective analysis was done on eight eyes of eight patients who underwent Boston Kpro implantation between July 2009 and October 2009. The best corrected visual acuity (BCVA) and slit-lamp biomicroscopy findings were assessed at 1, 3 and 6 months postoperatively. All eight eyes retained the prosthesis. BCVA of 20/40 or better was achieved in 8, 6, and 5 eyes at 1, 3, and 6 months, respectively, postoperatively. One patient each developed epithelial defect, sterile stromal melt and fungal keratitis in the late postoperative period associated with antecedent loss of the soft contact lens from the eye. Boston Kpro has good short-term visual and anatomical outcome in patients with bilateral LSCD, provided compliance with postoperative care can be ensured.

Context : Pediatric cataract surgery is traditionally done with the aid of high-molecular-weight viscoelastics which are expensive. It needs to be determined if low-cost substitutes are just as successful. Aims : The study aims to determine the success rates for anterior and posterior capsulorrhexis and intraocular lens (IOL) implantation in the bag for pediatric cataract surgery performed with the aid of a low-molecular-weight viscoelastic. Settings and Design : Nonrandomized observational study. Materials and Methods: Children less than 6 years of age who underwent cataract surgery with IOL implantation in the period May 2008-May 2009 were included. The surgeries were done by pediatric ophthalmology fellows. A standard procedure of anterior capsulorrhexis, lens aspiration with primary posterior capsulorrhexis, anterior vitrectomy, and IOL implantation was followed. Three parameters were studied: successful completion of anterior and posterior capsulorrhexis and IOL implantation in the bag. Results: 33 eyes of 28 children were studied. The success rate for completion was 66.7% and 88.2 % for anterior and posterior capsulorrhexis, respectively. IOL implantation in the bag was successful in 87.9%. Conclusions: 2% hydroxypropylmethylcellulose is a viable low-cost alternative to more expensive options similar to high-molecular-weight viscoelastics. This is of great relevance to hospitals in developing countries.

Visual axis opacification (VAO) occurs in up to 40% of pediatric patients after cataract surgery withintraocular lens implantation(IOL) even with a primary posterior capsulotomy (PPC). In both children and adult group, opacification does obscure the visual axis. However, in children after PPC, there is no capsule. Hence, the terminology VAO is used in children rather than posterior capsular opacification. This opacification is caused by a proliferation of epithelial cells on the posterior capsule or anterior vitreous face and can hinder the optical image quality needed for normal visual development. The rate of epithelial mitotic activity is higher in children compared to adult. It can be managed by Yag laser or surgical membranectomy, the latter is preferable. International and national published articles were systematically reviewed on aetio-pathogenesis, surgical techniques and equipment, type and material of IOL, and management of VAO in children operated for cataract. Author's experience was also included to write manuscript. VAO is frequent complication following cataract surgery in pediatric patients. Age of cataract patients, surgical technique and type and materials of IOL are most common influencing factor for VAO. Immediate management with advance equipment of VAO reduces the incidence for development of irreversible stimulation deprivation amblyopia. Keywords: pediatric cataract; pediatric cataract surgery; visual axis opacification.

Purpose: To determine the cumulative incidence of strabismus surgery after pediatric cataract surgery and identify the associated risk factors., Design: US population-based insurance claims retrospective cohort study., Participants: Patients ≤ 18 years old who underwent cataract surgery in 2 large databases: Optum Clinformatics Data Mart (2003-2021) and IBM MarketScan (2007-2016)., Methods: Individuals with at least 6 months of prior enrollment were included, and those with a history of strabismus surgery were excluded. The primary outcome was strabismus surgery within 5 years of cataract surgery. The risk factors investigated included age, sex, persistent fetal vasculature (PFV), intraocular lens (IOL) placement, nystagmus and strabismus diagnoses before cataract surgery, and cataract surgery laterality., Main Outcome Measures: Kaplan-Meier estimated cumulative incidence of strabismus surgery 5 years after cataract surgery and hazard ratios (HRs) with 95% confidence intervals (CIs) from multivariable Cox proportional hazards regression models., Results: Strabismus surgery was performed on 271/5822 children included in this study. The cumulative incidence of strabismus surgery within 5 years after cataract surgery was 9.6% (95% CI, 8.3%-10.9%). Children who underwent strabismus surgery were more likely to be of younger age at the time of cataract surgery, of female sex, have a history of PFV or nystagmus, have a pre-existing strabismus diagnosis, and less likely to have an IOL placed (all P < 0.001). Factors associated with strabismus surgery in the multivariable analysis included age 1 to 4 years (HR, 0.50; 95% CI, 0.36-0.69; P < 0.001) and age > 5 years (HR, 0.13; 95% CI, 0.09-0.18; P  < 0.001) compared with age < 1 year at time of cataract surgery, male sex (HR, 0.75; 95% CI, 0.59-0.95; P  < 0.001), IOL placement (HR, 0.71; 95% CI, 0.54-0.94; P  = 0.016), and strabismus diagnosis before cataract surgery (HR, 4.13; 95% CI, 3.17-5.38; P < 0.001). Among patients with strabismus diagnosis before cataract surgery, younger age at cataract surgery was the only factor associated with increased risk of strabismus surgery., Conclusions: Approximately 10% of patients will undergo strabismus surgery within 5 years after pediatric cataract surgery. Children of younger age, female sex, and with a pre-existing strabismus diagnosis undergoing cataract surgery without IOL placement are at greater risk., Financial Disclosures: The author(s) have no proprietary or commercial interest in any materials discussed in this article., (© 2023 Published by Elsevier Inc. on behalf of American Academy of Ophthalmology.)

Purpose: To evaluate the early and late post-operative results of the multifocal intraocular lens (IOL) implantation in pediatric cases. Material and Methods: Eleven eyes of 9 patients aged 5 to 11 years who underwent multifocal IOL implantation were enrolled. Pre and post-operative distance/near visual acuities with and without correction, spectacle usage, binocular function, contrast sensitivity, complications and subjective symptoms were evaluated. Results: Standard lensectomy surgery and multifocal IOL (Acrysof Restor SN6AD3) implantation was performed in all eyes. The mean age was 7.18±2.08 and the mean follow-up period was 43.8±13.2 months. Mean corrected visual acuity was 0.16±0.11 pre-operatively, and 0.63±0.15 in the early and 0.77±0.18 in the late post-operative period. Post-operative near visual acuity with distance correction was 0.34 in both the early and late periods. With additional near correction, visual acuities were 0.44±0.13 and 0.52±0.13 in the early and late periods, respectively. Two patients reported using spectacles for only distance post-operatively. Contrast sensitivity was Affected only in higher spatial frequencies in 75% of the eyes and both in lower and higher spatial frequencies in 12.5%. Posterior capsular opacification developed in all patients at the end of 18 months. YAG laser capsulotomy solved the problem in 8 eyes whereas pars plana capsulotomy was required in 3 eyes. Conclusion: Implantation of multifocal IOLs could be a satisfactory alternative in pediatric population above age 5, with better control of amblyopia, more patient comfort and less spectacle dependency. Long-term studies with big series are needed to show the safety and efficacy of multifocal IOLs in this age group. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate visual results and complications after bilateral implantation of multifocal versus monofocal intraocular lens (IOL) in children above five years of age. Methods: In this prospective non-randomized controlled trial, children with bilateral developmental cataract above five years of age were divided into two groups - Group A implanted with multifocal IOL (both refractive and diffractive) and Group B implanted with monofocal IOL in both eyes. Outcome measures of best corrected visual acuity (BCVA) for distance, distance-corrected near visual acuity (DCNVA), mean refractive spherical equivalent (MRSE), contrast sensitivity, stereopsis and complications such as posterior capsular opacification (PCO) and glare were analyzed using the Mann-Whitney U and the Wilcoxon Signed Rank tests. Results: Forty-two eyes of 21 children (mean age: 7.19 years, range: 5-12 years) were included in the study. Group A included 14 eyes (seven children) Group B included 28 eyes (14 children). Both groups showed significant improvement in BCVA at one year follow-up, but no significant difference was found on comparing contrast sensitivity. Stereopsis was slightly better in Group A (125.71 arc-sec) as compared to Group B (140 arc-sec) ( p = 0.280). Most patients in Group A were spectacle-independent for near (71.4 %) versus Group B. MRSE at one year was 0.21 in Group A and 0.5 in Group B. Incidence of PCO was similar in either groups (35.7 %). No intraoperative complication was noted in any child. Conclusion: Multifocal IOL implantation is a viable option in children above five years of age with bilateral cataract. [ABSTRACT FROM AUTHOR]