Surgical Management of Pediatric Cataract

  • Sudarshan Kumar Khokhar
  • Chirakshi Dhull
  • Yogita Gupta


The aim of surgery is not just to clear visual axis but also to maintain clear visual axis for a long time. Success of pediatric cataract surgery depends on meticulous surgery, close follow-up, and compliance to visual rehabilitation aids. Surgery is not required in all cases of cataract. It is recommended in visually significant cataract >3 mm [1], dense nuclear or posterior cataracts, cataracts not permitting fundus evaluation, and those associated with nystagmus or strabismus.


  1. 1.
    Vasavada AR, Nihalani BR. Pediatric cataract surgery. Curr Opin Ophthalmol. 2006;17:54–61.PubMedGoogle Scholar
  2. 2.
    Beck AD, Freedman SF, Lynn MJ, Bothun E, Neely DE, Lambert SR. Glaucoma-related adverse events in the infant Aphakia treatment study: 1-year results. Arch Ophthalmol. 2012;130:300–5.CrossRefGoogle Scholar
  3. 3.
    Freedman SF, Lynn MJ, Beck AD, et al. Glaucoma-related adverse events in the first 5 years after unilateral cataract removal in the infant Aphakia treatment study. JAMA Ophthalmol. 2015;133:907–14.CrossRefGoogle Scholar
  4. 4.
    Birch EE, Stager DR. The critical period for surgical treatment of dense congenital unilateral cataract. Invest Ophthalmol Vis Sci. 1996;37:1532–8.PubMedGoogle Scholar
  5. 5.
    Hartmann EE, Lynn MJ, Lambert SR. Infant Aphakia treatment study G. Baseline characteristics of the infant aphakia treatment study population: predicting recognition acuity at 4.5 years of age. Invest Ophthalmol Vis Sci. 2015;56:388–95.CrossRefGoogle Scholar
  6. 6.
    Khokhar SK, Pillay G, Dhull C, Agarwal E, Mahabir M, Aggarwal P. Pediatric cataract. Indian J Ophthalmol. 2017;65(12):1340–9.CrossRefGoogle Scholar
  7. 7.
    Gayer S, Tutiven J. Anesthesia for pediatric ocular surgery. Ophthalmol Clin North Am. 2006;19(2):269–78.PubMedGoogle Scholar
  8. 8.
    Bar-Sela SM, Spierer A. Astigmatism outcomes of scleral tunnel and clear corneal incisions for congenital cataract surgery. Eye (Lond). 2006;20:1044–8.CrossRefGoogle Scholar
  9. 9.
    Matsumoto Y, Hara T, Chiba K, et al. Optimal incision sites to obtain an astigmatism-free cornea after cataract surgery with a 3.2 mm sutureless incision. J Cataract Refract Surg. 2001;27:1615–9.CrossRefGoogle Scholar
  10. 10.
    Wilson ME Jr. Anterior lens capsule management in pediatric cataract surgery. Trans Am Ophthalmol Soc. 2004;102:391–422.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Krag S, Olsen T, Andreassen TT. Biomechanical characteristics of the human anterior lens capsule in relation to age. Invest Ophthalmol Vis Sci. 1997;38:357–63.PubMedGoogle Scholar
  12. 12.
    Taylor D. Choice of surgical technique in the management of congenital cataract. Trans Ophthalmol Soc U K. 1981;101:114–7.PubMedGoogle Scholar
  13. 13.
    Wilson ME, Saunders RA, Roberts EL, et al. Mechanized anterior capsulectomy as an alternative to manual capsulorhexis in children undergoing intraocular lens implantation. J Pediatr Ophthalmol Strabismus. 1996;33:237–40.PubMedGoogle Scholar
  14. 14.
    Comer RM, Abdulla N, O’Keefe M. Radiofrequency diathermy capsulorhexis of the anterior and posterior capsules in pediatric cataract surgery: preliminary results. J Cataract Refract Surg. 1997;23(Suppl 1):641–4.CrossRefGoogle Scholar
  15. 15.
    Kloti R. Anterior high frequency capsulotomy. I. Experimental study. Klin Monbl Augenheilkd. 1992;200:507–10.CrossRefGoogle Scholar
  16. 16.
    Fugo RJ, Delcampo DM. The Fugo blade: the next step after capsulorhexis. Ann Ophthalmol. 2001;33:13–20.Google Scholar
  17. 17.
    Khokhar S, Tejwani LK, Kumar G, Kushmesh R. Approach to cataract with persistent hyperplastic primary vitreous. J Cataract Refract Surg. 2011;37:1382–5.CrossRefGoogle Scholar
  18. 18.
    Palanker DV, Blumenkranz MS, Andersen D, et al. Femtosecond laser assisted cataract surgery with integrated optical coherence tomography. Sci Transl Med. 2010;2:58–85.CrossRefGoogle Scholar
  19. 19.
    Toropygin SG, Krause M, Akkaya A, et al. Experimental femtosecond laser-assisted nanosurgery of anterior lens capsule. Eur J Ophthalmol. 2011;21:237–42.CrossRefGoogle Scholar
  20. 20.
    Vasavada AR, Trivedi RH, Apple DJ, et al. Randomized, clinical trial of multiquadrant hydrodissection in pediatric cataract surgery. Am J Ophthalmol. 2003;135:84–8.CrossRefGoogle Scholar
  21. 21.
    Parks MM. Management of the posterior capsule in congenital cataracts. J Pediatr Ophthalmol Strabismus. 1984;21:114–7.PubMedGoogle Scholar
  22. 22.
    BenEzra D, Cohen E. Posterior capsulectomy in pediatric cataract surgery the necessity of a choice. Ophthalmology. 1997;104:2168–74.CrossRefGoogle Scholar
  23. 23.
    Vasavada A, Desai J. Primary posterior capsulorhexis with and without anterior vitrectomy in congenital cataracts. J Cataract Refract Surg. 1997;23(Suppl 1):645–51.CrossRefGoogle Scholar
  24. 24.
    Alexandrakis G, Peterseim MM, Wilson ME. Clinical outcomes of pars plana capsulotomy with anterior vitrectomy in pediatric cataract surgery. J AAPOS. 2002;6:163–7.CrossRefGoogle Scholar
  25. 25.
    Guo S, Wagner RS, Caputo A. Management of the anterior and posterior lens capsules and vitreous in pediatric cataract surgery. J Pediatr Ophthalmol Strabismus. 2004;41:330–7.CrossRefGoogle Scholar
  26. 26.
    Lin AA, Buckley EG. Update on pediatric cataract surgery and intraocular lens implantation. Curr Opin Ophthalmol. 2010;21:55–9.CrossRefGoogle Scholar
  27. 27.
    Burk SE, Da Mata AP, Snyder ME, et al. Visualizing vitreous using Kenalog suspension. J Cataract Refract Surg. 2003;29:645–51.CrossRefGoogle Scholar
  28. 28.
    Khokhar S, Sharma R, Patil B, Sinha G, Nayak B, Kinkhabwala RA, et al. A safe technique for in-the-bag intraocular lens implantation in pediatric cataract surgery. Eur J Ophthalmol. 2015;25:57–9.CrossRefGoogle Scholar
  29. 29.
    Gimbel HV, DeBroff BM. Intraocular lens optic capture. J Cataract Refract Surg. 2004;30:200–6.CrossRefGoogle Scholar
  30. 30.
    Raina UK, Gupta V, Arora R, et al. Posterior continuous curvilinear capsulorhexis with and without optic capture of the posterior chamber intraocular lens in the absence of vitrectomy. J Pediatr Ophthalmol Strabismus. 2002;39:278–87.CrossRefGoogle Scholar
  31. 31.
    Zhou HW, Zhou F. A meta-analysis on the clinical efficacy and safety of optic capture in pediatric cataract surgery. Int J Ophthalmol. 2016;9:590–6.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Nihalani BR, Vanderveen DK. Secondary intraocular lens implantation after pediatric aphakia. J AAPOS. 2011;15:435–40.CrossRefGoogle Scholar
  33. 33.
    Kim DH, Kim JH, Kim SJ, et al. Long-term results of bilateral congenital cataract treated with early cataract surgery, aphakic glasses and secondary IOL implantation. Acta Ophthalmol. 2012;90:231–6.CrossRefGoogle Scholar
  34. 34.
    Wilson ME Jr, Hafez GA, Trivedi RH. Secondary in-the-bag intraocular lens implantation in children who have been aphakic since early infancy. J AAPOS. 2011;15:162–6.CrossRefGoogle Scholar
  35. 35.
    Grewal DS, Basti S. Modified technique for removal of Soemmering ring and in-the-bag secondary intraocular lens placement in aphakic eyes. J Cataract Refract Surg. 2012;38:739–42.CrossRefGoogle Scholar
  36. 36.
    Epley KD, Shainberg MJ, Lueder GT, et al. Pediatric secondary lens implantation in the absence of capsular support. J AAPOS. 2001;5:301–6.CrossRefGoogle Scholar
  37. 37.
    Dureau P, de Laage de Meux P, Edelson C, et al. Iris fixation of foldable intraocular lenses for ectopia lentis in children. J Cataract Refract Surg. 2006;32:1109–14.CrossRefGoogle Scholar
  38. 38.
    Bardorf CM, Epley KD, Lueder GT, et al. Pediatric transscleral sutured intraocular lenses: efficacy and safety in 43 eyes followed an average of 3 years. J AAPOS. 2004;8:318–24.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Sudarshan Kumar Khokhar
    • 1
  • Chirakshi Dhull
    • 1
  • Yogita Gupta
    • 1
  1. 1.Dr. Rajendra Prasad Centre for Ophthalmic SciencesAll India Institute of Medical SciencesNew DelhiIndia

Personalised recommendations