What is it?

There is a belief that cataracts only occur in elderly
people. However, children can also have cataracts. These are known as pediatric
cataracts.
Pediatric cataract is one of the leading causes of childhood blindness.
Cataracts in children can be congenital (present at birth) or acquired (develop
after birth).
Pediatric cataracts have special characteristics and their management is
completely different from that of adults.

Causes

Congenital cataracts can be sporadic or caused by
chromosomal abnormalities, metabolic diseases, intrauterine infection (i.e.,
rubella), or other maternal illness during pregnancy. Congenital cataracts can
also be an isolated familial genetic abnormality.

Diagnosis

In some cases, it is the pediatrician or the parents themselves who detect
a whitish spot in the pupillary area (leukocoria). In fact, pediatric cataract
is the most common cause of leukocoria in childhood. Before the detection of a
whitish reflex in the pupillary area, it is essential to consult an
ophthalmologist.
Its rapid diagnosis and treatment is extremely important to avoid the
development of irreversible amblyopia.
A complete ophthalmologic examination should be performed, paying particular
attention to examining the anterior segment of the eye to assess the size,
location, and density of the opacity. In addition, intraocular pressure and
corneal diameter have to be measured. A fundus examination should be performed
(provided opacity allows). In cases where the cataract difficult or makes
impossible to visualize the fundus, an ultrasound study should be performed.

Treatment

Treatment depends on the type and severity of the cataracts. However, most
children require surgery to remove them. Unlike adults, whose eyes have already
reached their final size, children need special surgical instruments and
techniques.
In children with bilateral congenital cataracts, surgery would be indicated
before 10-12 weeks of life. In unilateral congenital cataracts, the most
appropriate period of treatment is before 6-8 weeks of life.

Surgical technique
Pediatric cataract surgery is performed under general anesthesia.
The cataract is extracted using an aspiration technique, either anteriorly or
posteriorly, at the discretion of the surgeon. In some cases, depending on the
age of the child, the surgery is accompanied by an anterior vitrectomy (removal
of the anterior part of the vitreous gel).
A very important step is deciding whether or not to implant an intraocular lens
in the child. The decision to implant an intraocular lens will be determined by
the age of the child, the preferences of the surgeon, and always in consensus
with the family.
By removing the lens, the eye loses much of its dioptric power, to correct this
defect there are several options:

·        Intraocular lens implantation: An
intraocular lens can be implanted in the surgical act or it can be deferred to
a second surgery (to be performed years later). Its placement in the first
months of life may involve a greater number of surgeries due to increased
inflammation. In addition, it must be taken into account that the child’s eye
will continue to grow, so it will be necessary to change the lens. For these
reasons, in surgeries of children with a few months of life, the surgeon may
choose not to put an intraocular lens.

·        Correction with contact lenses: A
correct option in childhood for these cases. There are suitable materials for
prolonged use (such as silicone lenses). They allow graduation changes to be
made as the child’s graduation changes.

·        Correction in glasses:
Although a priori it is the safest method, it involves an aesthetic difficulty
due to the thickness of the lenses.

Prognosis

Cataract surgery represents the first step on the long
road to a child’s visual recovery. After the surgery, a process of
rehabilitation and visual recovery should be started to reverse and / or
prevent the development of amblyopia (lazy eye).

The success of the treatment (achieving a good visual
recovery) will depend both on the treatments prescribed by the ophthalmologist,
and on the correct involvement of the family and the child.