Pediatric cataract surgery – indications for surgery, treatment techniques and postoperative procedures Review article

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Marek E. Prost


Currently, surgery methods of pediatric cataracts allow obtaining good visual acuity in operated children. The operation should be performed in infants over 2 months of age because of more frequent occurrence of glaucoma in earlier operated patients. In children under 10 years of age posterior capsulotomy and anterior vitrectomy are required during surgery to prevent opacification of the posterior lens capsule after surgery. Due to the frequent occurrence of opacities in the visual axis, it is recommended no to implant intraocular lenses in infants under 7th month of life (2nd year of life according to some recommendations).

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Prost ME. Pediatric cataract surgery – indications for surgery, treatment techniques and postoperative procedures. Ophthatherapy [Internet]. 2020Dec.31 [cited 2021Mar.5];7(4):326-32. Available from:
Surgery and laser therapy


1. Self JE, R Taylor R, Solebo AL et al. Cataract management in children: a review of the literature and current practice across five large UK centres. Eye. 2020.
2. Francis PJ, Moore AT. Genetics of childhood cataract. Curr Opin Ophthalmol. 2004; 15: 10-5.
3. Birch EE, Stager DR. The critical period for surgical treatment of dense, congenital, unilateral cataracts. Invest Ophthalmol Vis Sci. 1996; 37: 1532-8.
4. Birch EE, Cheng C, Stager DR Jr et al. The critical period for surgical treatment of dense congenital bilateral cataracts. J AAPOS. 2009; 13: 67-71.
5. Abadi RV, Forster JE, Lloyd IC. Ocular motor outcomes after bilateral and unilateral infantile cataracts. Vis Res. 2006; 46: 940-52.
6. Watts P, Abdolell M, Levin AV. Complications in infants undergoing surgery for congenital cataract in the first 12 weeks. J AAPOS. 2003; 7: 81-5.
7. Beck AD, Freedman SF, Lynn MJ et al. Glaucoma-related adverse events in the Infant Aphakia Treatment Study: 1-year results. Arch Ophthalmol. 2012; 130: 300-5.
8. Lambert SR, Aakalu VK, Hutchinson AK et al. Intraocular lens implantation during early childhood: A report by the American Academy of Ophthalmology. Ophthalmology. 2019; 126: 1454-61.
9. Vishwanath M, Cheong-Leen R, Taylor D et al. Is early surgery for congenital cataract a risk factor for glaucoma? Br J Ophthalmol. 2004; 88: 905-10.
10. Comer RM, Abdulla N, O’Keefe M. Radiofrequency diathermy capsulorhexis of the anterior and posterior capsule in pediatric cataract surgery: Preliminary results. J Cataract Refract Surg. 1997; 23: 641-4.
11. Trivedi RH, Wilson ME, Bartholomew LR. Extensibility and scanning electron microscopy evaluation of 5 pediatric anterior capsulotomy techniques in a porcine model. J Cataract Refract Surg. 2006; 32: 1206-13.
12. Izak AM, Werner L, Pandey SK et al. Analysis of the capsule edge after Fugo plasma blade capsulotomy, continuous curvilinear capsulorhexis, and can-opener capsulotomy. J Cataract Refract Surg. 2004; 30: 2606-11.
13. Nguyen A, Kraus CL. Surgical steps. In: Kraus CL (ed). Pediatric cataract surgery and IOL implantation: a case based guide. Springer Nature, Cham 2020: 89-104.
14. Vasavada AR, Praveen MR, Tassignon MJ et al. Posterior capsule management in congenital cataract surgery. J Cataract Refract Surg. 2011; 37: 173-93.
15. Vasavada AR, Vasavada V, Shah SK et al. Postoperative outcomes of intraocular lens implantation in the bag versus posterior optic capture in pediatric cataract surgery. J Cataract Refract Surg. 2017; 43: 1177-83.
16. Choi SH, Kim YD, Yu YS et al. Long-term outcome of Nd:YAG laser posterior capsulotomy in children: procedural strategies and visual outcome. Am J Ophthalmol. 2019; 197: 121-7.
17. Basti S, Krishnamachary M, Gupta S. Results of sutureless wound construction in children undergoing cataract extraction. J Pediatr Ophthalmol Strabismus. 1996; 33: 52-4.
18. Wilson ME, Bartholomew LR, Trivedi RH. Pediatric cataract surgery and intraocular lens implantation: Practice styles and preferences of the 2001 ASCRS and AAPOS memberships. J Cataract Refract Surg. 2003; 29: 1811-20.
19. Kaur S, Sukhija J, Jugran D et al. Viscosealing of ports in pediatric cataract surgery. Clin Exper Vision and Eye Res. 2019; 2: 1-4.
20. Wilson ME, Apple DJ, Bluestein EC et al. Intraocular lenses for pediatric implantation: biomaterials, designs, and sizing. J Cataract Refract Surg. 1994; 20: 584-91.
21. Lin AA, Buckley DG. Update on pediatric cataract surgery and intraocular lens implantation. Curr Opin Ophthalmol. 2010; 21: 55-9.
22. The Infant Aphakia Treatment Study Group. A randomized clinical trial comparing contact lens to intraocular lens correction of monocular aphakia during infancy: HOTV optotype acuity at age 4.5 years and clinical findings at age 5 years. JAMA Ophthalmol. 2014; 132: 676-82.
23. Lambert SR, Cotsonis G, DuBois L et al.; Infant Aphakia Treatment Study Group. Long-term effect of intraocular lens vs contact lens correction on visual acuity after cataract surgery during infancy. A randomized clinical trial. JAMA Ophthalmol. 2020; 138(4): 365-72.
24. Solebo AL, Cumberland P, Rahi JS; British Isles Congenital Cataract Interest Group. 5-year outcomes after primary intraocular lens implantation in children aged 2 years or younger with congenital or infantile cataract: findings from the IoLunder2 prospective inception cohort study. Lancet Child Adolesc Health. 2018; 2: 863-71.
25. Koo EB, VanderVeen DK, Lambert SR. Global practice patterns in the management of infantile cataracts. Eye Contact Lens. 2018; 44(suppl 2): S292-6.
26. Prost M. Visual function after bilateral implantation of multifocal versus monofocal IOLs in children below 5 years of age. Ophthatherapy. 2019; 6: 192-7.
27. Barry P, Seal DV, Gettinby G; ESCRS Endophthalmitis Study Group. ESCRS study of prophylaxis of postoperative endophthalmitis after cataract surgery: Preliminary report of principal results from a European multicenter study. J Cataract Refract Surg. 2006; 32: 407-10.
28. Arsinoff SA. Dose and administration of intracameral moxifloxacin for prophylaxis of postoperative endophthalmitis. J Cataract Refract Surg. 2016; 42: 1730-41.
29. Prost M. Czy można nie stosować kropli sterydowych po operacjach wewnątrzgałkowych u dzieci? Referat wygłoszony na 48. Zjeździe Okulistów Polskich, Kraków 2017.
30. Chen TC, Bhatia LS, Halpern EF et al. Risk factors for the development of aphakic glaucoma after congenital cataract surgery. Trans Am Ophthalmol Soc. 2006; 104: 241-51.
31. Asrani S, Freedman S, Hasselblad V et al. Does primary intraocular lens implantation prevent “aphakic” glaucoma in children? J AAPOS. 2000; 4: 33-9.
32. Kirwan C, Lanigan B, O’Keefe M. Glaucoma in aphakic and pseudophakic eyes following surgery for congenital cataract in the first year of life. Acta Ophthalmol. 2010; 88: 53-9.
33. Beck AD, Lynn MJ, Crandall J et al. Surgical outcomes with 360-degree suture trabeculotomy in poor prognosis primary congenital glaucoma and glaucoma associated with congenital anomalies or cataract surgery. J AAPOS. 2011; 15: 54-8.
34. Morrison DG, Lynn MJ, Freedman SF et al.; Infant Aphakia Treatment Study Group. Corneal changes in children after unilateral cataract surgery in the Infant Aphakia Treatment Study. Ophthalmology. 2015; 122: 2186-92.
35. Wilson ME, Trivedi RH, Weakley Jr et al.; Infant Aphakia Treatment Study Group. Globe axial length growth at age 5 years in the Infant Aphakia Treatment Study. Ophthalmology. 2017; 124: 730-3.
36. Bothun ED, Lynn MJ, Christiansen SP et al.; Infant Aphakia Treatment Study Group. Sensorimotor outcomes by age 5 years after monocular cataract surgery in the Infant Aphakia Treatment Study (IATS). J AAPOS. 2016; 20: 49-53.