CATARACT IN PEDIATRIC-PATIENTS - IMPACT O F RECENT THERAPEUTIC ADVANCES ON VISUAL OUTCOME - A REVIEW OF 108 CASES

To determine whether recent advances in pediatric ophthalmology and mi cro-surgery have improved functional outcomes of children with catarac t, 108 cases were studied. After a brief review of pediatric cataracts and their effect on visual development, the management strategy used in the 108 patients is described. The patients are divided into four g roups based on the type of cataract. Fifteen patients had early total opacification of both lenses; many also had nonophthalmological abnorm alities. All patients in this group developed nystagmus due to the abs ence of fixation, irrespective of the treatment used, and there was ma rked loss of vision that was not substantially improved by any of the techniques used to correct the aphakia. In the 51 patients with delaye d opacification of both lenses, the prognosis became increasingly simi lar to that in adults with cataract as the age at cataract development increased; every effort should be made to achieve the same results in these children as in surgically-treated adults. Unilateral amblyopia was very rare in these two groups. Thirteen patients had early total o pacification of one lens; the prognosis was poor, requiring very early , rigorous treatment. In the 29 patients with delayed opacification of one lens, the prognosis was better and varied with the duration and q uality of visual experience before cataract development; rapid restora tion of vision and prevention of secondary complications are the main goals in this situation. The management of cataracts in pediatric pati ents should not be viewed as a set of unconnected procedures but rathe r as an overall strategy that should be developed early through discus sion with the parents and physicians involved with the child. The most effective, safest treatment should be selected for each type of catar act. Neonatal cataracts should be detected very early to allow immedia te treatment.