October 4, 2015
Globally, congenital cataracts account for 5% to 20% of blindness in children, and these numbers differ in various countries. In the U.S., the prevalence of visually significant infantile cataract was estimated to be three or four per 10,000 live births. Congenital cataracts may involve one or both eyes and can span a wide spectrum of lens opacities, from a visually insignificant, small, focal opacity not involving the visual axis to total lens opacification. Hence, treatment strategies will vary depending on the type of lens opacity. The overall focus is to clear the visual axis in a timely fashion to prevent potential lifelong amblyopia.
Extent and location of the congenital cataract, combined with presenting age, are important factors that determine whether or not surgical intervention is indicated. If surgery can safely be delayed until eye growth stabilization has been attained and IOL implantation is appropriate, temporary nonsurgical avenues may be pursued, including pupillary dilation with tropicamide or phenylephrine; also, avoiding amblyogenic atropine may be appropriate. In selected cases, part-time occlusion may be required to prevent amblyopia. When surgical intervention is necessary, the type of procedure would be influenced by presenting age, and the surgeon should be familiar with the various complexities in the overall management of pediatric cataracts. A pediatric ophthalmologist should be an integral part of the overall team approach, along with family support, for an optimal outcome.