Please wait a minute...
Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front Med    2012, Vol. 6 Issue (4) : 360-365     DOI: 10.1007/s11684-012-0235-1
Advances in the management of the surgical complications for congenital cataract
Fangqin Ma, Qi Wang, Lihua Wang()
Department of Ophthalmology, Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
Download: PDF(120 KB)   HTML
Export: BibTeX | EndNote | Reference Manager | ProCite | RefWorks

The greatest concern in children with cataracts is irreversible visual loss. The timing of congenital cataract surgery is critical for the visual rehabilitation. Cataract surgery in children remains complex and challenging. The incidence of complications during or after operation is higher in children than adults. Some complications could be avoided by meticulous attention to surgical technique and postoperative care, and others were caused by more exuberant inflammatory response associated with surgery on an immature eye or the intrinsic eyes abnormalities. Utilizing of advanced techniques and timely applying topical corticosteroids and cycloplegic agents can reduce the occurrence of visual axis opacification. Operation on children with strabismus or nystagmus, and applying occlusion therapy on amblyopic eyes can balance the visual inputs to the two eyes. Diagnosis of glaucoma following congenital cataract surgery requires lifelong surveillance and continuous assessment of the problem. So cataract surgeries in children are not the end of journey, but one step on the long road to visual rehabilitation. This paper describes recent evidence from the literature regarding the advance of management after congenital cataract surgery.

Keywords cataract/congenital      surgery      cataract/complication     
Corresponding Authors: Wang Lihua,   
Issue Date: 05 December 2012
URL:     OR
StudyNumber of patientsMean age at operation (months)Mean follow-up(months)PCO* (%)Secondary glaucoma (%)Synechia pigmentation (%)Setinal detachment (%)IOL decentration (%)
China [3]48658.60±48.0053.228.003.400.25
China [9]* *246 (399 eye)37.8841.3021.65.800.500.50
Korea [10]6138.0±42.3640.02±29.9914.103.5716.701.192.38
Nepal [11]8574.40±51.605.40±5.3019.64<
Tab.1  The incidences of postoperative complications for congenital cataract among different Asiatic countries/regions
1 Trivedi RH, Wilson ME. Pediatric cataract surgery: operative and postoperative issues. In: lson ME, Saunders RA, Trivedi RH. Pediatric Ophthalmology: current thought and a practical guide . Leipzig:. Springer Verlag2009: 311
2 Hug D. Update on pediatric cataracts and cataract surgery. Int Ophthalmol Clin 2010; 50(4): 107-113
doi: 10.1097/IIO.0b013e3181f0f13c pmid:20930585
3 Zhang H, Xie L, Wu X, Tian J. Long-term results of pediatric cataract surgery after delayed diagnosis. J AAPOS 2012; 16(1): 65-69
doi: 10.1016/j.jaapos.2011.09.012 pmid:22245021
4 Kim DH, Kim JH, Kim SJ, Yu YS. Long-term results of bilateral congenital cataract treated with early cataract surgery, aphakic glasses and secondary IOL implantation. Acta Ophthalmol (Copenh) 2012; 90(3): 231-236
doi: 10.1111/j.1755-3768.2010.01872.x pmid:20819081
5 Cacciatori M, Arpa P. Surgical technique for anterior segment surgery in pediatric patients using 25-gauge instruments. J Cataract Refract Surg 2006; 32(4): 562-564
doi: 10.1016/j.jcrs.2006.01.006 pmid:16698472
6 Chee KY, Lam GC. Management of congenital cataract in children younger than 1 year using a 25-gauge vitrectomy system. J Cataract Refract Surg 2009; 35(4): 720-724
doi: 10.1016/j.jcrs.2008.12.012 pmid:19304095
7 Vasavada AR, Shah SK, Praveen MR, Vasavada VA, Trivedi RH, Karve SJ. Pars plicata posterior continuous curvilinear capsulorhexis. J Cataract Refract Surg 2011; 37(2): 221-223
doi: 10.1016/j.jcrs.2010.11.012 pmid:21241901
8 Meier P, Sterker I, Tegetmeyer H, Wiedemann P.23-gauge-lentectomy for the treatment of congenital cataract. Ophthalmologe 2010; 107(3): 241-245 (n German))
doi: 10.1007/s00347-009-1947-8 pmid:19513723
9 Yang ML, Hou CH, Lee JS, Liang YS, Kao LY, Lin KK. Clinical characteristics and surgical outcomes of pediatric cataract in Taiwan. Graefes Arch Clin Exp Ophthalmol 2006; 244(11): 1485-1490
doi: 10.1007/s00417-006-0308-4 pmid:16628419
10 Kim KH, Ahn K, Chung ES, Chung TY. Clinical outcomes of surgical techniques in congenital cataracts. Korean J Ophthalmol 2008; 22(2): 87-91
doi: 10.3341/kjo.2008.22.2.87 pmid:18612225
11 Thakur J, Reddy H, Wilson ME Jr, Paudyal G, Gurung R, Thapa S, Tabin G, Ruit S. Pediatric cataract surgery in Nepal. J Cataract Refract Surg 2004; 30(8): 1629-1635
doi: 10.1016/j.jcrs.2003.12.047 pmid:15313283
12 Sj?strand J, Magnusson G, Nystr?m A, Jonsson R. Stability of visual outcome from 7 years in children treated surgically for bilateral dense congenital cataracts before 37 weeks of age. Acta Ophthalmol (Copenh) 2011; 89(1): 30-36
doi: 10.1111/j.1755-3768.2009.01618.x pmid:19725812
13 Lu Y, Ji YH, Luo Y, Jiang YX, Wang M, Chen X. Visual results and complications of primary intraocular lens implantation in infants aged 6 to 12 months. Graefes Arch Clin Exp Ophthalmol 2010; 248(5): 681-686
doi: 10.1007/s00417-010-1310-4 pmid:20162296
14 Allen RJ, Speedwell L, Russell-Eggitt I. Long-term visual outcome after extraction of unilateral congenital cataracts. Eye (Lond) 2010; 24(7): 1263-1267
doi: 10.1038/eye.2009.295 pmid:20019767
15 Perucho-Martínez S, Tejada-Palacios P, de-la-Cruz-Bertolo J. Congenital cataracts: complications and functional results according to different surgical techniques. Arch Soc Esp Oftalmol 2010; 85(1): 16-21 (in Spanish )
16 Thoumazet F, Mauris-Tyson S, Colin J, Mortemousque B. Congenital cataract removed early: long-term visual acuity outcome and refractive changes. J Fr Ophtalmol 2010; 33(6): 373-379 ( in French)
doi: 10.1016/j.jfo.2010.03.028 pmid:20546969
17 Russell B, Ward MA, Lynn M, Dubois L, Lambert SR. The infant aphakia treatment study contact lens experience: one-year outcomes. Eye Contact Lens 2012; 38(4): 234-239
doi: 10.1097/ICL.0b013e3182562dc0 pmid:22669008
18 Plager DA, Lynn MJ, Buckley EG, Wilson ME, Lambert SR. Complications, adverse events, and additional intraocular surgery 1 year after cataract surgery in the infant Aphakia Treatment Study. Ophthalmology 2011; 118(12): 2330-2334
doi: 10.1016/j.ophtha.2011.06.017 pmid:21925737
19 Lambert SR, Plager DA, Lynn MJ, Wilson ME. Visual outcome following the reduction or cessation of patching therapy after early unilateral cataract surgery. Arch Ophthalmol 2008; 126(8): 1071-1074
doi: 10.1001/archopht.126.8.1071 pmid:18695101
20 Drews-Botsch CD, Celano M, Kruger S, Hartmann EE. Adherence to occlusion therapy in the first six months of follow-up and visual acuity among participants in the Infant Aphakia Treatment Study (IATS). Invest Ophthalmol Vis Sci 2012; 53(7): 3368-3375
doi: 10.1167/iovs.11-8457 pmid:22491410
21 Drews-Botsch CD, Hartmann EE, Celano M. Predictors of adherence to occlusion therapy 3 months after cataract extraction in the Infant Aphakia Treatment Study. J AAPOS 2012; 16(2): 150-155
doi: 10.1016/j.jaapos.2011.12.149 pmid:22525171
22 Mandal AK, Netland PA. Glaucoma in aphakia and pseudophakia after congenital cataract surgery. Indian J Ophthalmol 2004; 52(3): 185-198
23 Rabiah PK. Frequency and predictors of glaucoma after pediatric cataract surgery. Am J Ophthalmol 2004; 137(1): 30-37
doi: 10.1016/S0002-9394(03)00871-7 pmid:14700641
24 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 (Copenh) 2010; 88(1): 53-59
doi: 10.1111/j.1755-3768.2009.01633.x pmid:19758403
25 Kang KD, Yim HB, Biglan AW. Comparison of delayed-onset glaucoma and early-onset glaucoma after infantile cataract surgery. Korean J Ophthalmol 2006; 20(1): 41-46
doi: 10.3341/kjo.2006.20.1.41 pmid:16768189
26 Mills MD, Robb RM. Glaucoma following childhood cataract surgery. J Pediatr Ophthalmol Strabismus 1994; 31(6): 355-360, discussion 361
27 Asrani S, Freedman S, Hasselblad V, Buckley EG, Egbert J, Dahan E, Gimbel H, Johnson D, McClatchey S, Parks M, Plager D, Maselli E. Does primary intraocular lens implantation prevent “aphakic” glaucoma in children? J AAPOS 2000; 4(1): 33-39
doi: 10.1016/S1091-8531(00)90009-0 pmid:10675869
28 Chen TC, Walton DS, Bhatia LS. Aphakic glaucoma after congenital cataract surgery. Arch Ophthalmol 2004; 122(12): 1819-1825
doi: 10.1001/archopht.122.12.1819 pmid:15596586
29 Comer RM, Kim P, Cline R, Lyons CJ. Cataract surgery in the first year of life: aphakic glaucoma and visual outcomes. Can J Ophthalmol 2011; 46(2): 148-152
30 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(3): 300-305
doi: 10.1001/archophthalmol.2011.347 pmid:22084157
31 Hoyt CS, Taylor D. Pediatric Ophthalmology and Strabismus: Expert Consult. Elsevier- Health Sciences Division . 2012
32 Park SH, Na JH, Shin SY. Strabismus following bilateral cataract surgery in childhood. Jpn J Ophthalmol 2010; 54(4): 272-277
doi: 10.1007/s10384-010-0806-0 pmid:20700792
33 Birch EE, Wang J, Felius J, Stager DR Jr, Hertle RW. Fixation control and eye alignment in children treated for dense congenital or developmental cataracts. J AAPOS 2012; 16(2): 156-160
doi: 10.1016/j.jaapos.2011.11.007 pmid:22525172
34 Yagasaki T, Sato M, Awaya S, Nakamura N. Changes in nystagmus after simultaneous surgery for bilateral congenital cataracts. Jpn J Ophthalmol 1993; 37(3): 330-338
35 Ram J, Gupta N, Sukhija JS, Chaudhary M, Verma N, Kumar S, Severia S. Outcome of cataract surgery with primary intraocular lens implantation in children. Br J Ophthalmol 2011; 95(8): 1086-1090
doi: 10.1136/bjo.2010.186072 pmid:20935312
36 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(6): 330-337 ; quiz 356-337
37 Vasavada AR, Nihalani BR. Pediatric cataract surgery. Curr Opin Ophthalmol 2006; 17(1): 54-61
38 Fan DS, Yip WW, Yu CB, Rao SK, Lam DS. Updates on the surgical management of paediatric cataract with primary intraocular lens implantation. Ann Acad Med Singapore 2006; 35(8): 564-570
39 Vasavada AR, Praveen MR, Tassignon MJ, Shah SK, Vasavada VA, Vasavada VA, Van Looveren J, De Veuster I, Trivedi RH. Posterior capsule management in congenital cataract surgery. J Cataract Refract Surg 2011; 37(1): 173-193
doi: 10.1016/j.jcrs.2010.10.036 pmid:21183112
40 Lambert SR, Drack AV. Infantile cataracts. Surv Ophthalmol 1996; 40(6): 427-458
doi: 10.1016/S0039-6257(96)82011-X pmid:8724637
41 Zetterstr?m C, Kugelberg M. Paediatric cataract surgery. Acta Ophthalmol Scand 2007; 85(7): 698-710
doi: 10.1111/j.1600-0420.2007.01007.x pmid:17944624
42 Harley RD, Nelson LB, Olitsky SE. Harley’s pediatric ophthalmology. In: Tesser RA, Hess DB, Buckley EG. Pediatric cataracts and lens anomalies . Philadelphia: Lippincott Williams & Wilkins. 2005: 371
43 Hiles DA, Hered RW. Modern intraocular lens implants in children with new age limitations. J Cataract Refract Surg 1987; 13(5): 493-497
44 Fruscella S, Ducoli P, Manni GL. Decentration of posterior chamber IOL: effects of loop material and fixation technique. Eur J Ophthalmol 1994; 4(2): 111-114
45 Wilson ME Jr, Trivedi RH. Low molecular-weight heparin in the intraocular irrigating solution in pediatric cataract and intraocular lens surgery. Am J Ophthalmol , 2006; 141:537-538
46 Bar-Sela SM, Barequet IS, Spierer A. Vector analysis of high early postoperative astigmatism after congenital cataract surgery. Graefes Arch Clin Exp Ophthalmol 2005; 243(9): 881-885
doi: 10.1007/s00417-005-1153-6 pmid:15806371
47 Bradfield YS, Plager DA, Neely DE, Sprunger DT, Sondhi N. Astigmatism after small-incision clear corneal cataract extraction and intraocular lens implantation in children. J Cataract Refract Surg 2004; 30(9): 1948-1952
doi: 10.1016/j.jcrs.2004.01.019 pmid:15342060
48 Spierer A, Nahum A. Changes in astigmatism after congenital cataract surgery and intraocular lens implantation using scleral tunnel incision. Eye (Lond) , 2002; 16(4): 466-468
49 Lim Z, Muir KW, Duncan L, Freedman SF. Acquired central corneal thickness increase following removal of childhood cataracts. Am J Ophthalmol 2011; 151(3): 434-441 e121236412
doi: 10.1016/j.ajo.2010.09.019
50 Faramarzi A, Javadi MA, Jabbarpoor Bonyadi MH, Yaseri M. Changes in central corneal thickness after congenital cataract surgery. J Cataract Refract Surg 2010; 36(12): 2041-2047
doi: 10.1016/j.jcrs.2010.07.016 pmid:21111305
51 Good WV, Hing S, Irvine AR, Hoyt CS, Taylor DS. Postoperative endophthalmitis in children following cataract surgery. J Pediatr Ophthalmol Strabismus 1990; 27(6): 283-285
52 Lambert SR, Dave H, Phoenix V, Becker ER. Simultaneous vs sequential bilateral cataract surgery for infants with congenital cataracts: weighing the risks of general anesthesia during infancy vs endophthalmitis. Arch Ophthalmol 2011; 129(4): 524-525, author reply 525-526
53 Kushner BJ. Simultaneous cataract surgery for bilateral congenital cataracts: are the cost savings worth the risk? Arch Ophthalmol 2010; 128(8): 1073-1074
doi: 10.1001/archophthalmol.2010.148 pmid:20697013
54 Nihalani BR, Vanderveen DK. Secondary intraocular lens implantation after pediatric aphakia. J AAPOS 2011; 15(5): 435-440
doi: 10.1016/j.jaapos.2011.05.019 pmid:22108355
55 Yorston D, Yang YF, Sullivan PM. Retinal detachment following surgery for congenital cataract: presentation and outcomes. Eye (Lond) 2005; 19(3): 317-321
doi: 10.1038/sj.eye.6701463 pmid:15258607
56 Kirwan C, O’Keeffe M. Cystoid macular oedema in paediatric aphakia and pseudophakia. Br J Ophthalmol 2006; 90(1): 37-39
doi: 10.1136/bjo.2005.075465 pmid:16361664
57 Rao SK, Ravishankar K, Sitalakshmi G, Ng JS, Yu C, Lam DS. Cystoid macular edema after pediatric intraocular lens implantation: fluorescein angioscopy results and literature review. J Cataract Refract Surg 2001; 27(3): 432-436
doi: 10.1016/S0886-3350(00)00578-2 pmid:11255057
[1] Eric C. H. Lai,Chung Ngai Tang. Robotic distal pancreatectomy versus conventional laparoscopic distal pancreatectomy: a comparative study for short-term outcomes[J]. Front. Med., 2015, 9(3): 356-360.
[2] Rui Zhu,Lin Shen,Caoyuan Wang,Yanping Yang,Rui Chen,Hen Fang,Xiaojuan Xu. A new minimally invasive treatment for anal fistula[J]. Front. Med., 2015, 9(1): 77-81.
[3] Yunfeng Fu, Xinyu Wang, Zimin Pan, Xing Xie. Clinical outcomes and prognostic factors of patients with epithelial ovarian cancer subjected to first-line treatment: a retrospective study of 251 cases[J]. Front Med, 2014, 8(1): 91-95.
[4] Shu Zhang, Yinwei Li, Xianqun Fan. Application of endoscopic techniques in orbital blowout fractures[J]. Front Med, 2013, 7(3): 328-332.
[5] Qinggang Hu, Shanglong Liu, Jianwei Jiang, Chen Zhang, Xiaowei Liu, Qichang Zheng. Potential indicators predict progress after surgical resection of gastrointestinal stromal tumors[J]. Front Med, 2012, 6(3): 317-321.
[6] Junqing Wang, Lu Zhang, Weize Wu. Current progress on natural orifice transluminal endoscopic surgery (NOTES)[J]. Front Med, 2012, 6(2): 187-194.
[7] Jia Wei, Jiexiong Feng. Laparoscopic treatment of liver diseases in children[J]. Front Med, 2011, 5(4): 388-394.
[8] Jihui Ai, Pei Zhang, Lei Jin, Yufeng Li, Jing Yue, Ding Ma, Hanwang Zhang. Fertility outcome analysis after modified laparoscopic microsurgical tubal anastomosis[J]. Front Med, 2011, 5(3): 310-314.
[9] Ka Li, Zongguang Zhou, Zengrong Chen, Yi Zhang, Cun Wang. “Fast Track” nasogastric decompression of rectal cancer surgery[J]. Front Med, 2011, 5(3): 306-309.
[10] Hongyi Cui. Single incision laparoscopic cholecystectomy using the one-incision three-trocar technique with all straight instruments: how I do it?[J]. Front Med, 2011, 5(3): 283-287.
[11] Taiping Zhang, Xiao Du, Yupei Zhao. Laparoscopic surgery for pancreatic lesions: current status and future[J]. Front Med, 2011, 5(3): 277-282.
[12] Min ZHU, Xiang-Ning FU, Xiao-Ping CHEN. Lobectomy by video-assisted thoracoscopic surgery (VATS) for early stage of non-small cell lung cancer[J]. Front Med, 2011, 5(1): 53-60.
[13] Zhou-Fang XIONG MD, Wei-Hong DONG MD, Ze-Hua WANG MD, . Non-closure of the peritoneum and subcutaneous tissue at radical hysterectomy: A randomized controlled trial[J]. Front. Med., 2010, 4(1): 112-116.
[14] Minggen YANG, Xiaokun ZHAO. Retrospective study of the efficacy and complication of thoracoabdominal incision for nephrectomy: a comparison with flank approach[J]. Front Med Chin, 2009, 3(2): 191-196.
[15] WANG Shiliang. Achievements in burn surgery over the past 50 years in China[J]. Front. Med., 2008, 2(4): 332-336.
Full text