Mohammadpour Mehrdad, Shaabani Amirreza, Sahraian Alireza, Momenaei Bita, Tayebi Fereshteh, Bayat Reza, Mirshahi Reza
Ophthalmology Department and Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
J Curr Ophthalmol. 2018 Dec 22;31(2):118-126. doi: 10.1016/j.joco.2018.11.005. eCollection 2019 Jun.
A comprehensive review in congenital cataract management can guide general ophthalmologists in managing such a difficult situation which remains a significant cause of preventable childhood blindness. This review will focus on surgical management, postoperative complications, and intraocular lens (IOL)-related controversies.
Electrical records of PubMed, Medline, Google Scholar, and Web of Science from January 1980 to August 2017 were explored using a combination of keywords: "Congenital", "Pediatric", "Childhood", "Cataract", "Lens opacity", "Management", "Surgery", "Complication", "Visual rehabilitation", and "Lensectomy". A total number of 109 articles were selected for the review process.
This review article suggests that lens opacity obscuring the red reflex in preverbal children and visual acuity of less than 20/40 is an absolute indication for lens aspiration. For significant lens opacity that leads to a considerable risk of amblyopia, cataract surgery is recommended at 6 weeks of age for unilateral cataract and between 6 and 8 weeks of age for bilateral cases. The recommended approach in operation is lens aspiration via vitrector and posterior capsulotomy and anterior vitrectomy in children younger than six years, and IOL implantation could be considered in patients older than one year. Most articles suggested hydrophobic foldable acrylic posterior chamber intraocular lens (PCIOL) for pediatrics because of lower postoperative inflammation. Regarding the continuous ocular growth and biometric changes in pediatric patients, under correction of IOL power based on the child's age is an acceptable approach. Considering the effects of early and late postoperative complications on the visual outcome, timely detection, and management are of a pivotal importance. In the end, the main parts of post-operation visual rehabilitation are a refractive correction, treatment of concomitant amblyopia, and bifocal correction for children in school age.
The management of congenital cataracts stands to challenge for most surgeons because of visual development and ocular growth. Children undergoing cataract surgery must be followed lifelong for proper management of early and late postoperative complications. IOL implantation for infants less than 1 year is not recommended, and IOL insertion for children older than 2 years with sufficient capsular support is advised.
对先天性白内障治疗进行全面综述，可为普通眼科医生处理这一困难情况提供指导，先天性白内障仍是儿童可预防失明的重要原因。本综述将聚焦于手术治疗、术后并发症及人工晶状体（IOL）相关争议。
检索1980年1月至2017年8月期间PubMed、Medline、谷歌学术及科学网的电子记录，使用以下关键词组合：“先天性”“儿科”“儿童期”“白内障”“晶状体混浊”“治疗”“手术”“并发症”“视力康复”及“晶状体切除术”。共筛选出109篇文章用于综述。
本综述文章表明，对于尚不能言语的儿童，晶状体混浊遮挡红光反射且视力低于20/40是晶状体抽吸的绝对指征。对于导致弱视风险显著的明显晶状体混浊，单侧白内障建议在6周龄时进行白内障手术，双侧白内障则建议在6至8周龄时进行。手术推荐方法为：6岁以下儿童通过玻璃体切割器进行晶状体抽吸、后囊切开及前部玻璃体切除术，1岁以上患者可考虑植入人工晶状体。多数文章建议儿科使用疏水性可折叠丙烯酸后房型人工晶状体（PCIOL），因其术后炎症较低。考虑到儿科患者眼球的持续生长及生物测量变化，根据患儿年龄适当降低人工晶状体屈光度是可接受的方法。考虑到术后早期和晚期并发症对视力结果的影响，及时检测和处理至关重要。最后，术后视力康复的主要内容包括屈光矫正、治疗合并的弱视以及对学龄儿童进行双焦点矫正。
由于视觉发育和眼球生长，先天性白内障的治疗对大多数外科医生来说是一项挑战。接受白内障手术的儿童必须终身随访，以妥善处理术后早期和晚期并发症。不建议对1岁以下婴儿植入人工晶状体，建议对2岁以上且有足够囊膜支撑的儿童植入人工晶状体。
