Abstract
The successful outcome of treatment for infant and childhood cataract depends on many factors. It is crucial that the treatment falls into a phase in which neither the eye nor the visual pathway and visual cortex are fully developed. This review summarizes the current state of knowledge and provides an overview of the epidemiology, causes and clinical forms, early detection and, above all, treatment options. Special attention is paid to time-critical stages of development, according to which the therapeutic concepts are based. Complications, such as amblyopia and glaucoma are discussed in detail. In addition to surgical aspects, much emphasis is placed on orthoptic-refractive aftercare, the quality and execution of which is the essential predictor of a good functional outcome.
Zusammenfassung
Der erfolgreiche Ausgang einer Behandlung der Linsentrübung im Säuglings- und Kindesalter hängt von vielen Faktoren ab. Von Bedeutung ist, dass die Therapie in eine Phase fällt, in der weder das Auge, noch die Sehbahn und der visuelle Kortex ausgereift sind. Diese Übersichtsarbeit fasst den aktuellen Wissenstand zusammen und gibt einen Überblick über die Epidemiologie, die Ursachen und klinischen Formen, die Früherkennung und v. a. die Therapieoptionen. Besonderes Augenmerk wird dabei auf die Beachtung zeitkritischer Entwicklungsstufen gerichtet, nach denen sich die Therapiekonzepte richten. Komplikationen wie Amblyopie oder das Glaukom werden ausführlich diskutiert. Neben operativen Aspekten wird viel Gewicht auf die orthoptisch-refraktive Nachsorge gelegt, deren Qualität und Ausführung der wesentliche Prädiktor für ein gutes funktionelles Ergebnis sind.
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References
Hirneiss C, Neubauer AS, Tribus C, Kampik A (2006) Value-based medicine in ophthalmology. Ophthalmologe 103:493–500. https://doi.org/10.1007/s00347-006-1340-9
Foster A, Gilbert C, Rahi J (1997) Epidemiology of cataract in childhood: a global perspective. J Cataract Refract Surg 23(Suppl 1):601–604
Weyersberg A, Roth B, Köstler U, Woopen C (2019) Pädiatrie: Gefangen zwischen Ethik und Ökonomie. Dtsch Arztebl 116:A1586
Chak M, Rahi JS (2007) The health-related quality of life of children with congenital cataract: findings of the British Congenital Cataract Study. Br J Ophthalmol 91:922–926
Scott AW, Bressler NM, Ffolkes S et al (2016) Public attitudes about eye and vision health. JAMA Ophthalmol 134:1111–1118. https://doi.org/10.1001/jamaophthalmol.2016.2627
Noack C, Lagreze WA (2008) The treatment of congenital cataract in Germany—results of a survey. Klin Monatsbl Augenheilkd 225:80–85
Lagrèze WA (2009) The management of cataract in childhood. Klin Monatsbl Augenheilkd 226:15–21. https://doi.org/10.1055/s-2008-1027946
Wu X, Long E, Lin H, Liu Y (2016) Prevalence and epidemiological characteristics of congenital cataract: a systematic review and meta-analysis. Sci Rep 6:28564. https://doi.org/10.1038/srep28564
Gräf M (2007) Früherkennung von Sehstörungen bei Kindern: Durchleuchtungstest nach Brückner – Ein Muss bei allen Vorsorgeuntersuchungen im Kindesalter. Dtsch Arztebl 104:724–729
Haargaard B, Nyström A, Rosensvärd A et al (2015) The Pediatric Cataract Register (PECARE): analysis of age at detection of congenital cataract. Acta Ophthalmol 93:24–26. https://doi.org/10.1111/aos.12445
Nagamoto T, Oshika T, Fujikado T et al (2015) Clinical characteristics of congenital and developmental cataract undergoing surgical treatment. Jpn J Ophthalmol 59:148–156. https://doi.org/10.1007/s10384-015-0370-8
Neugeborenen-Screening auf angeborene Stoffwechselstörungen und EndokrinopathienRegisternummer 024-012. https://www.awmf.org/leitlinien/detail/ll/024-012.html
Gillespie RL, O’Sullivan J, Ashworth J et al (2014) Personalized diagnosis and management of congenital cataract by next-generation sequencing. Ophthalmology 121:2124–2137.e1–2. https://doi.org/10.1016/j.ophtha.2014.06.006
Lasseck J, Jehle T, Feltgen N, Lagreze WA (2008) Comparison of intraocular tonometry using three different non-invasive tonometers in children. Graefes Arch Clin Exp Ophthalmol 246:1463–1466. https://doi.org/10.1007/s00417-008-0863-y
Plager DA, Lynn MJ, Buckley EG et al (2011) Complications, adverse events, and additional intraocular surgery 1 year after cataract surgery in the infant Aphakia Treatment Study. Ophthalmology 118:2330–2334. https://doi.org/10.1016/j.ophtha.2011.06.017
Lambert SR (2016) The timing of surgery for congenital cataracts: Minimizing the risk of glaucoma following cataract surgery while optimizing the visual outcome. J AAPOS 20:191–192. https://doi.org/10.1016/j.jaapos.2016.04.003
Trivedi RH, Wilson ME, Golub RL (2006) Incidence and risk factors for glaucoma after pediatric cataract surgery with and without intraocular lens implantation. J AAPOS 10:117–123
Haargaard B, Ritz C, Oudin A et al (2008) Risk of glaucoma after pediatric cataract surgery. Invest Ophthalmol Vis Sci 49:1791–1796
Birch EE, Stager DR (1996) The critical period for surgical treatment of dense congenital unilateral cataract. Invest Ophthalmol Vis Sci 37:1532–1538
Lambert SR, Lynn MJ, Reeves R et al (2006) Is there a latent period for the surgical treatment of children with dense bilateral congenital cataracts? J AAPOS 10:30–36. https://doi.org/10.1016/j.jaapos.2005.10.002
Birch EE, Cheng C, Stager DR et al (2009) The critical period for surgical treatment of dense congenital bilateral cataracts. J AAPOS 13:67–71
Medsinge A, Nischal KK (2015) Pediatric cataract: challenges and future directions. Clin Ophthalmol 9:77–90. https://doi.org/10.2147/OPTH.S59009
Mohammadpour M, Shaabani A, Sahraian A et al (2019) Updates on managements of pediatric cataract. J Curr Ophthalmol 31:118–126. https://doi.org/10.1016/j.joco.2018.11.005
Kuhli-Hattenbach C, Fronius M, Kohnen T (2017) Bilaterale kongenitale Katarakt: Klinische und funktionelle Ergebnisse in Abhängigkeit vom Operationszeitpunkt. Ophthalmologe 114(3):252–258
Vasavada V (2018) Paradigms for pediatric cataract surgery. Asia Pac J Ophthalmol 7:123–127. https://doi.org/10.22608/APO.2017202
Stech M, Grundel B, Lagrèze WA et al (2019) Risk of aphakic glaucoma after pars plana-lensectomy with and without removal of the peripheral lens capsule. Eye 33:1472–1477. https://doi.org/10.1038/s41433-019-0435-x
Infant Aphakia Treatment Study Group, Lambert SR, Lynn MJ et al (2014) Comparison of contact lens and intraocular lens correction of monocular aphakia during infancy: a randomized clinical trial of HOTV optotype acuity at age 4.5 years and clinical findings at age 5 years. JAMA Ophthalmol 132:676–682. https://doi.org/10.1001/jamaophthalmol.2014.531
Greebel GJ, Gaffar MA (2015) Preferred practice patterns for pediatric cataract surgery and postoperative management. J AAPOS 19:e44–e45. https://doi.org/10.1016/j.jaapos.2015.07.134
Vanderveen DK, Trivedi RH, Nizam A et al (2013) Predictability of intraocular lens power calculation formulae in infantile eyes with unilateral congenital cataract: results from the Infant Aphakia Treatment Study. Am J Ophthalmol 156:1252–1260.e2. https://doi.org/10.1016/j.ajo.2013.07.014
Freedman SF, Lynn MJ, Beck AD et al (2015) Glaucoma-related adverse events in the first 5 years after unilateral cataract removal in the infant Aphakia treatment study. JAMA Ophthalmol 133:907–914. https://doi.org/10.1001/jamaophthalmol.2015.1329
Solebo AL, Russell-Eggitt I, Cumberland PM et al (2015) Risks and outcomes associated with primary intraocular lens implantation in children under 2 years of age: the IoLunder2 cohort study. Br J Ophthalmol 99:1471–1476. https://doi.org/10.1136/bjophthalmol-2014-306394
Mataftsi A, Haidich A‑B, Kokkali S et al (2014) Postoperative glaucoma following infantile cataract surgery: an individual patient data meta-analysis. JAMA Ophthalmol 132:1059–1067. https://doi.org/10.1001/jamaophthalmol.2014.1042
Ram J, Agarwal A, Kumar J, Gupta A (2014) Bilateral implantation of multifocal versus monofocal intraocular lens in children above 5 years of age. Graefes Arch Clin Exp Ophthalmol 252:441–447. https://doi.org/10.1007/s00417-014-2571-0
Witschel H (1987) Pars plana lentectomy. Klin Monatsbl Augenheilkd 190:406–411
Dave H, Phoenix V, Becker ER, Lambert SR (2010) Simultaneous vs sequential bilateral cataract surgery for infants with congenital cataracts: visual outcomes, adverse events, and economic costs. Arch Ophthalmol 128:1050–1054. https://doi.org/10.1001/archophthalmol.2010.136
Eibenberger K, Stifter E, Pusch F, Schmidt-Erfurth U (2020) Simultaneous bilateral pediatric and juvenile cataract surgery under general anesthesia: outcomes and safety. Am J Ophthalmol. https://doi.org/10.1016/j.ajo.2020.01.001
Vasavada AR, Vasavada V, Shah SK et al (2017) Postoperative outcomes of intraocular lens implantation in the bag versus posterior optic capture in pediatric cataract surgery. J Cataract Refract Surg 43:1177–1183. https://doi.org/10.1016/j.jcrs.2017.07.022
Dick HB, Schultz T (2013) Femtosecond laser-assisted cataract surgery in infants. J Cataract Refract Surg 39:665–668. https://doi.org/10.1016/j.jcrs.2013.02.032
Tassignon M‑J, Gobin L, De Veuster I, Godts D (2009) Advantages of the bag-in-the-lens intraocular lens in pediatric cataract surgery. J Fr Ophtalmol 32:481–487. https://doi.org/10.1016/j.jfo.2009.06.007
Repka MX, Dean TW, Lazar EL et al (2016) Cataract surgery in children from birth to less than 13 years of age: baseline characteristics of the cohort. Ophthalmology 123:2462–2473. https://doi.org/10.1016/j.ophtha.2016.09.003
Writing Committee for the Pediatric Eye Disease Investigator Group (PEDIG), Repka MX, Dean TW et al (2019) Visual acuity and ophthalmic outcomes in the year after cataract surgery among children younger than 13 years. JAMA Ophthalmol 137:817–824. https://doi.org/10.1001/jamaophthalmol.2019.1220
Lambert SR, Cotsonis G, DuBois L et al (2020) Long-term effect of intraocular lens vs contact lens correction on visual acuity after cataract surgery during infancy: a randomized clinical trial. JAMA Ophthalmol. https://doi.org/10.1001/jamaophthalmol.2020.0006
Bothun ED, Wilson ME, Traboulsi EI et al (2019) Outcomes of unilateral cataracts in infants and toddlers 7 to 24 months of Age: toddler Aphakia and Pseudophakia study (TAPS). Ophthalmology 126:1189–1195. https://doi.org/10.1016/j.ophtha.2019.03.011
Bothun ED, Wilson ME, Vanderveen DK et al (2020) Outcomes of bilateral cataracts removed in infants 1 to 7 months of age using the toddler Aphakia and Pseudophakia treatment study registry. Ophthalmology 127:501–510. https://doi.org/10.1016/j.ophtha.2019.10.039
Chak M, Wade A, Rahi JS (2006) Long-term visual acuity and its predictors after surgery for congenital cataract: findings of the British congenital cataract study. Invest Ophthalmol Vis Sci 47:4262–4269
Acknowledgements
The author would like to thank his colleagues Prof. Judith Fischer, Prof. Claudia Kuhli-Hattenbach, Dr. Terese Neuhann, and Prof. Ute Spiekerkötter, as well as the orthoptists Ute Gilles, Heike Link, and Carolin Wolf for their critical review of the manuscript and helpful suggestions and additions.
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W.A. Lagrèze; A. Financial interests: Research funding: BMBF, DFG. Speaker fees or reimbursement of expenses: Boehringer Ingelheim, Santhera, med update, Alcon. Paid advisor/internal training reference/salary recipient or similar activities: Boehringer Ingelheim, InfectoPharm. B. Non-financial interests: Official University Professor, University Hospital Freiburg, Department of Ophthalmology. Memberships: DOG, BVA, EUNOS, ARVO, Bielschowsky Society.
For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were in accordance with the ethical standards indicated in each case.
The supplement containing this article is not sponsored by industry.
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Lagrèze, W.A. Treatment of congenital and early childhood cataract. Ophthalmologe 118 (Suppl 2), 135–144 (2021). https://doi.org/10.1007/s00347-021-01370-z
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DOI: https://doi.org/10.1007/s00347-021-01370-z