Cataract prognosis

The visual prognosis for pediatric cataracts is worse than that of adult cataracts. Vision may be limited by amblyopia as well as other associated abnormalities of the eye. In the case of congenital cataracts, the most critical factor affecting visual prognosis is the age at which the lens is removed.

Unilateral congenital cataracts have a worse prognosis than bilateral ones. Assuming proper visual rehabilitation, mean visual acuity was found to be 20/60 if operated prior to 2 months of age. Final visual acuity is generally poor if operated after this timeframe. In addition, these children nearly all develop

strabismus and lack binocular fusion. Even when operated early, the potential for binocular function is often limited.

Bilateral congenital cataracts tend to have a better visual prognosis, but in the case of dense opacities, early intervention is equally as critical for achieving good visual outcomes. Similar to unilateral cataracts, visual results are best if surgery and subsequent optical correction take place prior to 2 months of age. These patients generally achieve 20/50 or better vision most of the time. Sensory nystagmus may develop if early intervention is not undertaken. Once this occurs, visual potential is often limited and outcomes are usually 20/100 or worse.28

•Diagnosis of pediatric glaucoma

Ocular examination

•Differential diagnosis of pediatric glaucoma

•Primary infantile glaucoma

•Juvenile open-angle glaucoma

•Primary pediatric glaucoma associated with systemic disease

Lowe’s syndrome Sturge–Weber syndrome Neurofibromatosis

•Pediatric glaucoma associated with ocular anomalies

Axenfeld–Rieger syndrome Aniridia

Peters anomaly

Trauma Neoplasia Uveitis (iritis)

Glaucoma following pediatric cataract surgery

Other causes of secondary glaucoma in children

•Treatment of pediatric glaucoma

Drug treatment Surgical management

•Summary