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PEDIATRIC CATARACT: EPIDEMIOLOGY, SURGICAL TECHNIQUES, AND
VISUAL REHABILITATION
Jalalova Dilfuza Zuhridinovna
Scientific supervisor.
Department of Ophthalmology, Samarkand State Medical University
Eshnazarova Umida
Samarkand State Medical University, Department of Ophthalmology,
2st year clinical ordinator,
https://doi.org/10.5281/zenodo.17583825
Annotation.
Pediatric cataract represents one of the leading causes of preventable
childhood blindness worldwide, posing a significant challenge for pediatric ophthalmologists due
to its complex etiology, varied presentation, and long-term impact on visual development.
This study provides a comprehensive evaluation of the epidemiological patterns, surgical
techniques, and postoperative rehabilitation methods in pediatric cataract management. The
research was conducted on 220 pediatric patients aged from 1 month to 15 years who underwent
cataract extraction at the Department of Ophthalmology, Samarkand State Medical University
between 2019 and 2024. Modern surgical interventions such as phacoaspiration with posterior
chamber intraocular lens implantation, posterior capsulorhexis with anterior vitrectomy, and
manual small incision cataract surgery were compared for safety, efficacy, and visual outcomes.
Postoperative visual rehabilitation using optical correction, amblyopia therapy, and
continuous follow-up was also analyzed. The findings reveal that early surgical intervention
coupled with structured rehabilitation programs significantly improves functional vision and
reduces the risk of amblyopia and postoperative complications.
Keywords:
Pediatric cataract, congenital cataract, phacoaspiration, intraocular lens
implantation, visual rehabilitation, amblyopia prevention, postoperative outcome.
Introduction
Pediatric cataract is a major cause of visual disability in children, accounting
for approximately 10–20% of childhood blindness globally. It can be congenital, developmental,
or secondary to trauma, infection, or metabolic disorders. The visual system in children is highly
plastic, making early detection and timely surgical intervention crucial to prevent irreversible
amblyopia. Despite advances in surgical technology and anesthesia safety, pediatric cataract
remains more challenging to manage than adult cataract due to smaller ocular dimensions,
increased inflammatory response, and the need for long-term visual rehabilitation.
The incidence of congenital cataract ranges between 1 and 15 cases per 10,000 live births,
with a higher prevalence in low- and middle-income countries. Genetic mutations, intrauterine
infections (such as rubella or cytomegalovirus), and metabolic syndromes like galactosemia are
among the leading etiological factors. The timing of surgery plays a critical role: operations
performed within the first 6–8 weeks of life in bilateral cases, and as early as possible in unilateral
cases, are associated with better visual prognosis. However, early surgery must be accompanied
by appropriate intraocular lens selection, postoperative anti-inflammatory management, and long-
term amblyopia therapy to achieve optimal outcomes.
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Materials and Methods
A prospective clinical study was conducted at the Ophthalmology
Department of Samarkand State Medical University, involving 220 children diagnosed with
pediatric cataract from January 2019 to June 2024. The study included 132 males and 88 females,
aged between 1 month and 15 years. Etiological assessment involved genetic counseling,
metabolic screening, and serological testing for TORCH infections. Preoperative evaluation
included slit-lamp biomicroscopy, B-scan ultrasonography, keratometry, and axial length
measurement using A-scan biometry. Surgical techniques were chosen based on the child’s age
and cataract morphology. Infants under two years underwent lens aspiration with primary
posterior capsulorhexis and anterior vitrectomy without intraocular lens (IOL) implantation,
followed by aphakic correction using contact lenses or spectacles. Older children (≥2 years)
underwent phacoaspiration or manual small incision cataract surgery (MSICS) with posterior
chamber IOL implantation. Postoperative follow-up was conducted at 1 week, 1 month, 3 months,
6 months, and annually thereafter. The visual outcomes were measured using age-appropriate
visual acuity charts. Amblyopia therapy involved occlusion of the dominant eye, visual
stimulation, and optical correction adjustments.
Results
Among the 220 children studied, 128 (58.2%) had bilateral cataracts, while 92
(41.8%) presented with unilateral involvement. The mean age at surgery was 3.8 ± 2.1 years.
Etiological analysis revealed that 42% of cases were congenital, 36% developmental, 12%
traumatic, and 10% secondary to metabolic or infectious causes. Phacoaspiration with posterior
chamber IOL implantation was performed in 146 cases (66.4%), while 74 (33.6%) underwent lens
aspiration with posterior capsulorhexis and anterior vitrectomy. Postoperative complications
included posterior capsular opacification (18%), visual axis opacification (9%), transient
intraocular pressure elevation (6%), and strabismus (5%). At the 12-month follow-up, 72% of
patients achieved best-corrected visual acuity (BCVA) better than 0.5, while 21% reached
between 0.3–0.5, and 7% had less than 0.3 due to associated ocular pathologies.
Amblyopia therapy resulted in significant visual improvement, particularly in unilateral
cases. Compliance with postoperative optical correction and occlusion therapy was observed in
82% of patients, which correlated strongly with improved visual outcomes (p<0.01).
Discussion
The outcomes of this study highlight the importance of early diagnosis and
prompt surgical management in pediatric cataract to achieve favorable visual results. The data
confirm that bilateral cases benefit from early bilateral extraction, whereas unilateral cases require
aggressive amblyopia therapy to prevent visual deprivation. The surgical approach must be
tailored according to the child’s age and cataract morphology. Phacoaspiration with posterior
chamber IOL implantation offers stable visual outcomes in children older than two years, while
aphakic correction remains appropriate for younger infants to avoid postoperative refractive shifts.
The inclusion of primary posterior capsulorhexis with anterior vitrectomy is essential to
prevent posterior capsular opacification, which remains one of the most frequent postoperative
complications. The role of long-term visual rehabilitation cannot be overstated; optical correction,
amblyopia management, and periodic follow-up visits are critical components of care. Moreover,
public health strategies focusing on neonatal screening for congenital cataract and parental
education about early signs of visual impairment can substantially reduce the burden of pediatric
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blindness. Genetic counseling should be integrated into family planning programs to minimize the
recurrence of hereditary cataract cases.
Conclusion
Pediatric cataract is a major cause of visual impairment in children but can be
effectively managed through early detection, timely surgery, and comprehensive postoperative
rehabilitation. The study demonstrates that phacoaspiration with posterior chamber IOL
implantation provides reliable and safe outcomes for children older than two years, while lens
aspiration with anterior vitrectomy remains suitable for younger patients. Prevention of amblyopia
through structured visual rehabilitation, consistent optical correction, and family cooperation is
crucial for maximizing visual potential. Long-term follow-up and public health interventions
targeting early screening and genetic counseling are key to preventing pediatric blindness and
ensuring sustained ocular health.
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