Congenital and Childhood Cataracts

Childhood cataract may be associated with a variety of genetic, metabolic, and ocular conditions. Some causes of cataract can be elucidated by history or distinct phenotypic characteristics, while others require additional testing. A key to optimizing outcomes is early detection, and treatment can be surgical or nonsurgical; amblyopia must be a focus of treatment particularly for unilateral cases. Optical correction may be achieved with contact lenses, spectacles, intraocular lens implantation, or a combination thereof. If treatment is surgical, primary posterior capsulotomy and anterior vitrectomy is standard for young children, due to the high rate of early posterior capsule opacification, which can be dealt with by laser capsulotomy in older cooperative children. The most common complication after secondary opacities is glaucoma, though this is primarily seen after infantile cataract surgery. Pediatric cataracts present unique challenges to the clinician, who must recognize the wide variety of etiologies and morphologies, and understand how the growing eye and developing visual system play into treatment strategies.