Updates in pediatric cataract surgery: Experts Review
Pediatric cataracts may be unilateral or bilateral, congenital or acquired, and represent about 5% to 20% of global pediatric blindness. Pediatric cataract surgery can be challenging both in the operating room and after surgery with regard to clinical management and close follow-up, which are essential for an optimal visual outcome and avoiding amblyopia.

Improved wound construction and added surgical options with the performance of anterior and posterior capsulotomies, with or without anterior vitrectomy, have elevated the quality of these surgeries. However, various challenges continue to face the pediatric cataract surgeon.

Over the last decade, advances in technology and surgical techniques have brought pediatric cataract surgery into the modern age. This article will highlight recent updates in pediatric cataract surgery, in terms of both techniques and surgical paradigms that govern these techniques.

Surgical technique
Smaller incisions are becoming the norm in pediatric cataract surgery, similar to adult surgery, as they allow maintenance of a closed chamber and superior intraoperative performance.

Anterior capsule management
Manual anterior continuous curvilinear capsulorrhexis (ACCC), automated vitrectorhexis and Fugo plasma blade-assisted capsulotomy are popular options. Manual ACCC is the gold standard for ACCC but can be difficult in elastic pediatric capsules. Femtosecond laser-assisted cataract surgery promises to be a precise and predictable tool for performing ACCC. The laser can be docked onto the patient’s eye under anesthesia, and a desired size and centration of ACCC can be chosen based on real-time anterior segment OCT guidance.

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