PEDIATRIC CATARACT: EPIDEMIOLOGY, SURGICAL TECHNIQUES, AND VISUAL REHABILITATION

Аннотация

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. 84 Noyabr, 2025-Yil 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 pat