The challenge of childhood cataract blindness
Identifieur interne : 000894 ( Pmc/Checkpoint ); précédent : 000893; suivant : 000895The challenge of childhood cataract blindness
Auteurs : Jagat Ram [Inde] ; Aniruddha Agarwal [Inde]Source :
- The Indian Journal of Medical Research [ 0971-5916 ] ; 2014.
Url:
PubMed: 25488437
PubMed Central: 4277129
Affiliations:
Links toward previous steps (curation, corpus...)
Links to Exploration step
PMC:4277129Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">The challenge of childhood cataract blindness</title><author><name sortKey="Ram, Jagat" sort="Ram, Jagat" uniqKey="Ram J" first="Jagat" last="Ram">Jagat Ram</name><affiliation wicri:level="1"><nlm:aff id="aff1">Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India</nlm:aff><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012</wicri:regionArea><wicri:noRegion>Chandigarh 160 012</wicri:noRegion></affiliation></author><author><name sortKey="Agarwal, Aniruddha" sort="Agarwal, Aniruddha" uniqKey="Agarwal A" first="Aniruddha" last="Agarwal">Aniruddha Agarwal</name><affiliation wicri:level="1"><nlm:aff id="aff1">Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India</nlm:aff><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012</wicri:regionArea><wicri:noRegion>Chandigarh 160 012</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25488437</idno><idno type="pmc">4277129</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4277129</idno><idno type="RBID">PMC:4277129</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">000D38</idno><idno type="wicri:Area/Pmc/Curation">000D38</idno><idno type="wicri:Area/Pmc/Checkpoint">000894</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">The challenge of childhood cataract blindness</title><author><name sortKey="Ram, Jagat" sort="Ram, Jagat" uniqKey="Ram J" first="Jagat" last="Ram">Jagat Ram</name><affiliation wicri:level="1"><nlm:aff id="aff1">Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India</nlm:aff><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012</wicri:regionArea><wicri:noRegion>Chandigarh 160 012</wicri:noRegion></affiliation></author><author><name sortKey="Agarwal, Aniruddha" sort="Agarwal, Aniruddha" uniqKey="Agarwal A" first="Aniruddha" last="Agarwal">Aniruddha Agarwal</name><affiliation wicri:level="1"><nlm:aff id="aff1">Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India</nlm:aff><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012</wicri:regionArea><wicri:noRegion>Chandigarh 160 012</wicri:noRegion></affiliation></author></analytic><series><title level="j">The Indian Journal of Medical Research</title><idno type="ISSN">0971-5916</idno><idno type="eISSN">0975-9174</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Pascolini, D" uniqKey="Pascolini D">D Pascolini</name></author><author><name sortKey="Mariotti, Sp" uniqKey="Mariotti S">SP Mariotti</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Wilson, Me" uniqKey="Wilson M">ME Wilson</name></author><author><name sortKey="Pandey, Sk" uniqKey="Pandey S">SK Pandey</name></author><author><name sortKey="Thakur, J" uniqKey="Thakur J">J Thakur</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lambert, Sr" uniqKey="Lambert S">SR Lambert</name></author><author><name sortKey="Drack, Av" uniqKey="Drack A">AV Drack</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mostafa, Mse" uniqKey="Mostafa M">MSE Mostafa</name></author><author><name sortKey="Temtamy, S" uniqKey="Temtamy S">S Temtamy</name></author><author><name sortKey="El Gammal, My" uniqKey="El Gammal M">MY El-Gammal</name></author><author><name sortKey="Sayed, Si" uniqKey="Sayed S">SI Sayed</name></author><author><name sortKey="Abdel Salam, M" uniqKey="Abdel Salam M">M Abdel-Salam</name></author><author><name sortKey="El Baroudy, R" uniqKey="El Baroudy R">R El-Baroudy</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Devi, Rr" uniqKey="Devi R">RR Devi</name></author><author><name sortKey="Yao, W" uniqKey="Yao W">W Yao</name></author><author><name sortKey="Vijayalakshmi, P" uniqKey="Vijayalakshmi P">P Vijayalakshmi</name></author><author><name sortKey="Sergeev, Yv" uniqKey="Sergeev Y">YV Sergeev</name></author><author><name sortKey="Sundaresan, P" uniqKey="Sundaresan P">P Sundaresan</name></author><author><name sortKey="Hejtmancik, Jf" uniqKey="Hejtmancik J">JF Hejtmancik</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Stambolian, D" uniqKey="Stambolian D">D Stambolian</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sukhija, J" uniqKey="Sukhija J">J Sukhija</name></author><author><name sortKey="Ram, J" uniqKey="Ram J">J Ram</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Singh, R" uniqKey="Singh R">R Singh</name></author><author><name sortKey="Ram, J" uniqKey="Ram J">J Ram</name></author><author><name sortKey="Kaur, G" uniqKey="Kaur G">G Kaur</name></author><author><name sortKey="Prasad, R" uniqKey="Prasad R">R Prasad</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ram, J" uniqKey="Ram J">J Ram</name></author><author><name sortKey="Gupta, N" uniqKey="Gupta N">N Gupta</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cheng, Kp" uniqKey="Cheng K">KP Cheng</name></author><author><name sortKey="Hiles, Da" uniqKey="Hiles D">DA Hiles</name></author><author><name sortKey="Biglan, Aw" uniqKey="Biglan A">AW Biglan</name></author><author><name sortKey="Pettapiece, Mc" uniqKey="Pettapiece M">MC Pettapiece</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Courtright, P" uniqKey="Courtright P">P Courtright</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Apple, Dj" uniqKey="Apple D">DJ Apple</name></author><author><name sortKey="Ram, J" uniqKey="Ram J">J Ram</name></author><author><name sortKey="Foster, A" uniqKey="Foster A">A Foster</name></author><author><name sortKey="Peng, Q" uniqKey="Peng Q">Q Peng</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ram, J" uniqKey="Ram J">J Ram</name></author><author><name sortKey="Gupta, N" uniqKey="Gupta N">N Gupta</name></author><author><name sortKey="Sukhija, Js" uniqKey="Sukhija J">JS Sukhija</name></author><author><name sortKey="Chaudhary, M" uniqKey="Chaudhary M">M Chaudhary</name></author><author><name sortKey="Verma, N" uniqKey="Verma N">N Verma</name></author><author><name sortKey="Kumar, S" uniqKey="Kumar S">S Kumar</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Vasavada, Ar" uniqKey="Vasavada A">AR Vasavada</name></author><author><name sortKey="Nihalani, Br" uniqKey="Nihalani B">BR Nihalani</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Dahan, E" uniqKey="Dahan E">E Dahan</name></author><author><name sortKey="Drusedau, Mu" uniqKey="Drusedau M">MU Drusedau</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ram, J" uniqKey="Ram J">J Ram</name></author><author><name sortKey="Sukhija, J" uniqKey="Sukhija J">J Sukhija</name></author><author><name sortKey="Thapa, Br" uniqKey="Thapa B">BR Thapa</name></author><author><name sortKey="Arya, Vk" uniqKey="Arya V">VK Arya</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ram, J" uniqKey="Ram J">J Ram</name></author><author><name sortKey="Brar, Gs" uniqKey="Brar G">GS Brar</name></author><author><name sortKey="Kaushik, S" uniqKey="Kaushik S">S Kaushik</name></author><author><name sortKey="Gupta, A" uniqKey="Gupta A">A Gupta</name></author><author><name sortKey="Gupta, A" uniqKey="Gupta A">A Gupta</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fan, Ds" uniqKey="Fan D">DS Fan</name></author><author><name sortKey="Yip, Ww" uniqKey="Yip W">WW Yip</name></author><author><name sortKey="Yu, Cb" uniqKey="Yu C">CB Yu</name></author><author><name sortKey="Rao, Sk" uniqKey="Rao S">SK Rao</name></author><author><name sortKey="Lam, Ds" uniqKey="Lam D">DS Lam</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ram, J" uniqKey="Ram J">J Ram</name></author><author><name sortKey="Apple, D" uniqKey="Apple D">D Apple</name></author><author><name sortKey="Peng, Q" uniqKey="Peng Q">Q Peng</name></author><author><name sortKey="Visessook, N" uniqKey="Visessook N">N Visessook</name></author><author><name sortKey="Auffarth, Gu" uniqKey="Auffarth G">GU Auffarth</name></author><author><name sortKey="Schoderbek, Rj" uniqKey="Schoderbek R">RJ Schoderbek</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gupta, A" uniqKey="Gupta A">A Gupta</name></author><author><name sortKey="Ram, J" uniqKey="Ram J">J Ram</name></author><author><name sortKey="Gupta, A" uniqKey="Gupta A">A Gupta</name></author><author><name sortKey="Gupta, V" uniqKey="Gupta V">V Gupta</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ram, J" uniqKey="Ram J">J Ram</name></author><author><name sortKey="Agarwal, A" uniqKey="Agarwal A">A Agarwal</name></author><author><name sortKey="Kumar, J" uniqKey="Kumar J">J Kumar</name></author><author><name sortKey="Gupta, A" uniqKey="Gupta A">A Gupta</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tassignon, Mj" uniqKey="Tassignon M">MJ Tassignon</name></author><author><name sortKey="De Veuster, I" uniqKey="De Veuster I">I De Veuster</name></author><author><name sortKey="Godts, D" uniqKey="Godts D">D Godts</name></author><author><name sortKey="Kosec, D" uniqKey="Kosec D">D Kosec</name></author><author><name sortKey="Van Den Dooren, K" uniqKey="Van Den Dooren K">K Van den Dooren</name></author><author><name sortKey="Gobin, L" uniqKey="Gobin L">L Gobin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Deng, H" uniqKey="Deng H">H Deng</name></author><author><name sortKey="Yuan, L" uniqKey="Yuan L">L Yuan</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="editorial"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Indian J Med Res</journal-id><journal-id journal-id-type="iso-abbrev">Indian J. Med. Res</journal-id><journal-id journal-id-type="publisher-id">IJMR</journal-id><journal-title-group><journal-title>The Indian Journal of Medical Research</journal-title></journal-title-group><issn pub-type="ppub">0971-5916</issn><issn pub-type="epub">0975-9174</issn><publisher><publisher-name>Medknow Publications & Media Pvt Ltd</publisher-name><publisher-loc>India</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25488437</article-id><article-id pub-id-type="pmc">4277129</article-id><article-id pub-id-type="publisher-id">IJMR-140-472</article-id><article-categories><subj-group subj-group-type="heading"><subject>Editorial</subject></subj-group></article-categories><title-group><article-title>The challenge of childhood cataract blindness</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Ram</surname><given-names>Jagat</given-names></name><xref ref-type="aff" rid="aff1"></xref><xref ref-type="corresp" rid="cor1">*</xref></contrib><contrib contrib-type="author"><name><surname>Agarwal</surname><given-names>Aniruddha</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib></contrib-group><aff id="aff1">Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India</aff><author-notes><corresp id="cor1"><label>*</label><italic>For correspondence</italic>: <email xlink:href="drjagatram@gmail.com">drjagatram@gmail.com</email></corresp></author-notes><pub-date pub-type="ppub"><month>10</month><year>2014</year></pub-date><volume>140</volume><issue>4</issue><fpage>472</fpage><lpage>474</lpage><permissions><copyright-statement>Copyright: © Indian Journal of Medical Research</copyright-statement><copyright-year>2014</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-sa/3.0"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions></article-meta></front><body><p>Childhood blindness remains a cause of great concern globally despite large advances in the field of ophthalmology in the past few decades. Childhood visual impairment and blindness are due to preventable causes in most cases<xref rid="ref1" ref-type="bibr">1</xref>. With over 1.4 million children blind throughout the world, low vision that can significantly hinder activities of daily living is present in over 17.5 million<xref rid="ref1" ref-type="bibr">1</xref>. Cataract forms a large share of the preventable blindness with the latest WHO estimates (2010) ranging above 200,000 cases world over<xref rid="ref2" ref-type="bibr">2</xref>. Developing countries like India and China form the epicenter of the problem with more than 20 per cent of their population visually impaired<xref rid="ref1" ref-type="bibr">1</xref>. High percentages are also reported from Africa (15%) and Eastern Mediterranean Region (EMR)<xref rid="ref1" ref-type="bibr">1</xref><xref rid="ref2" ref-type="bibr">2</xref>. These figures are likely underestimating the actual numbers because many children with multiple disabilities may go unreported. Economic burden and years of productive life lost due to untreated paediatric cataract clearly favours urgent attention to this challenge<xref rid="ref1" ref-type="bibr">1</xref><xref rid="ref2" ref-type="bibr">2</xref><xref rid="ref3" ref-type="bibr">3</xref>.</p><p><bold><italic>The best way to address a problem is to delve into the root cause</italic></bold>: There are numerous lacunae in the understanding of aetio-pathogenesis of infantile/developmental cataract<xref rid="ref3" ref-type="bibr">3</xref><xref rid="ref4" ref-type="bibr">4</xref>. While certain causes of cataract in children are well-documented, including perinatal and intrauterine infections, many cases may go without a definite aetiological diagnosis<xref rid="ref3" ref-type="bibr">3</xref>. Childhood cataract is associated with genetic<xref rid="ref5" ref-type="bibr">5</xref><xref rid="ref6" ref-type="bibr">6</xref>, metabolic<xref rid="ref7" ref-type="bibr">7</xref> and acquired causes, such as trauma<xref rid="ref8" ref-type="bibr">8</xref>, retinopathy of prematurity (ROP)<xref rid="ref4" ref-type="bibr">4</xref>, enzyme defects<xref rid="ref9" ref-type="bibr">9</xref> and idiopathic. Drug-induced cataracts due to steroids are also common in this age group. Certain genetic defects are associated with abnormal lenticular shape/position needing surgical management including entities like spherophakia<xref rid="ref10" ref-type="bibr">10</xref> and lenticonus<xref rid="ref11" ref-type="bibr">11</xref>. Mutations in crystallin and connexin genes have been identified as putative causes of cataract in children. Genetic polymorphisms may be associated with increased incidence of cataract, some of which are yet to be identified<xref rid="ref4" ref-type="bibr">4</xref><xref rid="ref6" ref-type="bibr">6</xref>.</p><p><bold><italic>The patients are hidden in the community - we need to identify them</italic></bold>: There is often a delay in the diagnosis of paediatric cataract that compounds the problem<xref rid="ref2" ref-type="bibr">2</xref>. Delayed treatment is associated with permanent visual impairment even after adequate specialized care due to development of severe amblyopia. Vigorous case-search and prompt referral are areas that need to be strengthened if we desire to tackle the problem successfully<xref rid="ref1" ref-type="bibr">1</xref><xref rid="ref12" ref-type="bibr">12</xref>. Thorough visual acuity assessment using specialized charts, pupillary reaction, strabismus and ocular motility must be done. Slit-lamp biomicroscopy is the best method to evaluate lenticular opacities and study the morphology of cataract<xref rid="ref4" ref-type="bibr">4</xref>. Intraocular pressure measurement is a must to rule out congenital glaucoma which can frequently co-exist. Fundus examination is performed by indirect ophthalmoscopy after pupillary dilation to rule out posterior segment pathology. Detailed evaluation of family history, features of congenital rubella syndrome, metabolic diseases and survey of enzyme defects must follow if clinical symptoms suggest.</p><p><bold><italic>The biggest challenge in paediatric cataract surgery is gearing up for the next challenge</italic></bold>: Though there have been tremendous changes with the ushering of technology in the field of ophthalmology but the task of managing childhood cataract remains difficult, fraught with potential complications at every stage<xref rid="ref3" ref-type="bibr">3</xref><xref rid="ref13" ref-type="bibr">13</xref>. Presently, the modern technique of phacoaspiration with posterior chamber intraocular lens implantation in the capsular bag is the preferred technique to manage paediatric cataract<xref rid="ref3" ref-type="bibr">3</xref><xref rid="ref4" ref-type="bibr">4</xref><xref rid="ref13" ref-type="bibr">13</xref><xref rid="ref14" ref-type="bibr">14</xref><xref rid="ref15" ref-type="bibr">15</xref>. This has replaced older techniques of lensectomy and extracapsular cataract surgery. Ultrasound B-scan rules out posterior segment pathology in children with dense cataracts. Calculation of intraocular lens (IOL) power is a subject in itself with more than a dozen guidelines available in literature<xref rid="ref3" ref-type="bibr">3</xref><xref rid="ref13" ref-type="bibr">13</xref><xref rid="ref14" ref-type="bibr">14</xref><xref rid="ref15" ref-type="bibr">15</xref><xref rid="ref16" ref-type="bibr">16</xref>. Popular guidelines include those laid down by Dahan and Drusedau<xref rid="ref16" ref-type="bibr">16</xref>, where an under-correction is performed keeping in mind the future growth of the eye.</p><p><bold><italic>A child's eye is different from those of an adult in many more ways than one</italic></bold>: Unlike for adult cataracts, there is a sense of urgency in the management of childhood cataracts, especially unilateral cases given the poor prognosis associated with delayed surgery<xref rid="ref3" ref-type="bibr">3</xref><xref rid="ref4" ref-type="bibr">4</xref><xref rid="ref14" ref-type="bibr">14</xref><xref rid="ref15" ref-type="bibr">15</xref>. Certain attributes such as low scleral rigidity, highly elastic anterior capsule and increased vitreous pressure contribute to surgical difficulty. Hence, interventions may be limited to dedicated, specialized centers<xref rid="ref17" ref-type="bibr">17</xref>. Phacoaspiration in children is performed using automated systems under controlled parameters. Specialized Ophthalmic Viscosurgical Devices (OVDs) are used, <italic>viz</italic>. 1.4 per cent sodium hyaluronate to maintain the integrity of anterior chamber intraoperatively. After continuous curvilinear capsulorhexis (CCC), cortical aspiration is performed<xref rid="ref14" ref-type="bibr">14</xref><xref rid="ref15" ref-type="bibr">15</xref>. In young children aged 1 month to 6 years, posterior capsulotomy is done as a primary procedure with limited anterior vitrectomy to minimize the risk of posterior capsular opacification (PCO) and further interventions<xref rid="ref18" ref-type="bibr">18</xref>. The current preferred practice to manage surgical aphakia is to place posterior chamber IOL in children to achieve optimal visual rehabilitation<xref rid="ref3" ref-type="bibr">3</xref><xref rid="ref4" ref-type="bibr">4</xref><xref rid="ref14" ref-type="bibr">14</xref><xref rid="ref15" ref-type="bibr">15</xref><xref rid="ref16" ref-type="bibr">16</xref><xref rid="ref19" ref-type="bibr">19</xref>. Extensive studies have proven that hydrophobic acrylic IOLs perform the best with lesser complication rates compared to older IOLs<xref rid="ref3" ref-type="bibr">3</xref><xref rid="ref14" ref-type="bibr">14</xref><xref rid="ref15" ref-type="bibr">15</xref><xref rid="ref20" ref-type="bibr">20</xref>.</p><p><bold><italic>Cornerstone of successful paediatric cataract surgery is the post-operative management</italic></bold>: Post-operative care in children is highly specialized as paediatric eyes are susceptible to high levels of inflammation<xref rid="ref18" ref-type="bibr">18</xref>. High dose steroids are required topically combined with antibiotic therapy. Complicated cases of uveitis and trauma may benefit from intraocular depot steroids like dexamethasone implants<xref rid="ref21" ref-type="bibr">21</xref>. Visual axis obscuration (VAO) can occur in the post-operative period due to formation of PCO or other IOL-related complications like tilt, decentration or subluxation/dislocation<xref rid="ref18" ref-type="bibr">18</xref>. Maintaining a clear visual axis by managing VAO and prompt institution of occlusion therapy are <italic>sine-quo-none</italic> for achieving optimal amblyopia therapy.</p><p><bold><italic>The future holds promise</italic></bold>: Futuristic approach includes surgery with newer IOL designs including multifocal IOLs in children<xref rid="ref22" ref-type="bibr">22</xref>, bag-in-the-lens IOL<xref rid="ref23" ref-type="bibr">23</xref>, use of newer synthetic suture materials, better vitrectomy devices, innovative instruments like plasma blade, maneuvers like optic capture and array of more efficacious drugs to control inflammation<xref rid="ref3" ref-type="bibr">3</xref><xref rid="ref4" ref-type="bibr">4</xref><xref rid="ref8" ref-type="bibr">8</xref><xref rid="ref13" ref-type="bibr">13</xref><xref rid="ref15" ref-type="bibr">15</xref><xref rid="ref19" ref-type="bibr">19</xref>. Benchmarks for post-operative outcomes after paediatric cataract surgery have risen and presently, the focus is on achieving highest grades of binocularity, stereopsis and contrast sensitivity along with emmetropia<xref rid="ref22" ref-type="bibr">22</xref>.</p><p>With increasing evidence of genetic polymorphisms responsible for cataract, genetic counselling is probably going to play an important role in the management of these patients in the future<xref rid="ref24" ref-type="bibr">24</xref>. Identification of mutations responsible for early cataractogenesis can help formulate guidelines regarding genetic counselling and prenatal diagnosis in the future<xref rid="ref24" ref-type="bibr">24</xref>. It may become possible to identify cataract very early and intervene before damage is done.</p><p>To conclude, the future of paediatric cataract management is exciting. It is the need of the hour to take cognizance of this challenge and the rewards will be truly gratifying.</p></body><back><ref-list><ref id="ref1"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Pascolini</surname><given-names>D</given-names></name><name><surname>Mariotti</surname><given-names>SP</given-names></name></person-group><article-title>Global estimates of visual impairment: 2010</article-title><source>Br J Ophthalmol</source><year>2012</year><volume>96</volume><fpage>614</fpage><lpage>8</lpage><pub-id pub-id-type="pmid">22133988</pub-id></element-citation></ref><ref id="ref2"><label>2</label><element-citation publication-type="webpage"><article-title>Open Database: World Health Organization. Visual impairment and blindess. Factsheet N°282 updated August</article-title><year>2014</year><date-in-citation>accessed on October 8, 2014</date-in-citation><comment>Available from: <uri xlink:type="simple" xlink:href="http://www.who.int/mediacentre/factsheets/fs282/en">http://www.who.int/mediacentre/factsheets/fs282/en</uri></comment></element-citation></ref><ref id="ref3"><label>3</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wilson</surname><given-names>ME</given-names></name><name><surname>Pandey</surname><given-names>SK</given-names></name><name><surname>Thakur</surname><given-names>J</given-names></name></person-group><article-title>Paediatric cataract blindness in the developing world: surgical techniques and intraocular lenses in the new millennium</article-title><source>Br J Ophthalmol</source><year>2003</year><volume>87</volume><fpage>14</fpage><lpage>9</lpage><pub-id pub-id-type="pmid">12488254</pub-id></element-citation></ref><ref id="ref4"><label>4</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Lambert</surname><given-names>SR</given-names></name><name><surname>Drack</surname><given-names>AV</given-names></name></person-group><article-title>Infantile cataracts</article-title><source>Surv Ophthalmol</source><year>1996</year><volume>40</volume><fpage>427</fpage><lpage>58</lpage><pub-id pub-id-type="pmid">8724637</pub-id></element-citation></ref><ref id="ref5"><label>5</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Mostafa</surname><given-names>MSE</given-names></name><name><surname>Temtamy</surname><given-names>S</given-names></name><name><surname>El-Gammal</surname><given-names>MY</given-names></name><name><surname>Sayed</surname><given-names>SI</given-names></name><name><surname>Abdel-Salam</surname><given-names>M</given-names></name><name><surname>El-Baroudy</surname><given-names>R</given-names></name></person-group><article-title>Genetic studies of congenital cataract</article-title><source>Metab Pediatr Ophthalmol</source><year>1981</year><volume>5</volume><fpage>233</fpage><lpage>42</lpage><pub-id pub-id-type="pmid">7311663</pub-id></element-citation></ref><ref id="ref6"><label>6</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Devi</surname><given-names>RR</given-names></name><name><surname>Yao</surname><given-names>W</given-names></name><name><surname>Vijayalakshmi</surname><given-names>P</given-names></name><name><surname>Sergeev</surname><given-names>YV</given-names></name><name><surname>Sundaresan</surname><given-names>P</given-names></name><name><surname>Hejtmancik</surname><given-names>JF</given-names></name></person-group><article-title>Crystallin gene mutations in Indian families with inherited pediatric cataract</article-title><source>Mol Vis</source><year>2008</year><volume>14</volume><fpage>1157</fpage><lpage>70</lpage><pub-id pub-id-type="pmid">18587492</pub-id></element-citation></ref><ref id="ref7"><label>7</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Stambolian</surname><given-names>D</given-names></name></person-group><article-title>Galactose and cataract</article-title><source>Surv Ophthalmol</source><year>1988</year><volume>132</volume><fpage>333</fpage><lpage>49</lpage><pub-id pub-id-type="pmid">3043741</pub-id></element-citation></ref><ref id="ref8"><label>8</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Sukhija</surname><given-names>J</given-names></name><name><surname>Ram</surname><given-names>J</given-names></name></person-group><article-title>Pediatric traumatic cataract: maximizing the surgical outcome</article-title><source>J Cataract Refract Surg</source><year>2012</year><volume>38</volume><fpage>2210</fpage><lpage>1</lpage><pub-id pub-id-type="pmid">23195277</pub-id></element-citation></ref><ref id="ref9"><label>9</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Singh</surname><given-names>R</given-names></name><name><surname>Ram</surname><given-names>J</given-names></name><name><surname>Kaur</surname><given-names>G</given-names></name><name><surname>Prasad</surname><given-names>R</given-names></name></person-group><article-title>Galactokinase deficiency induced cataracts in Indian infants: identification of 4 novel mutations in <italic>GALK</italic> gene</article-title><source>Curr Eye Res</source><year>2012</year><volume>37</volume><fpage>949</fpage><lpage>54</lpage><pub-id pub-id-type="pmid">22632133</pub-id></element-citation></ref><ref id="ref10"><label>10</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ram</surname><given-names>J</given-names></name><name><surname>Gupta</surname><given-names>N</given-names></name></person-group><article-title>Bilateral spontaneous anterior dislocation of crystalline lens in an infant</article-title><source>Lancet</source><year>2011</year><volume>378</volume><fpage>1501</fpage><pub-id pub-id-type="pmid">21872322</pub-id></element-citation></ref><ref id="ref11"><label>11</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Cheng</surname><given-names>KP</given-names></name><name><surname>Hiles</surname><given-names>DA</given-names></name><name><surname>Biglan</surname><given-names>AW</given-names></name><name><surname>Pettapiece</surname><given-names>MC</given-names></name></person-group><article-title>Management of posterior lenticonus</article-title><source>J Pediatr Ophthalmol Strabismus</source><year>1991</year><volume>28</volume><fpage>143</fpage><lpage>9</lpage><pub-id pub-id-type="pmid">1890571</pub-id></element-citation></ref><ref id="ref12"><label>12</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Courtright</surname><given-names>P</given-names></name></person-group><article-title>Childhood cataract in sub-Saharan Africa</article-title><source>Saudi J Ophthalmol</source><year>2012</year><volume>26</volume><fpage>3</fpage><lpage>6</lpage><pub-id pub-id-type="pmid">23960961</pub-id></element-citation></ref><ref id="ref13"><label>13</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Apple</surname><given-names>DJ</given-names></name><name><surname>Ram</surname><given-names>J</given-names></name><name><surname>Foster</surname><given-names>A</given-names></name><name><surname>Peng</surname><given-names>Q</given-names></name></person-group><article-title>Elimination of cataract blindness: A global perspective entering new Millennium</article-title><source>Survey Ophthalmol</source><year>2000</year><volume>45</volume><issue>Suppl</issue><fpage>1</fpage><lpage>196</lpage></element-citation></ref><ref id="ref14"><label>14</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ram</surname><given-names>J</given-names></name><name><surname>Gupta</surname><given-names>N</given-names></name><name><surname>Sukhija</surname><given-names>JS</given-names></name><name><surname>Chaudhary</surname><given-names>M</given-names></name><name><surname>Verma</surname><given-names>N</given-names></name><name><surname>Kumar</surname><given-names>S</given-names></name><etal></etal></person-group><article-title>Outcome of cataract surgery with primary intraocular lens implantation in children</article-title><source>Br J Ophthalmol</source><year>2011</year><volume>95</volume><fpage>1086</fpage><lpage>90</lpage><pub-id pub-id-type="pmid">20935312</pub-id></element-citation></ref><ref id="ref15"><label>15</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Vasavada</surname><given-names>AR</given-names></name><name><surname>Nihalani</surname><given-names>BR</given-names></name></person-group><article-title>Paediatric cataract surgery</article-title><source>Curr Opin Ophthalmol</source><year>2006</year><volume>17</volume><fpage>54</fpage><lpage>61</lpage><pub-id pub-id-type="pmid">16436925</pub-id></element-citation></ref><ref id="ref16"><label>16</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Dahan</surname><given-names>E</given-names></name><name><surname>Drusedau</surname><given-names>MU</given-names></name></person-group><article-title>Choice of lens and dioptric power in pediatric pseudophakia</article-title><source>J Cataract Refract Surg</source><year>1997</year><volume>23</volume><fpage>618</fpage><lpage>23</lpage><pub-id pub-id-type="pmid">9278814</pub-id></element-citation></ref><ref id="ref17"><label>17</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ram</surname><given-names>J</given-names></name><name><surname>Sukhija</surname><given-names>J</given-names></name><name><surname>Thapa</surname><given-names>BR</given-names></name><name><surname>Arya</surname><given-names>VK</given-names></name></person-group><article-title>Comparison of hospital versus rural eye camp based pediatric cataract surgery</article-title><source>Middle East Afr J Ophthalmol</source><year>2012</year><volume>19</volume><fpage>141</fpage><lpage>6</lpage><pub-id pub-id-type="pmid">22346130</pub-id></element-citation></ref><ref id="ref18"><label>18</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ram</surname><given-names>J</given-names></name><name><surname>Brar</surname><given-names>GS</given-names></name><name><surname>Kaushik</surname><given-names>S</given-names></name><name><surname>Gupta</surname><given-names>A</given-names></name><name><surname>Gupta</surname><given-names>A</given-names></name></person-group><article-title>Role of posterior capsulotomy with vitrectomy and intraocular lens design and material in reducing posterior capsule opacification after pediatric cataract surgery</article-title><source>J Cataract Refract Surg</source><year>2003</year><volume>29</volume><fpage>1579</fpage><lpage>84</lpage><pub-id pub-id-type="pmid">12954310</pub-id></element-citation></ref><ref id="ref19"><label>19</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Fan</surname><given-names>DS</given-names></name><name><surname>Yip</surname><given-names>WW</given-names></name><name><surname>Yu</surname><given-names>CB</given-names></name><name><surname>Rao</surname><given-names>SK</given-names></name><name><surname>Lam</surname><given-names>DS</given-names></name></person-group><article-title>Updates on the surgical management of paediatric cataract with primary intraocular lens implantation</article-title><source>Ann Acad Med Singapore</source><year>2006</year><volume>35</volume><fpage>564</fpage><lpage>70</lpage><pub-id pub-id-type="pmid">17006585</pub-id></element-citation></ref><ref id="ref20"><label>20</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ram</surname><given-names>J</given-names></name><name><surname>Apple</surname><given-names>D</given-names></name><name><surname>Peng</surname><given-names>Q</given-names></name><name><surname>Visessook</surname><given-names>N</given-names></name><name><surname>Auffarth</surname><given-names>GU</given-names></name><name><surname>Schoderbek</surname><given-names>RJ</given-names><suffix>Jr</suffix></name><etal></etal></person-group><article-title>Update on fixation of rigid and foldable posterior chamber intraocular lenses. Part II: Choosing the correct haptic fixation and intraocular lens design to help eradicate posterior capsule opacification</article-title><source>Ophthalmology</source><year>1999</year><volume>106</volume><fpage>891</fpage><lpage>900</lpage><pub-id pub-id-type="pmid">10328386</pub-id></element-citation></ref><ref id="ref21"><label>21</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Gupta</surname><given-names>A</given-names></name><name><surname>Ram</surname><given-names>J</given-names></name><name><surname>Gupta</surname><given-names>A</given-names></name><name><surname>Gupta</surname><given-names>V</given-names></name></person-group><article-title>Intraoperative dexamethasone implant in uveitis patients with cataract undergoing phacoemulsification</article-title><source>Ocul Immunol Inflamm</source><year>2013</year><volume>21</volume><fpage>462</fpage><lpage>7</lpage><pub-id pub-id-type="pmid">23941542</pub-id></element-citation></ref><ref id="ref22"><label>22</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ram</surname><given-names>J</given-names></name><name><surname>Agarwal</surname><given-names>A</given-names></name><name><surname>Kumar</surname><given-names>J</given-names></name><name><surname>Gupta</surname><given-names>A</given-names></name></person-group><article-title>Bilateral implantation of multifocal versus monofocal intraocular lens in children above 5 years of age</article-title><source>Graefes Arch Clin Exp Ophthalmol</source><year>2014</year><volume>252</volume><fpage>441</fpage><lpage>7</lpage><pub-id pub-id-type="pmid">24441952</pub-id></element-citation></ref><ref id="ref23"><label>23</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Tassignon</surname><given-names>MJ</given-names></name><name><surname>De Veuster</surname><given-names>I</given-names></name><name><surname>Godts</surname><given-names>D</given-names></name><name><surname>Kosec</surname><given-names>D</given-names></name><name><surname>Van den Dooren</surname><given-names>K</given-names></name><name><surname>Gobin</surname><given-names>L</given-names></name></person-group><article-title>Bag-in-the-lens intraocular lens implantation in the pediatric eye</article-title><source>J Cataract Refract Surg</source><year>2007</year><volume>33</volume><fpage>611</fpage><lpage>7</lpage><pub-id pub-id-type="pmid">17397732</pub-id></element-citation></ref><ref id="ref24"><label>24</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Deng</surname><given-names>H</given-names></name><name><surname>Yuan</surname><given-names>L</given-names></name></person-group><article-title>Molecular genetics of congenital nuclear cataract</article-title><source>Eur J Med Genet</source><year>2014</year><volume>57</volume><fpage>113</fpage><lpage>22</lpage><pub-id pub-id-type="pmid">24384146</pub-id></element-citation></ref></ref-list></back></pmc><affiliations><list><country><li>Inde</li></country></list><tree><country name="Inde"><noRegion><name sortKey="Ram, Jagat" sort="Ram, Jagat" uniqKey="Ram J" first="Jagat" last="Ram">Jagat Ram</name></noRegion><name sortKey="Agarwal, Aniruddha" sort="Agarwal, Aniruddha" uniqKey="Agarwal A" first="Aniruddha" last="Agarwal">Aniruddha Agarwal</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Ticri/CIDE/explor/HapticV1/Data/Pmc/Checkpoint
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 000894 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Pmc/Checkpoint/biblio.hfd -nk 000894 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Ticri/CIDE
|area= HapticV1
|flux= Pmc
|étape= Checkpoint
|type= RBID
|clé= PMC:4277129
|texte= The challenge of childhood cataract blindness
}}
Pour générer des pages wiki
HfdIndexSelect -h $EXPLOR_AREA/Data/Pmc/Checkpoint/RBID.i -Sk "pubmed:25488437" \
| HfdSelect -Kh $EXPLOR_AREA/Data/Pmc/Checkpoint/biblio.hfd \
| NlmPubMed2Wicri -a HapticV1
| This area was generated with Dilib version V0.6.23. |  |