RESUMO ABSTRACTPurpose: This study aimed to evaluate the frequency of strabismus and chronological, etiological, and morphological features in patients with pediatric cataracts. Methods: Medical records of pediatric patients were evaluated at the Congenital Cataract Section, Department of Ophthalmology, Federal University of São Paulo, from 2001 to 2011. Patients with congenital cataract or developmental cataract were included. The patients with traumatic cataract, cataract secondary to uveitis, radiation or drugs, aphakic or pseudophakic patients who underwent surgery in another hospital, patients with glaucoma, non-lenticular leukocorias (retinoblastoma, retinopathy of prematurity, prelenticular leukocorias), and lens subluxation were excluded from the study. The following outcomes were evaluated: frequency of chronological, etiological, and morphological features, laterality, and occurrence of associated strabismus. Results: A total of 207 patients were included. One hundred and seventeen patients (56.5%) had congenital cataract and 90 patients (43.5%) had developmental cataract. One hundred and nine patients (52.6%) had unilateral cataract. In terms of morphology, 72 children (33.8%) had zonular cataract and 66 (31.9%) had total cataract. Idiopathic cataract affected 150 patients (72.5%). There were 108 patients (52.2%) with strabismus, mainly secondary esotropia. Conclusion: Idiopathic etiology was the most frequent cause in this group of pa tients. Zonular cataract was the main morphological type of cataract in the study. Unilateral cataract occurred more frequently in patients with persistent fetal vasculature (PFV). Strabismus presented in 52% of the patients. The current analysis may help establish an earlier and more accurate diagnosis of pediatric cataracts.

RESUMO ABSTRACTPurpose: To study the results of cataract surgery in children with radiation-induced cataract after treatment for retinoblastoma. Methods: Retrospective interventional case series. Six consecutive patients diagnosed with secondary cataracts due to radiation therapy for retinoblastoma. Intervention: Phacoemulsification and foldable acrylic intraocular lens implantation. Outcomes mea sured: Visual acuity, binocular indirect ophthalmoscopy and slit-lamp biomicroscopy. Aspirated lens material and aqueous humor samples were collected during surgery. Results: Six uniocular children between 3 to 5 years of age at time of surgery were studied. The mean time interval between radiotherapy and cataract diagnosis was 22.3 months. The mean follow-up after surgery was 17.2 months (range: 12 to 23 months). All eyes achieved a clear visual axis after surgery allowing monitoring of the tumor status. None developed recurrence or retinoblastoma dissemination. His topathological analysis of the aspired material showed no tumoral cells in all sam ples. All patients improved vision after cataract surgery. Conclusions: Phacoemulsification with acrylic intraocular lens implantation seems to be a safe, feasible, and effective method for the removal of radiation-induced cataracts in patients with treated retinoblastoma.

BackgroundTo report a case series of nine patients presenting with leukocoria without lens opacification or retrolental abnormalities and to propose a novel classification for leukocoria.MethodsAn institutional and retrospective study including a case series of patients assisted in the Congenital Cataract Section of Federal University of São Paulo, Brazil, during the period between 2005 and 2010 with prelenticular leukocoria and clear lens.ResultsNine patients younger than 4 years old presented with the diagnosis of unilateral prelenticular opacities without cataract formation. Echography in all patients revealed no posterior segment or lens abnormalities in the affected eye. Among the patients, three had idiopathic prelenticular membrane, two presented with juvenile xanthogranuloma with secondary pupillary membrane, one had persistent fetal pupillary membrane, one had prelenticular membrane due to congenital toxoplasmosis, one presented with pupillary membrane due to hyphema caused by iris hemangioma, and one had anterior segment persistent fetal vasculature.ConclusionsThis case series of patients presented unilateral prelenticular leukocoria without lens opacification or posterior segment abnormalities. Several etiologies were associated with this condition. The correct diagnosis is important in order to avoid clear lens extraction. A new classification of leukocoria is proposed herein including: prelenticular leukocoria, lenticular leukocoria, retrolenticular leukocoria, and mixed presentation leukocoria.