ACADEMIC RESEARCH IN MODERN SCIENCE
International scientific-online conference
63
DEVELOPMENT OF CLINICAL ALGORITHMS FOR THE TREATMENT
OF SECONDARY CATARACTS AND PUPILLARY MEMBRANES IN
CHILDREN
Kariyev Abdufarrux Varisovich
Zokirkhuzhaev Rustam Asrolovich
Children's National Medical Center
Doctor of Medical Sciences, Associate Professor Tashkent Medical Academy
https://doi.org/10.5281/zenodo.15280938
Abstract
This study presents the development and clinical validation of diagnostic
and treatment algorithms for secondary cataracts and pupillary membranes in
pediatric patients. A total of 160 children (320 eyes), aged 6 months to 15 years
(mean age 5.2 ± 3.1 years), were examined post-cataract surgery. Based on
cataract etiology, age, and intraocular lens status, personalized laser
intervention protocols were created. The proposed algorithm improved visual
outcomes and reduced complications. Postoperative optical axis clarity was
achieved in 92.5% (296 eyes), and visual acuity increased by two or more lines
in 88.4% (283 eyes). The algorithm provides structured decision-making for
pediatric ophthalmologists.
Keywords:
secondary cataract, pupillary membrane, children, clinical algorithm,
Nd:YAG laser, individualized treatment, postoperative outcome
Relevance
Secondary cataracts and pupillary membranes are frequent complications
following pediatric cataract surgery, with incidence rates up to 60–90%,
especially in children under 5 years old. Effective management of these
conditions is vital for preventing amblyopia and ensuring long-term visual
rehabilitation. However, pediatric patients present diverse challenges due to
differences in age, type of primary cataract, and intraocular lens (IOL) status.
Currently, treatment decisions vary significantly among clinicians and lack
standardization. This study addresses the need for a unified, evidence-based
approach by developing a structured clinical algorithm that guides the diagnosis,
treatment selection, and postoperative care of secondary cataracts and pupillary
membranes in children. The algorithm incorporates patient-specific factors,
timing, and technical parameters of Nd:YAG laser capsulotomy. It improves
clinical consistency, enhances safety, and optimizes visual outcomes.
Widespread adoption of such algorithms can elevate the standard of pediatric
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ophthalmic care and reduce vision loss due to inconsistent management
strategies in young children.
Aim:
To develop and clinically validate structured algorithms for the treatment of
secondary cataracts and pupillary membranes in children, tailored to cataract
type, patient age, and intraocular lens status.
Materials and Methods
This prospective multicenter study involved 160 children (320 eyes) aged 6
months to 15 years who developed secondary cataracts and/or pupillary
membranes post-cataract surgery. Patients were categorized by primary
cataract etiology, presence of IOL, and age group. Based on these parameters,
treatment algorithms were developed. Nd:YAG laser capsulotomy was
performed with customized settings for each group. Clinical outcomes were
evaluated at 1, 3, 6, and 12 months postoperatively. Visual acuity, optical axis
transparency, and postoperative complications were recorded. Statistical
analysis included paired t-tests and chi-square tests, with significance set at
p<0.05.
Results
Implementation of the clinical algorithm led to significant improvements in
treatment outcomes. At 12 months, optical axis transparency was achieved in
92.5% (296 eyes), and visual acuity improved by two or more lines in 88.4%
(283 eyes). Complications were recorded in 9.4% (30 eyes): transient IOP
elevation (5.6%), mild anterior uveitis (2.5%), and posterior synechiae (1.3%).
Children under 3 years required sedation and had higher recurrence rates
(12%). Adherence to the algorithm reduced complication rates by 30%
compared to historical controls. Age-specific adjustments and personalized laser
parameters played a key role in minimizing risk and improving efficacy.
Conclusion
The proposed clinical algorithm for managing secondary cataracts and
pupillary membranes in children significantly enhances treatment consistency
and outcomes. With a 92.5% success rate in maintaining a clear visual axis and
88.4% improvement in visual acuity, the algorithm demonstrates strong clinical
value. It standardizes treatment planning, incorporates patient-specific criteria,
and reduces adverse events. Early intervention and individualized laser settings,
especially in younger children, further optimize outcomes. The algorithm can
serve as a decision-making tool in pediatric ophthalmology, promoting best
ACADEMIC RESEARCH IN MODERN SCIENCE
International scientific-online conference
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practices and reducing complications. Future studies will refine protocol details
and assess its applicability in broader clinical settings.
