To evaluate the accuracy of intraocular lens (IOL) power calculation formulas with/without preoperative aphakic anterior chamber depth (aph-ACD) in pediatric aphakia.

A total of 102 pediatric patients (150 eyes) undergoing secondary IOL implantation were divided into two groups (in-the-bag or ciliary sulcus). Prediction error was calculated for 9 IOL power calculation formulas, including: 1) not requiring ACD: Hoffer Q, Holladay 1, SRK/T; 2) usable without or with entering ACD: Barrett Universal Ⅱ (BUII), Emmetropia Verifying Optical (EVO) 2.0, and Ladas Artificial Intelligence Super (Ladas AI); 3) requiring ACD: Haigis, Kane, and Pearl-DGS. Mean prediction error (ME), mean absolute error (MAE), median absolute error (MedAE) and the percentage of eyes within ±0.25, ±0.50, ±0.75, and ±1.00 D were calculated.

For the BUII, EVO 2.0, and Ladas AI, with aph-ACD demonstrated a higher MedAE compared to without aph-ACD (BUII: 1.27 vs 1.13 D, EVO 2.0: 1.26 vs 1.06 D, Ladas AI: 1.30 vs 1.10 D; all P<0.05). Formulas requiring ACD (Haigis, Kane, and Pearl-DGS) exhibited larger MedAE than those not requiring aph-ACD (Hoffer Q, Holladay 1, and SRK/T; P<0.05). In the capsular group, the percentage of eyes within ±1.00 D ranged from 44.83% to 74.14%, and it was 19.57% to 32.61% in the sulcus group.

The introduction of aph-ACD does not improve the accuracy of IOL calculation for pediatric aphakia, regardless of in-the-bag or sulcus IOL secondary implantation. The relationship between aph-ACD and effective lens position in pediatric aphakia warrants further study.

To establish a classification for congenital cataracts that can facilitate individualized treatment and help identify individuals with a high likelihood of different visual outcomes.

Consecutive patients diagnosed with congenital cataracts and undergoing surgery between January 2005 and November 2021 were recruited. Data on visual outcomes and the phenotypic characteristics of ocular biometry and the anterior and posterior segments were extracted from the patients’ medical records. A hierarchical cluster analysis was performed. The main outcome measure was the identification of distinct clusters of eyes with congenital cataracts.

A total of 164 children (299 eyes) were divided into two clusters based on their ocular features. Cluster 1 (96 eyes) had a shorter axial length (mean±SD, 19.44±1.68 mm), a low prevalence of macular abnormalities (1.04%), and no retinal abnormalities or posterior cataracts. Cluster 2 (203 eyes) had a greater axial length (mean±SD, 20.42±2.10 mm) and a higher prevalence of macular abnormalities (8.37%), retinal abnormalities (98.52%), and posterior cataracts (4.93%). Compared with the eyes in Cluster 2 (57.14%), those in Cluster 1 (71.88%) had a 2.2 times higher chance of good best-corrected visual acuity [<0.7 logMAR; OR (95%CI), 2.20 (1.25–3.81); P=0.006].

This retrospective study categorizes congenital cataracts into two distinct clusters, each associated with a different likelihood of visual outcomes. This innovative classification may enable the personalization and prioritization of early interventions for patients who may gain the greatest benefit, thereby making strides toward precision medicine in the field of congenital cataracts.

To explore the hotspots and frontiers of genetic research on pediatric cataracts.

Global publications from 2013 to 2022 related to genes in pediatric cataracts were extracted from the Web of Science Core Collection, and were analyzed in terms of the publication counts, countries, journals, authors, keywords, cited references, subject categories, and the underlying hotspots and frontiers.

Totally 699 publications were included in the final analysis. The predominant actors were identified, with China (n=240) and PLoS One (n=33) being the most productive country and journal respectively. The research hotspots extracted from keywords were crystallin gene mutations, pathogenicity evaluation, phenotypes of ocular and neurodevelopmental abnormalities, genes encoding membrane proteins, and diagnosis of multisystemic disorders. The co-cited articles formed 10 clusters of research topics, including FYCO1 (56 items), mutation screening (43 items), gap junction (29 items), the Warburg Micro syndrome (29 items), ephrin-A5 (28 items), novel mutation (24 items), eye development and function (22 items), cholestanol (7 items), OCRL (6 items), and pathogenicity prediction (3 items). The research frontiers were FYCO1, ephrin-A5, and cholestanol. Cell biology showed the strongest bridging effects among different disciplines in the field (betweenness centrality=0.44).

With the progress in next-generation sequencing and multidisciplinary collaboration, genetic research on pediatric cataracts broadens the knowledge scope of the crystalline lens, as well as other organs and systems, shedding light on the molecular mechanisms of systemic diseases. Cell biology may integrate multidisciplinary content to address cutting-edge issues in the field.