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      Monitoring and Morphologic Classification of Pediatric Cataract Using Slit-Lamp-Adapted Photography

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          Abstract

          Purpose

          To investigate the feasibility of pediatric cataract monitoring and morphologic classification using slit lamp–adapted anterior segmental photography in a large cohort that included uncooperative children.

          Methods

          Patients registered in the Childhood Cataract Program of the Chinese Ministry of Health were prospectively selected. Eligible patients underwent slit-lamp adapted anterior segmental photography to record and monitor the morphology of their cataractous lenses. A set of assistance techniques for slit lamp–adapted photography was developed to instruct the parents of uncooperative children how to help maintain the child's head position and keep the eyes open after sleep aid administration.

          Results

          Briefly, slit lamp–adapted photography was completed for all 438 children, including 260 (59.4%) uncooperative children with our assistance techniques. All 746 images of 438 patients successfully confirmed the diagnoses and classifications. Considering the lesion location, pediatric cataract morphologies could be objectively classified into the seven following types: total; nuclear; polar, including two subtypes (anterior and posterior); lamellar; nuclear combined with cortical, including three subtypes (coral-like, dust-like, and blue-dot); cortical; and Y suture. The top three types of unilateral cataracts were polar (55, 42.3%), total (42, 32.3%), and nuclear (23, 17.7%); and the top three types of bilateral cataracts were nuclear (110, 35.8%), total (102, 33.2%), and lamellar (34, 11.1%).

          Conclusions

          Slit lamp–adapted anterior segmental photography is applicable for monitoring and classifying the morphologies of pediatric cataracts and is even safe and feasible for uncooperative children with assistance techniques and sleep aid administration.

          Translational Relevance

          This study proposes a novel strategy for the preoperative evaluation and evidence-based management of pediatric ophthalmology (Clinical Trials.gov, NCT02748031).

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          Most cited references 40

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          Lens opacities classification system II (LOCS II)

          The Lens Opacities Classification System, version II (LOCS II), uses a set of colored slit-lamp and retroillumination transparencies to grade different degrees of nuclear, cortical, and subcapsular cataract. The system uses four nuclear standards for grading nuclear opalescence and color, five cortical standards, and four subcapsular standards. The LOCS II can be used to grade patients' cataracts at the slit lamp or to grade slit-lamp and retroillumination photographs; it is easy to learn and can be applied consistently by different observers. We obtained very good interobserver reproducibility of the clinical gradings at the slit lamp, excellent intraobserver reproducibility, very good to excellent interobserver reproducibility of photographic gradings, and good agreement between clinical and photographic gradings. The LOCS II is potentially useful for both cross-sectional and longitudinal studies of cataract.
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            An artificial intelligence platform for the multihospital collaborative management of congenital cataracts

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              Infantile cataracts.

               S Lambert,  A V Drack (2015)
              Cataracts are one of the most treatable causes of visual impairment during infancy. Recent epidemiological studies have shown that they have a prevalence of 1.2 to 6.0 cases per 10,000 infants. The morphology of infantile cataracts can be helpful in establishing their etiology and prognosis. Early surgery and optical correction have resulted in an improved outcome for infants with either unilateral or bilateral cataracts. While contact lenses continue to be the standard means of optically correcting an infant's eyes after cataract surgery, intraocular lenses are gaining in popularity as an alternative means of optically correcting these eyes. Post-operative complications occur more commonly after infantile than adult cataract surgery and many of these complications do not develop until years later. As a result, it is critical that children be followed closely on a long term basis after infantile cataract surgery.
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                Author and article information

                Journal
                Transl Vis Sci Technol
                Transl Vis Sci Technol
                tvst
                tvst
                TVST
                Translational Vision Science & Technology
                The Association for Research in Vision and Ophthalmology
                2164-2591
                November 2017
                2 November 2017
                : 6
                : 6
                Affiliations
                [1 ]State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510060, China
                Author notes
                Correspondence: Haotian Lin, MD, PhD, Xian Lie South Road 54#, Guangzhou, China, 510060. e-mail: gddlht@ 123456aliyun.com
                [*]

                E.L., Z.L., and J.C. contributed equally to this work.

                Article
                tvst-06-06-03 TVST-17-0564
                10.1167/tvst.6.6.2
                5678553
                Copyright 2017 The Authors

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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                Clinical Trials

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