Objectives: Congenital cataract is a rare disease with estimated prevalence of 4.24 per 10 000 and remains a significant cause of preventable childhood blindness. Management options for cataract in children is often controversial for details. To identify areas of consensus and disagreement in the management of pediatric cataract is challenging. Preoperative pediatric cataract management, Intraoperative pediatric cataract management, and Postoperative pediatric cataract management are priority of the surgeon. With Delphi Study, authors identified the following top five questions in the no consensus areas that need further research. (1) suggested minimum age for bilateral primary IOL Implantation, (2) IOL power calculation formula, (3) IOL type for in-the-bag IOL implantation, (4) medications on the table at the end of surgery and (5) upper age limit for performing posterior capsulectomy and anterior vitrectomy.
Indications of surgery, Preoperative workup, Anterior capsule management, Lens aspiration and anterior vitrectomy, Aphakia versus intraocular lens insertion, Intraocular lens types in congenital cataract surgery, Intraocular lens power, early and late postoperative complications, Post-operation care and Visual rehabilitation will be discussed. Lens opacity obscuring the red reflex in preverbal children and visual acuity of less than 20/40 is an absolute indication for lens aspiration. For significant lens opacity that leads to a considerable risk of amblyopia, cataract surgery is recommended at 6 weeks of age for unilateral cataract and between 6 and 8 weeks of age for bilateral cases. The recommended approach in operation is lens aspiration via vitrector and posterior capsulotomy and anterior vitrectomy in children younger than six years, and IOL implantation could be considered in patients older than one year or less according to axial length. Congenital cataract as the leading cause of preventable blindness in children can be a critical condition requiring well-timed and proper surgical or optical management. Optical rehabilitation and patch therapy in a pseudophakic or aphakic eye in operated children remains essential in the follow-up. The management of congenital cataracts stands to challenge for most surgeons because of visual development and ocular growth.

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