Introduction
A thick, cloudy area or an opacity that develops over the lens of the eye (transparent structure behind the center of the eye, which helps to focus) is referred to as a cataract. It occurs due to the breakdown of the proteins in the lens, resulting in hazy or blurry vision. Cataracts usually occur due to aging and are mostly seen in adults. However, children can also develop cataracts. It may be difficult to diagnose as some children do not express symptoms until the disorder becomes severe. Cataracts in children can be congenital (present at birth) or acquired. According to the American Academy of Ophthalmology (AAO), approximately 50 percent of pediatric cataracts occur due to genetic mutations. Still, these are usually isolated and may not be associated with other abnormalities.
What Is Pediatric Cataract Surgery?
Cataract surgery performed in children is called pediatric cataract surgery. It is performed in a hospital by a team of doctors, including ophthalmologists, pediatricians, anesthetists, etc. If the cataract is not causing any problems to the child, immediate treatment or surgery may not be required. However, regular check-ups are necessary to monitor the child’s vision. Pediatric cataract surgery is indicated in children with visually significant unilateral (single-eye) or bilateral cataracts (both eyes). The cloudy lens is removed and replaced with contact lenses or glasses to improve vision during the procedure. Pediatric cataracts are usually rare; hence, it is difficult for doctors to predict the improvement following the treatment.
How Is Pediatric Cataract Surgery Different From Adult Cataract Surgery?
The eyes' lens should be clear to focus the image and send signals to the brain to recognize it. A cataract is a condition in which light is prevented from reaching the retina (the innermost part of the eye that is sensitive to light), resulting in scattering as it passes through the cloudiness. This leads to image distortion (altered images) and blurry vision. In adults, cataracts occur due to aging and can be corrected, but in children, brain and eye development takes place until eight to ten years. Therefore, if the cataract is left untreated, it can cause serious or permanent effects on the vision.
Pediatric cataract surgery is different from cataract surgery in adults. It is complex and challenging and must be performed by expert healthcare professionals in the appropriate centers that are well-equipped and suitable for children. Adults have better corneal and scleral rigidity, a soft lens, a very elastic anterior capsule, and a well-formed vitreous than children. Best surgical techniques that are less invasive are employed for children to reduce inflammation, achieve a better prognosis, and prevent complications. The surgical approach and an appropriate intraocular lens power selection play a major role in the outcome of pediatric cataract surgery.
How Is Pediatric Cataract Surgery Performed?
Pediatric cataract surgery is performed under general anesthesia (the child will be unconscious during the surgery), and the procedure may take around one to two hours. In infants, the cataract must be removed during the first year of life, as it may be difficult to regain complete vision if the surgery is done later. If the cataract is present since birth, surgery will be recommended probably when the baby is one to two months old. If the child has bilateral cataracts, each eye is operated separately to reduce the risk of complications. The second eye is usually operated within a week following the first.
Before the operation, the doctor applies eye drops to the affected eye to dilate (widen) the pupil (black opening in the center of the eye). A small incision is then made on the cornea's surface (the outermost clear layer of the eye), and the cloudy lens is removed. A superior incision is preferred to allow the wound to be protected by the eyelid from trauma, especially in childhood. Sometimes, an intraocular implant or lens (artificial clear plastic lens) may be inserted during the operative procedure. Once the operation is complete, the incision is closed, and a transparent shield or a pad is placed over the eye to protect it. Generally, doctors recommend external contact lenses or glasses after about one or two weeks of surgery to compensate for the removed cloudy lens.
What Are the Post-operative Instructions for Pediatric Cataract Surgery?
-
The child needs to stay in the hospital at least overnight to monitor the recovery. If another eye needs to be operated, it is scheduled after a few days, and the child can go home between the procedures.
-
Eyedrops are prescribed after the surgery to reduce the redness and swelling, and caregivers must apply them to the patient every two to four hours.
-
Contact lenses or glasses are prescribed after a few weeks of surgery to help the patient to focus. The healthcare provider instructs the parents or caregivers on the usage of contact lenses and also recommends regular eye check-ups to monitor the vision. As the vision varies or develops with age, the strength of the glasses or the contact lenses can be modified.
-
In case of unilateral or bilateral cataracts with weak vision in the other eye, the doctor recommends occlusion therapy wherein a temporary patch is placed to cover the stronger eye. This forces the brain to recognize the visual signals from the weaker eye, which was previously ignored. Depending on the patient's condition, an orthoptist (eyecare professional) will teach the parents or caregivers how to apply the patch and the duration. It may be an unpleasant experience for many children. Hence, caregivers must educate and motivate the child to achieve better results.
What Are the Risk Factors of Pediatric Cataract Surgery?
Pediatric cataract surgery is successful in the majority of patients. However, some children experience complications and may require further treatment. Some of these include:
-
Post-surgical infection or endophthalmitis (a rare bacterial infection) can occur in some patients and is treated by medications or operative procedures. Therefore, any signs of pain, bleeding, severe redness, or other adverse reactions observed following the surgery must be immediately reported to the healthcare professional.
-
Cloudy vision can develop in patients with artificial lenses due to opacification in the posterior capsule (a pocket where the lens sits). It may occur between four to 12 months after surgery and requires another surgery to correct the condition. The younger the child, the higher and earlier the onset of posterior capsule opacification (PCO).
-
Increased pressure inside the eyes can result in glaucoma, and the patients will have to monitor their ocular pressure at least once a year.
-
Abnormalities in the pupil can occur in some cases. However, it may not affect the vision.
Conclusion
Cataracts that develop in children or babies are called childhood or pediatric cataracts. A team of doctors performs pediatric cataract surgery to replace the affected eye’s lens with an artificial lens or glasses. It is indicated when the lens opacity significantly obstructs the visual axis and causes blurred vision. It poses different challenges and has potential risks compared to those performed in adults. However, the main aim of the treatment is to obtain a better and long-term visual outcome and prevent further complications.
