Barraquer Specialties: Cataracts
The congenital cataract surgery involces extracting the opacified crystalline lens and replacing it with a lens that will compensate for its optical power.
It is necessary to consider surgery if a child's visual development is interfered with.
In childhood, a congenital cataract may cause nystagmus, which is the dancing or balance of the eyes, as they cannot focus on a specific point. It can also cause problems like lazy eye and visual development difficulties, therefore it's necessary to undergo surgery as soon as possible in cases where it is indicated.
Usually in very young children we perform the surgery without the intraocular lens implant. It is performed under general anaesthesia, normally one eye first and the other after a week or a fortnight.
It is performed by making two small incisions, an opening is made in the crystalline lens, in the anterior capsule, called capsulorhexis. The congenital cataract is aspired and then an opening is made in the posterior capsule, called posterior capsulorhexis, and a small amount of the anterior vitreous is aspired, which is called an anterior vitrectomy.
A small capsular ring is put in place, which will be used as a support in the future. At the age of around 3, 4 or 6 years or whenever the surgeon or the family decides, an intraocular lens may be implanted in a simple way.
Evidently, when these children lose their crystalline lens, they need many dioptres. Small children normally, aged 2 or 3 months, have to wear glasses with 18 dioptes, but the best rehabilitation is attained with the adaptation of silicone contact lenses.
We have a contactology centre specilised in the adaptation of contact lenses for babies and we belief visual rehabilitation to be optimum in the large majority of cases.
The results are usually good provided that the cataract is operated on as early as possible, taking into account the criteria of the eye surgeon and of the binocular and strabismus department ophthalmologist.
Congenital cataract treatment is approached in a multidisciplinary way and various specialists are involved in the surgery and then the visual development of these children continues to evolve until the best results possible are attained.
Intraocular lenses can be implanted from age 3 in a secondary way. When children over one year old are operated on, we put the intraocular lens directly in, the patient does not need to be without it or have it put in subsequently..
The power of the intraocular lens will vary with the growth of the eye. The power is usually calculated to compensate for this growth of the eye in childhood and adolescence. In addition, the intraocular lens, can be changed in the future, plus refractive errors that appear in adolescence can be corrected with laser surgery or another type of technique.
Frequently asked questions
Cataracts can form in newborns or small children, not just adults and the elderly. In children, cataracts can form for many reasons and we have to investigate the possibility that they have a metabollic disease or another general systemic congenital problem, that may be connected to congenital cataracts. Traumatic cataracts may also exist in childhood, particularly in children who get a blow to the eye when they are small. However, congenital cataracts appear at birth, they may be dense or not so dense, and cause amblyopia or lazy eye if not treated. It's essential to see an ophthalmologist who will determine when surgery might be necessary based whether your child's visual development is interfered with or not.