Cataracts are normally associated with aging. Congenital cataract is the clouding or blurring of the natural lens of the eyes that occurs at birth. An undetected congenital cataract could result in permanent visual loss.
Screening of the baby’s eye after birth is mandatory. Certain congenital cataracts need immediate surgery whereas certain types which block vision at the peripheral portion of the lens may not need cataract removal. Unlike adults where a delayed cataract surgery may have a lesser impact on the visual outcome but in case of children affected with congenital cataract a delay in surgery may result in never regaining vision thereafter.
Studies have noted that children treated for bilateral dense congenital cataracts, surgery prior 3 months of age is paramount to decrease the risk of visual acuity loss. The anatomical features in baby’s eye e.g. small lenses, soft cataract and developing size of the lens makes cataract surgery different and challenging. In certain cases it is conducted when the baby is just few weeks old.
Types of Congenital cataract
- Anterior polar cataracts: These are located in the front part of the eye’s lens and surgical intervention may not be required.
- Posterior polar cataracts: These are well defined and appear in the back portion of the lens.
- Nuclear cataracts: These are located in the central part of the lens and comparatively more common form.
- Cerulean cataracts: These affect both eyes of infants and normally do not cause vision problems.
- Drug Reactions
- Metabolic issues
- Certain illnesses that affect the pregnant mother like measles or rubella.
- Cloudiness of the pupil.
- Blurring in vision when cataracts are in both eyes.
- Nystagmus -rapid eye movements.
Treatment: Our pediatric ophthalmologist would advise the best time to conduct the surgery after detailed examination if surgery is recommended.
Too early surgery could risk the eye from getting secondary glaucoma and too late would result in blindness. If the occurrence is small in size may not require surgery. Prenatal and family history are closely noted and recorded. Parent’s illnesses or drugs used during pregnancy are noted.
Comprehensive examination and Tests: The eye screening examination in the new born mainly consists of the evaluation of the red reflexes, Retinoscopy and Laboratory Tests.
Surgery: Unlike adults wherein local anesthesia or tropical drops are used, the pediatric cataract surgery would require general anesthesia. In some cases the posterior capsule is removed during the surgical procedure.
The treatment begins with cataract surgery and the process may take years of accurate optical rehabilitation, other related therapies and postoperative supervision
- Lumpectomy: During this procedure the lens (including the posterior capsule) and anterior vitreous are removed.
- IOL implantation: IOL implantation is safe and effective in the treatment of congenital cataract specifically at a suitable age. Secondary intraocular lens implantation is normally conducted after a certain gap as required. Spectaclesare prescribed according to the vision requirement and the age the child can wear them. IOL implantation may sometimes need spectacles at the later stage.
Post Operative Complications:
- Glaucoma -Early diagnosis of Glaucoma can delay the onset.
- Posteriorcapsule opacification (PCO) – Nd: YAG laser capsulotomy in children is done to overcome PCO.
- Uveitis – Uveitis is a chronic inflammation in the eye could also occur.
- Pupillary Capture
- Decentration of IOL
- Secondary Membrane Formation
- Retinal complications- Retinal detachment is most common surgically treated eye.
- Amblyopia (Lazy eye) – Most commonly occurred in children where one eye becomes a weaker in focus and subsequently the stronger eye becomes the preferred eye. This makes the weaker eye amblyopic.
- Strabismus(Crossed eyes)
Do report us if you observe any kind of swelling, bleeding, redness, pain that requires prompt medical attention.
In case of congenital cataract in the family it is advisable to have genetic counseling. The success of congenital surgery would require co-operation from the parents. The treatment is most effective when parents partner with us to symphonise in the overall management and treatment in congenital cataract.
Do get in touch with us for more details for an effective congential cataract management for your child’s visual development.