The pediatric cataract surgery is performed to treat cataract occurring in children due to various reasons. The surgery can sometimes causes some complications such as glaucoma in the eye.
We shall start first by understanding what actually is pediatric cataract surgery and it’s conditions. It is a cataract condition which occurs in young children. It can occur in children through genetic causes such as Down syndrome, and sometimes during pregnancy, the mother might get attacked with infections such as chickenpox which might increase the chances for the child getting a cataract and also the child can get an injury which causes cataract.
There are numerous types of cataracts and pediatric cataract is one of them. There are two types of pediatric cataracts namely acquired and congenital. The acquired cataract is the one which is seen because of any kind of injury or inflammation near the eye. The congenital cataract is caused by genes and it can be easily treated.
Before the pediatric cataract surgery: (pre operative work)
Before the pediatric cataract surgery takes place, a series of certain tests must be performed so that the need of pediatric cataract surgery can be determined.
The pediatric cataract surgery is not as simple as that of adults. While performing a surgery on children, it requires immense care and caution due to various causes such as
- Presence of young ocular tissues anatomically.
- The ocular growth is continuous in children
A test that helps in determining the significance of lens opacification on visual development and amblyopia is done so that appropriate age acuity is detected on visual functioning.
For children who are in pre verbal stage, based on their ability to follow the light and preferential acuity test such as teller’s acuity test etc.
And for those who are in verbal stage, optotype charts are used.
Presence of strabismus condition
Usually, the patients who undergo with cataracts can have strabismus or nystagmus as one of the side effects.
The presence of strabismus is less than that of nystagmus. Nystagmus is a condition in which the eyes perform involuntarily i.e, there is a sudden movement in the eyes and these kind of eye movements are also called as ‘dancing eyes’. The strabismus is usually caused by congenital cataract and is usually seen in cases of bilateral congenital cataract.
Laboratory diagnosis of pediatric cataract surgery
The congenital cataract can be also diagnosed in laboratory tests such as CBCs, blood sugars and red galactose kinase and serum calcium and phosphorus.
The study of history of the patient can help in increasing chances of understanding the cause of cataract even more clearly and help with the pediatric cataract surgery, The history of life style such as consumption of drugs or alcohol and any kind of traumatic experience while delivering the child and galactosemia.
New tests for pediatric cataract surgery
There are a set of newer tests which help in determining the cataract condition. The advances in DNA sequencing technology, which are called as next Gen sequencing (NGS). There is a possibility that this test is useful in future in identifying the congenital cataract which is caused by various genetically heterogeneous conditions.
Treatment of pediatric cataract surgery
Not all the cataracts should be treated with surgical procedures, there are certain conditions which do not require surgery to treat such conditions.
- When the cataract lens size is not more than 3mm.
- When there is an absence of extra conditions such as strabismus or nystagmus.
- A good red glow is seen in ophthalmoscope
- If there is no change in cataract or any development of amblyopia inside the eye then there is no requirement of any kind of surgery.
- Usage of eye drops that causes eye dilation, the increased eye pupil size helps the child to view from the clear part.
- But it also a side effect i.e, use of strong cycloplegic drops which cause loss of accommodation and increased chances of amblyopia occurrence.
Pediatric cataract Surgery
The ultimate option left after the increase in other diseases such as strabismus and nystagmus etc. is pediatric cataract surgery.
While operating on a child before 4 weeks, there is an increase of complications due to use of general anesthesia. So, an experienced doctor operates over both the eyes simultaneously with a set of other equipments for both eyes separately.
In case of unilateral cataracts in children, the pediatric cataract surgery must be performed within 6 weeks so that there is no risk of amblyopia and also chance of glaucoma.
In case of bilateral cataracts in children, the pediatric cataract surgery takes in six to eight weeks with a gap of a week between surgeries of both eyes.
There are various differences seen in between performing a surgery in adult eyes and child’s eyes i.e, difference in normal cataract surgery and pediatric cataract surgery. As children’s eyes are far more delicate than adult ones and also the presence of much younger cornea and less sclera rigidity and well formed vitreous and softer lenses and the anterior lenses are very elastic in children.
Use of anesthesia during pediatric cataract surgery can create an impact, as the children above 10 years of age can understand the local anesthesia effect and sedation takes place. But for the infants (below 1 month of age) the effect of local anesthesia can be more even after the operation (post operative).
The set of complications are of two types in pediatric cataract surgery. They are early complications and late complications. In early complications, there are a set of problems that are seen in post operative duration such as
- Intraocular lens capture or iris capture.
- During injury, the iris or vitreous incineration of wound.
- Inflammation caused after operation.
- The intraocular pressure can increase after the operation.
- Hemorrhages in vitreous region.
- Due to decrease in intraocular pressure, there is a retinal hemorrhage.
- Detachment of retina from the eye.
- Leakages from the particular wound.
It is a set of eye related problems caused by inflammation. After the pediatric cataract surgery, due to any kind of problem or postoperative inflammation or structural and anatomical damages, there is a risk of occurrence of glaucoma. The aphakic patients are the patients who have absence of lens inside their eyes, due to cataract surgery. They have loss of accommodation and far sightedness in high degree. So, chances of getting glaucoma is more in aphakic patients. The children whose families have a history of aphakic glaucoma are easy targets for the glaucoma.
Presence of fetel vasculature syndrome and nuclear cataract condition. There is a life long risk of getting a glaucoma inside the eye. So, the monitoring of the intraocular pressure inside the eye is prudent in this case. The inflammation inside the eye is usually much more seen in post operative because of immature blood aqueous barrier. The inflammation inside the eye is a common side effect in this case. The inflammation can be treated by usage of medications.
The pediatric cataract surgery is a complicated but successful surgery procedure which helps in treating blindness in children that occur through various reasons such as amblyopia or cataract.
The secondary lens which is implanted is taken care and effective methods to treat the amblyopia conditions with the help of post operative refractive error and along with patching. Monitoring the complications before they become fatal really helps in treating this condition.
The best way to treat your eyes is to visit your eye care professional and get your eyes checked regularly. He will be able to assess the best method of treatment for your eye ailment. Visit our website Eyemantra.