With the advancement of technology, cataracts have now become a treatable disease. Most adult cataract patients are able to achieve satisfactory vision after surgical treatment. Therefore, the public perception is that cataracts can be easily cured by surgery. So, if the cataract patient is a child, is the problem still this simple?
Cataract surgery for children.
Unlike adult cataracts, the timing of cataract surgery for children and the choice of the surgical procedure need to be based on the age of the child, the type of cataract, the disease in one or both eyes and the development of the eye, and the treatment plan chosen varies from surgeon to surgeon. Therefore, the first thing you need to do after discovering a child’s cataract is to go to a regular hospital and find an experienced cataract specialist to develop the most suitable treatment plan for the child. It is important to emphasize that only through excellent surgical skills, scientific follow-up treatment and regular review as prescribed by the doctor, it is possible to achieve better post-operative vision for children with cataracts.
The main postoperative complications of congenital cataract are
1.Secondary glaucoma
Glaucoma is one of the most common complications leading to vision loss after cataract surgery in children, and the incidence of glaucoma after congenital cataract surgery can be as high as 3% to 32%. Although children with elevated intraocular pressure may show a series of manifestations such as increased crying, photophobia and tearing, they lack specificity and more often than not, secondary glaucoma manifestations are often silent and mostly painless, so children cannot express them and parents can hardly detect them. Therefore, the importance of long-term postoperative follow-up observation of IOP must be emphasized in order to detect glaucoma at the earliest stage and provide effective treatment.
2. Posterior cataract
In children, proliferation is active and the residual lens cells proliferate and produce collagen fibers, forming posterior cataracts. It develops rapidly and severely, and is the main reason that prevents vision recovery after cataract surgery in children. It is characterized by a higher incidence the younger the child is and the longer the postoperative period. If the re-clouding of the visual axis is not detected in time, the visual pathway that has been painstakingly opened will be blocked once again, resulting in irreversible form deprivation amblyopia, and the surgery is equivalent to a useless effort. If posterior cataracts are detected in time, surgery or laser treatment can be performed. For children (especially infants), laser incision is more difficult and surgery under general anesthesia is required.
3. Pupil deformation or even atresia
Inflammatory reactions of varying degrees can occur 1-2 days after cataract surgery in children, and the formation of fibrous membrane in the pupil area is a serious complication caused by postoperative inflammation in infants and children. Usually, the younger the child, the more severe the postoperative inflammatory reaction. Parents who are able to do so can also purchase their own penlight and observe the postoperative pupillary changes at home on a daily basis.
4.Strabismic amblyopia
Children with strabismus usually do not cooperate well with visual acuity examinations, but they have more or less residual refractive error after surgery, whether they have a lens-free eye or a lens-implanted eye after stage II IOL implantation. If the child is unable to obtain a clearer retinal image, the establishment of visual function is severely compromised and failure to correct it in a timely manner may cause or aggravate strabismus. Therefore, it is essential to see an optometrist as soon as possible after surgery (usually one week after surgery) to understand the refractive status of the child through professional retinal imaging and to correct the visual acuity so as to effectively prevent the occurrence of strabismus.
At the same time, it is important to emphasize that amblyopia treatment is a long-term and lengthy process, and as the child’s eyes grow up, the refractive state changes, and the treatment plan needs to be reviewed regularly and changed at the right time. The treatment time can be as short as 1-2 years or as long as 7-8 years. Parents should not be in a hurry to correct amblyopia in a few months, which is very unrealistic. First of all, parents must fit their children with appropriate glasses, and secondly, adhere to the standardized amblyopia training, only then can they obtain the expected results.
5. Corneal edema
Surgical trauma, intraoperative or postoperative high intraocular pressure, endothelial damage, and the application of postoperative topical drugs may all cause corneal edema after cataract surgery. There are many causes of corneal edema. Mild corneal edema is not easy to detect with the naked eye, but if diffuse corneal edema occurs, parents who are careful can find that the child’s eyes are white, like a fog. If there is an increase in finger pressure, the eye pressure should be further measured with an ophthalmometer.
6. Other complications
Such as abnormal IOL position, large vesicular keratitis, iris atrophy, etc.
Why children need regular review after cataract surgery.
As a special group, children’s eyes are in the development stage and the eye tissues are very delicate, and various complications may occur after surgery. According to statistics, the incidence of postoperative complications in children is much higher than that of adult cataracts, and the occurrence of complications inevitably affects the long-term postoperative outcome. Worryingly, the small size of the child, poor cooperation, small pupils, residual crystalline cortex, nystagmus, etc. predetermine that these complications mentioned above can only be detected by experienced ophthalmologists with sophisticated ophthalmic instruments.
Successful surgery is only the first step in a long journey: the
Congenital cataract surgery may only take a few minutes to complete for one eye, and the surgery helps the child to see again, but how heartbreaking it is if the child becomes blind again because of the lack of scientific and effective follow-up treatment! Parents should not think that a successful surgery means that the child is completely cured, because congenital cataract can never be cured once and for all. In severe cases, lifelong blindness may result from some serious postoperative complications. Lifelong blindness, for a person who has seen the light for a short period of time, will be more and more painful than ever.