What is a congenital cataract? What effects will it have on the baby? Hua Ning, Strabismus and Pediatric Ophthalmology, Eye Hospital of Tianjin Medical University Congenital cataract is a clouding of the lens that occurs at birth or within the first year of life and can be associated with other eye abnormalities or systemic diseases. About one-third are familial, mostly autosomal dominant; one-third are associated with viral infections, drug applications or metabolic diseases in early pregnancy; and the other one-third are disseminated cases with no clear etiology. If there is a congenital cataract or other disease that affects the input of external visual information, the development of the visual system will be delayed, which is medically called form-deprivation amblyopia. Form-deprivation amblyopia is the most serious type of amblyopia, which can seriously affect children’s vision and cause blindness or low vision. Who is suitable for surgery and how to treat neonatal cataract in clinical practice? What is the best time for surgery to treat neonatal cataracts? What are the adverse effects if it is missed? Depending on the form and extent of the congenital cataract, treatment includes refractive correction, amblyopia treatment and surgery. If the lens is cloudy in the form of a scattered snowflake and the red light reflection in the fundus of the eye is good, suggesting that the lesion has less impact on light transmission, these children can be suspended from surgery. In addition, if the lens clouding is limited in extent or located in the peripheral part of the lens, it has limited impact on visual information input and surgery may not be urgent. In contrast, if the lens is dense or located in the center of the pupil with a large diameter of 3.0 mm or more, this means that the lesion is blocking the visual pathway and seriously affecting visual development, and surgery should be performed in a timely manner to effectively prevent the formation of severe amblyopia. Surgical treatment of congenital cataract is different from the treatment of age-related cataract. Since children’s eyes develop very rapidly in the first two years of life, cataract surgery for children within 2 years of age does not advocate simultaneous implantation of an artificial lens, but rather early cataract extraction and post-operative glasses to correct vision; after the child is 2 years old, he or she should undergo second-stage implantation of an artificial lens at a later date according to the situation. Early surgery is recommended for congenital cataracts affecting visual development, i.e., surgical treatment under general anesthesia can be performed 2 months after birth. Children begin to establish binocular vision between 1 and 3 months after birth and begin to develop binocular fixation and pursuit vision with gradual coordination of binocular movements. Abnormal visual experience during this time can lead to binocular motor disorders, nystagmus and strabismus. Therefore, early surgical intervention is an effective measure to reduce the risk of nystagmus and strabismus. So why not opt for surgery within the first month of life? According to several studies, cataract extraction within the first month of life affects the development of the atrial drainage system in the eye and the risk of aphakic glaucoma is higher, therefore, the second month of life is a better time for cataract surgical treatment. Safety of surgery Cataract surgery in children is a highly technical internal eye surgery that needs to be done under a microscope. It is safe with adequate preoperative systemic and ocular care. However, children have a higher risk of developing posterior cataracts (clouding of the lens and/or anterior vitreous membrane due to cellular proliferation). Almost every child with congenital cataracts has varying degrees of posterior cataracts, and many children require reoperation for treatment. Precautions for surgery 1. 5 days before surgery, use antimicrobial eye drops in both eyes to prevent infection 2. 6 hours before surgery, no breastfeeding or drinking 3. Pre-operative eye drops with compound tropicamide to dilate the pupil 4.