Congenital cataract is a common eye disease in children. A partial or total clouding of the lens that occurs in the first year of life is called a congenital cataract. Congenital cataracts can be familial or disseminated; they can develop in one or both eyes; and they can be associated with other ocular abnormalities. In addition, congenital cataracts can be associated with a variety of genetic or systemic diseases. Cataract is the disease with the highest incidence of visual disability in the world. 45% of the 30-45 million blind people are due to cataract, and the incidence of congenital cataract is 0.05% in China.
Since congenital cataract can occur at an early stage of deprivation amblyopia, its treatment is different from that of general adult cataract. For cataracts that cause pupillary area occlusion, early surgical removal of cataracts should be performed in cases with basic visual ability after visual function assessment. In order to prevent the recurrence of posterior cataracts after surgery, posterior capsulotomy and anterior vitrectomy should also be performed at the same time. The surgical interval between the two eyes of cataracts of comparable degree should not be too long to avoid the formation of monocular amblyopia.
Surgery should not be performed when severe fundus and optic nerve developmental abnormalities are identified; subjective and objective examinations cannot determine the presence of optical function; combined with severe microphthalmia; and combined with intraocular active disease.
For children with cataracts, surgery is only the first step of treatment, and postoperative follow-up and rehabilitation are very crucial. First of all, post-operative optometry is needed to correct post-operative refractive error, otherwise the surgery will have no effect. Optometry should be performed every six months to a year to adjust the degree of glasses in time to adapt to the refractive changes brought about by the development of the eye.
For children with monocular cataracts or cases with significant differences in vision between the two eyes after cataract surgery, amblyopia treatment such as masking and fine visual training should be carried out under the guidance of a professional physician. Non-infantile children may be allowed to implant IOLs at the same time or in phase II according to their condition.
While correcting refractive error and treating amblyopia, long-term monitoring for possible complications such as glaucoma, keratopathy, retinal detachment, etc. is also required. It is recommended that the surgery be followed up once in 1-2 weeks recently and regularly for up to several years in the following 3-6 months.
The recovery of visual function after surgery is related to the type and nature of cataract, unilateral or bilateral cataract, the time of surgery, and the presence of other eye abnormalities. The key lies in the timing of surgery; if the cataract is existing at birth and surgery is performed after 2 months, it may be followed by lifelong nystagmus, and it is difficult to recover visual disability even after cataract extraction.