PEDIATRIC CATARACT SURGERY
How are pediatric cataracts treated?
Once a cataract is suspected, treatment begins with a full eye exam by one of our experienced pediatric ophthalmologists. Most pediatric cataracts are found at birth or at well-baby exams. Sometimes they are noticed by parents. Treatment will vary depending on the size and type of cataract and the overall eye health.
Not all cataracts will need to be removed. Cataracts that are small and/or off center in the lens may have minimal effect on vision. These children may be monitored, or medically treated with dilating eye drops, eyeglasses and/or patching therapy. Surgery may be delayed or avoided entirely.
Cataracts that interfere with vision development should be removed as soon as it is safely possible. Unlike adults with fully grown eyes, children require specialized surgical instrumentation and techniques.
Our experienced pediatric ophthalmologists will carefully evaluate your child and consider all factors. Surgery will be recommended only if necessary.
How is a cataract removed in children?
Unlike adult cataract surgery, general anesthesia is needed for pediatric cataract surgery. This means it will take place at our state-of-the-art Pediatric Cataract Center, at the Bristol-Myers Squibb Children’s Hospital (BMSCH). It is an outpatient procedure, so you and your child will be able to return home on the same day.
Depending on the age of the child, a full exam under anesthesia and measurements of the eye may be done before the cataract is removed.
Tiny incisions are made into the eye for specialized micro-sized surgical instruments to enter. Using these instruments, a small opening is first made on the surface of the lens capsule, and the cataract is then broken up and suctioned out. Depending on the age of the child, sometimes an opening is needed on the back surface of the lens capsule, and some of the thick gel (vitreous) that fills the eye will also be removed. This reduces the chance of scarring, which may cloud vision.
If a child is old enough and the eye is in healthy condition, a lens implant may be recommended. The implant is a man-made lens that will permanently remain in the eye. The power of the lens is a complex decision with many factors; this will be discussed with your surgeon. Whether a child receives a lens implant or not, they will need contact lenses and/or eyeglasses after surgery.
What are the risks of cataract surgery in children?
With modern technology, cataract surgery performed by an experienced surgeon is generally very safe and serious complications are rare. However, no surgical procedure is without risks. Some risks are the same as adult cataract surgery and other types of eye surgery. Other risks are more specific to the pediatric population.
Risks include inflammation, infection, retinal detachment, development of capsular scar or cloudiness in the visual axis, clouding of the vitreous, and glaucoma.
The risk of glaucoma is perhaps the most serious for kids undergoing pediatric cataract surgery, especially those at a younger age. Glaucoma is high pressure in the eye. It is not caused by cataract surgery, but due to improper development of the drainage channels in the eye. Glaucoma may develop months to years after surgery. The pressure can be controlled with medicated eye drops, but some children may require additional surgery to lower the pressure in the eye.
What to expect after cataract surgery?
Surgery will generally take about 1 to 2 hours, but it can vary depending on the complexity of the cataract. When you see your child in the recovery room, he or she will have a soft patch and hard shield protecting the eye. This will be secured with tape, which may be bothersome but will ensure protection of the eye and help with the mild discomfort that is normal after surgery. The patch and shield will be removed the next day at your post-operative appointment.
Overall, discomfort from cataract surgery is mild. Most children will require no pain medication, few may use Tylenol.
Medicated eye drops will help the eye heal and prevent infection during the first 4 to 6 weeks after surgery. A clear shield should be worn to protect the eye during the first two weeks. Your child should avoid rough play, submerging his or her eye in a bath, and swimming for 10 to 14 days after surgery. Most children will return to school after a few days.
How does vision improve after cataract surgery?
Cataract surgery is just the first step to improving vision. Connections between the eye and brain must be rebuilt. After removal of the cataract, children will need a combination of intraocular lens implanted in the eye, contact lenses, or eyeglasses to train the eye(s) to focus properly.
Amblyopia treatment is also an important part of vision rehabilitation. This involves patching, or covering the stronger eye to stimulate vision in the weaker eye.
Depending on the age of the child at the time of surgery, vision rehabilitation may continue until the child is 8 to 10 years of age and vision development is complete. After this time, amblyopia is very unlikely to return.
Stories of children with congenital cataracts: