Although cataract formation in the lens of the eye is often a disease of the ageing eye, it can sometimes occur in children – either at birth or later in life. In this situation, the condition assumes special significance, since it can seriously damage the development of the eye and the visual system, if not treated early.
Such changes in the lens occur due to a variety of causes – trauma, genetic causes, due to inflammation in the eye, infections in the mother during pregnancy, in association with other conditions affecting the eye and body, tumors and sometimes after the use of medications or radiation to treat other conditions.
Children with lens changes often do not see well with that eye. This can be noted by alterations in head posture, as the child tries to preferentially use the better eye, the appearance of a squint in the affected eye, a constant side to side shaking movement of the affected eye and in advanced cases – a white reflex in the center of the cornea of the affected eye.
Children with cataracts require careful evaluation of the affected eye to determine the need for and appropriate timing of surgery. Surgery in children is more complex than in adults – since the eye is smaller, is more reactive, and the proper placement of the intraocular lens is critical.
Apart from the surgical techniques used, the postoperative care and proper use of medicines is vital, as is the need for techniques of visual rehabilitation. If the above guidelines are properly adhered to, good visual outcomes are the rule.
Surgical management of cataracts in children requires special attention to IOL power calculations, surgical technique, posterior capsule management and attention to amblyopia and postoperative rehabilitation of vision. In infants lensectomy without placement of an IOL may be a better option, followed by the use of silicon hydrogel contact lens for visual restoration. The use of Cionni rings or scleral fixation of the IOL may be required in children with sublimed lens.