Hello Emefa,

Thank you so much for your question. As you might know, earlier the cataract extraction better the visual outcome. In my experience, the rehabilitation design in such cases depends upon the method of cataract extraction for e.g., whether Intra ocular lens is implanted or not. If the child is left aphakic, soft contact lenses will be a good option which provides optimal refractive correction. In addition to the optical correction, conventional method of patching 1-2 hours daily in alternate eyes can be useful. Regular follow-up in every 1-3 months until the child can give verbal response could be useful. Now-a-days many researchers are looking into different methods of visual stimulation like binocular stimulation using video games and tetris. We have to wait few more years to apply them in clinical practice though. Based on the current literature evidence, optimal optical correction either with soft contact lens(more preferable for aphakic) or glassess and minimal patching are available options. On top of that, for early visual stimulation we also used to advise parents for using bright and colourful decoration of the room where the child lives. If you want to see some scientific evidences on how to manage, see the Infant Aphakia Treatment Study, which is mostly for unilateral congenital cataract patients. See references forn this webpage: http://clinicaltrials.gov/show/NCT00212134, I hope it helps.

Regards,

Nabin

Nabin, thanks e link was very helpful.

earlier the surgery,better is the visual outcome...however rehabilitation is important,mere surgery is not enough.

Earlier surgery is definitely better to prevent amblyopia and thus provide better visual outcome. But the choice of surgery and visual rehabilitation are equally important in infants.

For unilateral Cong. cataracts. 6 weeks of age is the ideal threshold and for bilateral cases 10 weeks, remember for bilateral cases performed on consecutive basis, keep the first eye padded until the second eye is done, in order to achieve an equal visual cortex stimulation regardless of the symmetry of media opacities.

Duration of form deprivation and visual outcome in infants with bilateral congenital cataracts.Jain S, Ashworth J, Biswas S, Lloyd IC. J AAPOS. 2010 Feb;14(1):31-4. doi: 10.1016/j.jaapos.2009.11.016.

PMID: 20227619

Earlier surgery is associated with better visual outcome, but this is mostly based on theory and animal experiments from around 1960-70s. However, there are several case-reports showing (very) good visual outcome in cases with uni-ocular deprivation from time of birth (e.g. total ptosis of intraocular hemorrhage) during several months. So the proposed 6 weeks of age time limit in uniocular cataract might be more flexible.

An other problem might be that the risk of developing glaucoma seems higher after early surgery compared to late surgery, possibly totally destroying the earlier gained visual function.......

I agree that once cataract is visually significant i.e occupy the visual axis. It is best to remove the cataract it may be as early as 4-6week in unilateral cataract and 6-8 weeks in bilateral cataract to prevent amblyopia.

Early surgery for visually significant cataract is the rule. unilateral cases need early surgery than bilateral. Surgeons & Anaesthetist's skills and the available technology influences which is the best approach in any given situation. Earlier suggestions are gold standards to prevent or treat amblyopia, but the place of practice influences what is feasible.