Pediatric cataract surgery is confined to young children or infants. It may be one of the most challenging and tricky procedures to perform cataract surgery on a very young child or infant.
In fact, the idea of performing a surgery on the eye is just scary enough. Now think about performing a surgery on a three months old infant! Throughout the following, we will try to explain some of the obstacles and challenges that render pediatric cataract surgery rather difficult.
The minute gem
The eyes of infants are smaller in size than the eyes of adult patients, whose eyes are already considered small organs that need microsurgical tools and techniques. But the structure of the infants’ eyes is more delicate and immature, compared to adult eyes.
The diameter of the human eye at birth is 18 mm, which is around 75% of the diameter of the adult human eye. This requires extremely sensitive and meticulous hands.
Elective is never an option
Once an infant is diagnosed as having a cataract that affects his vision, it becomes mandatory to perform the surgery. The urgency is to save the child from amblyopia and subsequent blindness.
When the brain finds that it is getting a poor image from an eye, it automatically neglects this eye. With continued neglect, the eye becomes a non seeing eye. This condition is called amblyopia or lazy eye.
If the child is suffering from unilateral cataract, the delay in removing the lens opacity will convert the affected eye into a non seeing eye. The sad thing is that if the child is suffering from bilateral cataract, the brain will neglect both eyes, resulting in total blindness. This condition is called bilateral amblyopia.
So if the child is suffering from cataract in one or both eyes, it is of utmost priority to perform the surgery as early as possible to safeguard the child from blindness. In the end, the child is the only one who pays for any delay!
No luxury of topical anaesthesia
General anaesthesia is riskier than topical anesthesia because the chances of developing complications are higher. Unlike adults who can obey commands and stay calm during the surgery, the reactions of infants and children during surgery are unpredictable and uncontrollable. That’s why pediatric cataract surgery is always performed under general anesthesia.
The general condition of the child
Since general anesthesia is mandatory in pediatric cataract surgery, it all depends on the general physical condition of the child. The child won’t be fit for general anesthesia, if he is suffering from diseases like common cold, fever, chest infection, etc. This will lead to delaying the surgery until the condition of the child has improved.
Pre-term infants (infants born before expected delivery date) and infants of low birth weight are also not fit for surgery. The surgeon will have to wait until the infant becomes able to tolerate the effects of general anesthesia. The same applies to infants suffering from any disease that affects the general physical and/or developmental state of the infant.
Replacing the intra ocular lens
In cases of unilateral cataract, it is mandatory to remove the lens opacity. The child can’t be left aphakic (a condition in which the eye doesn’t have a lens inside it mostly due to surgical removal) because the brain will consider this eye a weak eye and will neglect it, resulting in amblyopia.
It is essential in this case, to implant an intraocular lens. The tricky thing is that the eye of the child will grow and increase in size as the child grows. So, it will also be mandatory to replace the intraocular lens few years later when the eye has become almost mature and approaches the size of adult eyes.
Children, unlike adults, are more liable to accidents during their development. They are less likely to obey instructions. This nature of theirs may lead to accidents that affect the position of the intraocular lens. Further surgical interventions will be necessary in this case to fix the resultant conditions, which might be severe enough to the extent of needing to replace the intraocular lens.