1. Dr. Anuradha Chandra
Susrut Eye Foundation & Research Centre
VISUAL REHABILITATION AFTER
CONGENITAL CATARACT SURGERY

3. AXIAL LENGTH AT BIRTH- 16MM
AT 2 YRS - 20MM
REFRACTIVE POWER
AT BIRTH- 30 D
AT 5 YRS- 20 TO 22 D
THIS MEANS IOL WHICH WILL GIVE NORMAL VISION IN INFANT
WILL PRODUCE SIGNIFICANT MYOPIA IN LATER
CHILDHOOD/ADULTHOOD
UNDERCORRECT
IMPORTANCE OF IOL POWER CALCULATION

4. PREVENTION OF AMBLYOPIA IN CHILDHOOD
LEAST POSSIBLE RESIDUAL REFRACTIVE ERROR IN
ADULTHOOD
Amblyopia resulting from residual hypermetropia is more difficult to treat than
myopia BETTER to leave
lesser hypermetropia and aim more for emmetropia with increasing age,
especially in unilateral cases
IOL POWER CALCULATED WITH:
KERATOMETRY – HAND HELD
A-SCAN IMMERSION TECHNIQUE
AIM

5. Table 1. Age at cataract surgery and residual
refraction recommendations for target
refraction
Age at cataract
surgery
Residual refraction
(Diopters)
<6 months +6 to +10
6-12 months +4 to +6
1 -3 years +4
3-4 +3
4-6 +2 to +3
6-8 +1 to +2
>8 +1 to 0
 Target refraction aimed for
INITIAL HYPERMETROPIA
(HIGH OR LOW) OR
EMMETROPIA. (Table 1)
 For calculation of the IOL, third-
generation theoretical formulae used
 SRK/T
 Holladay I & II
 Hoffer Q I & II
 Haigis
IOL POWER CALCULATION

6. SRK/T- AL>26mm,
Holladay II – AL 24-26mm,
Hoffer Q- AL<22mm
Haigis
ONE IOL POWER CHOICE FOR EVERY
AGE DOES NOT WORK FOR EVERY
SITUATION

7. Antibiotics
either moxifloxacin or tobramycin e/d,
no need of systemic antibiotics.
Steroids- Oral/Topical
Prednisolone eye drops are the mainstay
of treatment
Some surgeons advocate supplementing
with oral prednisolone at 1 mg/kg/day for the first
week to help reduce inflammation.
Cycloplegics and mydriatics
Homatropine or atropine e/d.
.
VISUAL REHABILITATION – STARTS WITH POST-OP MEDICATIONS

8. Frequency
postoperative day 1,
week 1,
month 1,
month 3,
every 3 months for 2 years, and thereafter every 6months
for 3 years.
Evaluation
visual acuity,
ocular alignment,
IOP,
refraction,
clarity of the visual axis at every visit.
any complication
FOLLOW-UP

9. For infants and toddlers,
refractive correction should result in good near vision (myopic refraction of
approximately -2 diopters).
For children with pseudophakia,
correction for distance vision and a bifocal correction for near viewing
should be offered
Children who use a contact lens may also benefit from a spectacle
overcorrection after age 2 or 3 years.
OPTICAL REHABILITATION AFTER CATARACT SURGERY

10. For children who have IOL implantation  residual refractive error 
spectacle correction needed for distance and/or near viewing.
Additionally, when IOL implantation occurs at an early age, myopic shift
 Spectacle correction
Correction of aphakia with spectacles may be preferred for infants and young
children.
Aphakic spectacles well tolerated by children who are bilaterally
aphakic.
Unilateral aphakia can also be corrected with spectacles less
desirable  aniseikonia , potential disruption of binocular vision, if present.
.
SPECTACLES PSEUDOPHAKIC AND
BILATERAL APHAKIA

11. Contact lens correction of aphakia is often planned for very young infants
after lensectomy,
Either a silicone elastomer lens (extended wear) or rigid gas permeable lens
(daily wear).
Advantage : (1)EASY ADJUSTMENT IN POWER FOR THE RAPIDLY
CHANGING REFRACTIONS ENCOUNTERED IN YOUNG CHILDREN.
(2)Contact lens correction of residual refractive error is
also possible after IOL implantation
CONTACT LENS APHAKIA

13. When the treatment of the congenital cataract is less
successful, low vision rehabilitation has an important role in how the
patient can cope with the limited visual capacities in education and
daily life.
organized either by the government, various nongovernmental
organizations, or private foundations.
The motto:
USE THE REMAINING VISUAL FUNCTION
WITH ALL OTHER SENSES TO ACHIEVE
THE OPTIMUM QUALITY OF LIFE.
.
LOW VISION REHABILITATION AND QUALITY OF LIFE
MEASURES

14. AMBLYOPIA MANAGEMENT

15. Postop complications after pediatric cataract surgery are
inversely proportional to the age at the time of surgery.
Visual axis opacification(VAO)
VAO in infants receiving posterior capsulectomy and vitrectomy 
surgical removal(MEMBRANECTOMY) 3 months to 1 year after
the original surgery, while
PCO in older children who had an intact posterior capsule
ND:YAG LASER CAPSULOTOMY OR SURGICAL
REMOVAL 2 years or more after cataract surgery.
Glaucoma
Secondary glaucoma - most sight-threatening complication
Younger age at the time of surgery most common risk factor
Children must be followed for this regularly for their entire life.
REHAB COMPRISES OF MANAGEMENT OF COMPLICATIONS AND SEQUELAE TOO

16. Inflammatory complications
Increased tissue reactivity in children
AC cell and flare, cell deposits on the IOL optic, posterior
synechiae, etc.
TASS
Contact lens related
Bacterial keratitis
IOL malposition
Endophthalmitis
Retinal detachment
Myopic shift
APPROPRIATE MANAGEMENT
COMPLICATIONS

17. Early detection
Vision screening programs
Improved education of primary health
care workers and the public
Surgical techniques continue to improve
and will allow childhood cataract removal
with less and less surgical trauma.
Planning for IOL implantation will
become easier as our knowledge of myopic
shift and axial globe growth evolve.
Future IOL technologies
TO CONCLUDE..

18. LETS MAKE THEIR WORLD COLOURFUL..