3. AXIAL LENGTH AT BIRTH- 16MM
AT 2 YRS - 20MM
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
IMPORTANCE OF IOL POWER CALCULATION
4. PREVENTION OF AMBLYOPIA IN CHILDHOOD
LEAST POSSIBLE RESIDUAL REFRACTIVE ERROR IN
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
5. Table 1. Age at cataract surgery and residual
refraction recommendations for target
Age at cataract
<6 months +6 to +10
6-12 months +4 to +6
1 -3 years +4
4-6 +2 to +3
6-8 +1 to +2
>8 +1 to 0
Target refraction aimed for
(HIGH OR LOW) OR
EMMETROPIA. (Table 1)
For calculation of the IOL, third-
generation theoretical formulae used
Holladay I & II
Hoffer Q I & II
IOL POWER CALCULATION
either moxifloxacin or tobramycin e/d,
no need of systemic antibiotics.
Prednisolone eye drops are the mainstay
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
postoperative day 1,
every 3 months for 2 years, and thereafter every 6months
for 3 years.
clarity of the visual axis at every visit.
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
Correction of aphakia with spectacles may be preferred for infants and young
Aphakic spectacles well tolerated by children who are bilaterally
Unilateral aphakia can also be corrected with spectacles less
desirable aniseikonia , potential disruption of binocular vision, if present.
SPECTACLES PSEUDOPHAKIC AND
11. Contact lens correction of aphakia is often planned for very young infants
Either a silicone elastomer lens (extended wear) or rigid gas permeable lens
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
organized either by the government, various nongovernmental
organizations, or private foundations.
USE THE REMAINING VISUAL FUNCTION
WITH ALL OTHER SENSES TO ACHIEVE
THE OPTIMUM QUALITY OF LIFE.
LOW VISION REHABILITATION AND QUALITY OF LIFE
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.
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
Contact lens related
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