Treatment of cataracts
In cases of congenital binocular and progressive cataracts, if opacity closes the optic axis, early surgical intervention is clearly shown. With partial cataracts, it is difficult to determine whether clouding the lens can cause amblyopia. In such cases, the morphology of cataracts helps: nuclear cataracts often provoke the development of amblyopia, rather than lamellar. Nevertheless, in order to clarify the expediency of surgical intervention in a patient with lamellar cataract, a survey is necessary in dynamics.
To clarify the possibility of a negative effect of the combined pathology on the functional effect of surgery, it is important to evaluate the state and other structures of the eyeball.
Monocular congenital cataracts
The issue of mandatory surgical removal of congenital monocular cataracts remains relevant. Despite the fact that some children, operated in the first months of life, can achieve excellent visual acuity, in most patients with monocular congenital cataracts visual acuity remains low. Parents should be warned about the difficulty of achieving a high and stable functional effect.
A general examination of a patient with congenital or developing cataract should be agreed with the pediatrician. In some cases, the morphology of lens opacity (for example, in the case of PGPS) indicates that there is no need for a general examination. In other cases, a detailed examination is performed to exclude metabolic or infectious causes of the disease.
Operation of cataract in children
For newborn children, the most appropriate method of removing monocular or binocular congenital cataracts is the technique of lenvitretomy performed on the closed eye. This procedure provides a free optical center and the availability of retinoscopy in the postoperative period. The technique is not associated with a significant risk of detachment of the retina, although there remains the need for prolonged follow-up of the patient in the postoperative period.
In children older than 2 years old, with the possibility of intraocular lens implantation, the standard technique of lens aspiration is preferable.
In the early postoperative period, in a large number of these patients, due to clouding of the posterior capsule, it becomes necessary to carry out the YAG laser capsulotomy.
The technique of phacoemulsification is rarely used in patients of child age.