Optimal Age for Infantile Cataract Surgery

The optimal age to perform cataract surgery in an infant with an infantile cataract remains controversial. As recently as the 1970s, it was recommended that surgery be deferred until an infant was 3-6 months of age [39]. However, following the pioneering work of Wiesel and Hubel [45] on the plasticity of the visual system during infancy, the trend shifted toward performing cataract surgery at younger and younger ages. The trend climaxed in a case report of a newborn undergoing cataract surgery on the 2nd day of life [14]. Other series have also noted

Fig. 6.1. Nuclear cataract in the right eye of a 4-week-old child. The left eye was normal

6.2 Optimal Age for Infantile Cataract Surgery 83

excellent visual outcomes in neonates undergoing cataract surgery during the istweek of life [11]; however, an analysis of 45 children with dense unilateral cataracts who underwent cataract surgery found that the visual outcome was the same regardless of when the surgery was performed during the first 6 weeks of life [6]. It is generally accepted that a latent period exists for 6 weeks in newborns with unilateral cataracts prior to them entering a sensitive period during which time they are susceptible to visual deprivation. While in the past is was presumed that the latent period for infants with bilateral cataracts extended to 8 weeks of age [1,30], a recent analysis found that it may even extend to 10 weeks of age [26]. While it is now generally accepted that the best visual outcomes are obtained if cataract surgery is performed during the first 6 weeks of life for an infant with a unilateral cataract and 8-10 weeks of life for an infant with bilateral cataracts, it is unclear if the visual outcome is better if surgery is performed as early as possible within this latent period. In a recent study of infants with unilateral cataracts who underwent cataract surgery during the first 6 weeks of life, the visual outcome correlated more closely with factors such as patching and contact lens compliance than the age of the child within this 6-week window [25]. In fact, very early cataract surgery may increase the risk of certain postoperative complications such as glaucoma and pupillary membranes. In addition, general anesthesia may be associated with more risks in a newborn than a 4-week-old infant.

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