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Pre- and Postoperative Treatment of Cataract in Childhood

1Zubcov-Iwantscheff A. A., 1Lüchtenberg M., 1Rosenkranz C., 2Vanselow K., 3Ohrloff C.,
1Johann-Wolfgang-Goethe-Universität, Klinik für Augenheilkunde, Kinderaugenheikunde und Strabologie (Frankfurt/Main)
2 (Frankfurt/Main)
3Johann-Wolfgang-Goethe-Universität, Klinik für Augenheilkunde (Frankfurt/Main)

Cataract in children is a threatening condition because of it’s irreversible amblyogenic potential. A successful cataract operation, an early diagnosis, a “right-on-time” operation and a close follow-up on the amblyopia therapy, all play an very important role in reaching a good visual function. Accurate observant parents, regular check by the paediatrician and careful ophthalmological check-up together enable us to detect cataract very early, if possible as soon as it develops. Indication for surgery is given under 3 years of age by not being able to performing retinoscopy and/or direct ophthalmoscopy, and later by a lower far/near visual acuity than 0,4 (Lea-Test). Early lens opacification, unilaterality, size, thickness an position of the opacification more towards the posterior capsule are related to a worse visual outcome. 10% of children with cataract have good visual acuity and binocular functions and do not need a surgical removal of the cataract. They are rather treated conservatively. Posterior capsular opacification in the most common feared postoperative complication due to it’s high amblyogenic effect during the period of sensoric vulnerability. IOL implantation in children over 20 months of age is now well established. In smaller children and infants, due to rapid axial length changes, the appropriate IOL power cannot be calculated properly, contact lenses (CL) are the gold standard for optical correction. The major advantage of CL is that their power can be easily adjusted as infantile eyes grow. Due to loss of accommodative power the CL power should be overcorrected to the age of 2,5 years. In view of rapid changes in axial length and myopic shift, at present, the most reasonable trend is to undercorrect the refractive error based on the child’s age. This should ensure a focused retinal image later in life. Follow-ups should regularly be performed and full correction for far and bifocal glasses for near should be prescribed. Occlusions therapy is being performed based on the child’s age and degree of amblyopia.

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