Global Health and the Surgeon 2013 Winning Abstract - Surgical Outcomes of Infantile Cataract Surgery

Abstract

Cataract extraction is the commonest surgical procedure performed in the UK. 1 Congenital cataracts are a treatable cause of childhood visual deficit, 2 with a prevalence of 6 cases per 10,000 births. 3 Various morphological types present in infants, some being visually significant, including posterior polar cataracts located near the macula. 4 Four decades ago, infants were managed conservatively with atropine for mydriasis allowing the child to “look around the opacity”. 5 Currently, it is a predominantly surgical task, however, surgeons are facing the question of which mode of optical correction to use, either a contact lens or an intra-ocular lens. 6 , 7 Many studies have not shown a significant difference in visual outcomes afforded by contact lens or intra-ocular lens. Other factors including the time the cataract has been visually significant, poor compliance of contact lens wear, and occlusion therapy have proven to be better determinants of visual outcome. Intra-ocular lenses are associated with a significantly higher incidence of complications including glaucoma and iris prolapse. 8 Younger age at surgery is also linked to a higher rate of adverse events, especially if before six weeks of life. 9 Early lensectomy is advised to prevent the cataract affecting vision for a longer period of time, which is associated with a poor prognosis. 10 Surgeons should make an informed decision on whether parents are likely to comply with contact lens wear and, if not, advise them on intraocular lenses, the more appropriate option for non-compliant parents.