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Dr. A.S. Desai
Dr. A.S. Desai, Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 2434
Experience:  MS Ophthalmology with 13 years of surgical experience, well versed with all eye diseases.
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HiI am a GP in the UK, and I have a niece aged 12 months

Resolved Question:

Hi
I am a GP in the UK, and I have a niece aged 12 months with a bilateral congenital cataract diagnosed lately in Algeria after a strabismus. she has no overt genetic/syndromic signs nor any metabolic problems.
The parents took her to a private ophthalmologist and he said he will do only a lensectomy and see how it goes for one eye then in 1 -2 months he will do the other eye. He was keen on IOL as concerned about the rate of complications communicated to parents. Whether he will proceed to a secondary implant insertion was not discussed. the parents saw another private doctor who is very keen to proceed and put IOLs at 1-2 weeks intervals; and he says he operate on paediatric as well as adults with cataracts?
Services for treating children with cataract are pretty patchy in Algeria, however they are few doctors who has been operating on children, but i have been out of the country to know whether there is any guidelines for surgical options in this case; or just easy choices made depending on the local resources and practicality.
I would like your opinion about the choice of best form of optical+ visual rehabilitation i.e with or without primary IOL? and how to improve her amblyopia.
Sorry I have no details about the classification of the cataract or any exam findings.
Many thanks
Amin
Submitted: 2 years ago.
Category: Eye
Expert:  Dr. Chip replied 2 years ago.
Hi Sorry for the delay. First off how's her vision right now?
Customer: replied 2 years ago.

Hi Dr Chip

I cannot tell you much about this and i will phone the parents today and get more info. From what i have been told, I do not think there is an obvious struggle with vision, other than a unilateral squint.

Thanks

Expert:  Dr. Chip replied 2 years ago.
No problem--let me know when you have more information
Customer: replied 2 years ago.
Relist: Other.
no disrespect. i would like to discuss this child's eye disease with an ophtalmologist.thanks
Amine
Expert:  Dr. Chip replied 2 years ago.
Sorry but your question was never picked up by an ophthalmologist but I do have an answer for you if you'd like to see it
Customer: replied 2 years ago.

Thanks for your help. I still would like to discuss with an ophthalmologist.

Expert:  Dr. A.S. Desai replied 2 years ago.
Hello,
Welcome to Just Answer. I am an ophthalmologist associated with this site.
Thank you for the question.
Pediatric cataracts are always challenging since they behave very differently from adult cataracts. First thing for deciding on surgery is to ensure that the ophthalmologist has adequate experience and exposure in management of pediatric cataracts, good anaesthesiologists, vitrectomy machine . A pedicatric cataract would be operated under general anaesthesia and a primary posterior capsulotomy with anterior vitrectomy are necessary.As for decision on primary IOL implantation, it can be done at the age of 12 months during cataract surgery. A thorough follow up is required and should watch out for glaucoma and amblyopia. If the eye had begun to deviate due to cataract( exotropia due to disuse) then it is very likely to get corrected after surgery.Both eyes can be operated within a span of one week so that visual rehabilitation is faster.
If you need more help, please use the reply tab to continue our conversation. If you do not require further assistance, kindly rate my service.
Thank you and best wishes.
It was a pleasure to have answered this question.
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Customer: replied 2 years ago.

Thanks for your reply and info.

I am a bit concerned about the pre and post op conditions , and i am not sure about the paediatric exposure of private ophthalmologists. the parents so little in choice.

I read about the complications of IOL -more frequent-in the young age and the latest IATS study results favouring secondary IOL after lensectomy. Although the age in the study was up to 6-9 months and they treated monocular cataract.

If either options is chosen, how often do you need to see the child -post op- and when the visual rehab has to start? how ofter you need to check on the corrective lenses if the aphakic eye . In Algeria they are no CL for paeds and spectacles would be the norm.

One of the ophtalmo who has better exposure to paeds cataract told the parents that he would operate on the more dense cataract(RE) and leave it in aphakia and then to treat the other. Obviously, this option prevent maybe many complications, although, I am guessing, he has to perform the the post capsulotomy and ant vitrectomy to prevent secondary cataract.

Do yo think that going for pseudoaphakia is better fot his girl , if the pre and post op conditions are optimum and in experts hands? if you are operating in a diff environment with less technical capabilities, do you think that lensectomy + PPC+AV is a safer way to start? and maybe opting for a secondary implant in 1-2 years?

thanks

Amine

Expert:  Dr. A.S. Desai replied 2 years ago.
Hello,
Thank you for the reply.
The disadvantage of going for primary IOL is that it will need replacement after the child grows older or after 5 to 6 years due to change in the refractive state of the eye. If lensectomy with primary posterior capsulotomy with anterior vitrectomy is done without IOL then spectacle correction has to be ensured early to prevent amblyopia, within a week of surgery. Since children go for more inflammation following surgery and glaucoma being another post op complications, weekly follow up are advised.
If you have concerns regarding facilities and surgeon expertise, then the second option can be taken, followed by secondary IOL after 2 years.
Thank you and best wishes
Customer: replied 2 years ago.

Many thanks.

"Since children go for more inflammation following surgery and glaucoma being another post op complications, weekly follow up are advised."

I guess this apply to both options. Is there any need for a general anaesthesia for these weekly follow ups? and for how long after the operation?

Expert:  Dr. A.S. Desai replied 2 years ago.
General anaesthesia is not required during follow up. Hand held instruments are used for pediatric patients. Best wishes
Dr. A.S. Desai, Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 2434
Experience: MS Ophthalmology with 13 years of surgical experience, well versed with all eye diseases.
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