Cataract in children and babies

Cataract can be corrected with surgery, whereby the cloudy lens is replaced with a clear artificial lens.
Post-operative treatment is also very important in children, as their vision is still developing.

Before we begin the actual operation, a few measurements are necessary to calculate the correct lens strength. In small children, we always perform these measurements under general anaesthesia in order to be as accurate as possible. To avoid having to administer additional anaesthesia, we do this immediately before the actual operation. After the measurements, we know what lens strength we will implant. In older children, we can take these measurements during the consultation.

A small, measured opening is made in the bag containing the lens tissue. The lens tissue is then removed. In children, it is usually sufficient to remove the lens tissue with a kind of vacuum cleaner because the lens tissue is still very soft. When the lens tissue is harder, we use ultrasound (phacoemulsification) to break up the lens and remove the pieces.
However, this is usually only necessary in adults.

At the UZA, we developed a specialised lens to prevent secondary cataracts, known as the bag-in-the-lens technique. Because secondary cataracts are a significant problem in children that can lead to repeated operations, this lens is ideal for use in children. To insert the lens, we make a second opening in the back of the lens capsule, which is exactly the same size as the opening at the front of the lens capsule. We then suspend the lens in the opening we have created.

A successful operation is the first step in treatment, but intensive follow-up care is still required after the operation. It is important that the brain relearns how to use the eye. If the cataract was present in both eyes, this development will usually be symmetrical, but if the cataract was only present in one eye, the brain will be accustomed to using the other eye more. This creates the risk that the operated eye will remain a “lazy” eye, which means that the brain will ignore the image from this eye to a certain extent. To counteract this, we cover the non-operated eye. This forces the brain to see with the operated eye and to accept this image. In the first few months after the operation, we often cover the eye as much as possible, usually all day except for two hours when the child is awake. This “total” occlusion will continue until we can no longer expect any improvement in the operated eye.

The new lens is unable to focus (‘accommodate’). This means that it will almost always be necessary to wear glasses or contact lenses after the operation. In babies, we usually correct their vision with contact lenses for the first few months, until their prescription has stabilised. The contact lenses we use for this can remain in the eye for a longer period of time (1 to 3 months), but must then be replaced. When the growth of the eyeball begins to slow down (after the age of 1) or if the contact lens is often lost, we usually prescribe glasses. For babies, a prescription is given that allows the baby to see well at close range.

For toddlers, we prefer multifocal/progressive glasses, so that their vision is sharp both close up and far away. Because children’s eyes are still growing, the prescription needs to be adjusted regularly, and the younger the child, the more often this needs to be done.

If the eye grows more than expected, it can become severely short-sighted (myopic). The cause of this accelerated growth may be increased eye pressure, which must be ruled out.
If increased pressure in the eye is ruled out and the myopia is very high (due to strong growth of the eye), this can possibly be corrected by replacing the implant lens (different strength). This is easy to do with the bag-in-the-lens, but is only necessary in case there is severe myopia or a large difference between both eyes.

In the first few weeks after the operation, you will also need to put drops in your child’s eyes several times a day. Instructions for this can be found at the end of this brochure. There will also be frequent check-ups; as the child gets older, the check-ups will become less frequent. However, eye pressure must be checked annually for life.

The ophthalmologist will decide together with the anaesthetist whether your child needs to stay in hospital overnight after the operation or can go home the same day. If your child needs to stay in hospital overnight, one of the parents may stay overnight with the child. We want to make your child’s (day) admission to the UZA as pleasant and smooth as possible. However, there may sometimes be a waiting time due to other urgent or difficult, lengthy procedures that are specific to a university hospital. We thank you in advance for your understanding.

1. General anaesthesia
   A pre-operative anaesthesia consultation must take place before the operation. Your child does not need to be fasting for this. 
   On the day of the procedure, your child must be fasting (no food or drink), and the anaesthetist will give you instructions for this.

What to bring with you when your child is admitted?

• Proof of identity/sticker from your child’s health insurance fund.
• A list of your child’s current medication at home; please also bring the medication itself.
• Documents relating to hospitalisation insurance and all documents that the doctor needs to complete.
• A book or toys for your child. There is also free Wi-Fi at the UZA.
• If your child is bottle-fed, please bring the formula (water and powder separately).
• For overnight stays: nightwear and toiletries.
• This brochure.

The duration of the operation can vary greatly depending on the degree of difficulty of the operation. At the start of the operation (after the preliminary examination under anaesthesia), we will be able to estimate this more accurately and will provide you with an update. After the operation, we will also come and tell you how it went and what the next steps will be.

Prior to the operation, a number of examinations may be carried out under anaesthesia to determine the further procedure.
After these examinations, the results will first be discussed with the parents before the operation begins.

If the eye shows interesting aspects from a scientific or educational point of view, the operation will be recorded on video. Your child will not be recognisable on this video. Anonymity on these video images is fully guaranteed.