Paediatric cataract blindness in the developing world: surgical techniques and intraocular lenses in the new millennium

Abstract

Paediatric cataract blindness presents an enormous problem to developing countries in terms of human morbidity, economic loss, and social burden. Managing cataracts in children remains a challenge: treatment is often difficult, tedious, and requires a dedicated team effort. To assure the best long term outcome for cataract blind children, appropriate paediatric surgical techniques need to be defined and adopted by ophthalmic surgeons of developing countries. The high cost of operative equipment and the uneven world distribution of ophthalmologists, paediatricians, and anaesthetists create unique challenges. This review focuses on issues related to paediatric cataract management that are appropriate and suitable for ophthalmic surgeons in the developing world. Practical guidelines and recommendations have also been provided for ophthalmic surgeons and health planners dealing with childhood cataract management in the developing world.

Figure 1

Bilateral dense infantile cataract. Early surgery is needed to avoid nystagmus and a lifetime of poor visual acuity.

Figure 2

Documentation of some of the surgical steps we recommend for paediatric cataract management in the developing world. (A) Vitrector hand piece and a blunt tip irrigation cannula have been inserted into the anterior chamber through MVR stab incisions. A 5 mm vitrectorhexis has been made (arrows) and the lens substance is being aspirated. (B) Lens cortex aspiration is completed before performing a posterior capsulectomy (arrows, anterior vitrectorhexis edge). (C) Posterior vitrectorhexis and an anterior vitrectomy can be performed after lens aspiration without removing the instruments from the eye (arrow, anterior vitrectorhexis edge; arrowhead, posterior vitrectorhexis edge). (D) Intraocular lens has been placed into the capsular bag (arrow, anterior vitrectorhexis edge; arrowhead, posterior vitrectorhexis edge).