Caught between a rock and a hard place: What is the optimal timing for infantile cataract surgery?

摘要

Imagine offering cataract surgery to your adult patients and telling them that the risk of a severe complication developing is well over 30%. To almost any doctor and in almost any hospital, this level of risk in cataract surgery would be unacceptable. All cataract surgeries would most likely be cancelled until the root cause of the complications could be identified and ameliorated. Yet for the paediatric ophthalmologist this may be a routine discussion with the parents of infants with cataracts. The complications of infantile cataract surgery (usually a lensectomy) can be severe and frequent, and may have an onset that is very long term. Aphakic glaucoma is one such severe complication that can develop at almost any time after infantile lensectomy. It is difficult to explain to parents the full impact of aphakic glaucoma on the day-to-day life of their infant. Parents often know adults who have been through cataract surgery with ease. Some of those adult patients may have required anti-glaucoma medication prior to cataract surgery, and as an added positive side-effect of cataract surgery, they no longer do so. The issue of the temporal nature of the development of complications is also difficult for parents to comprehend: despite seemingly successful infantile cataract removal, one of the most difficult glaucomas to manage, aphakic glaucoma, can develop at least up to 10 years post-surgery.