Restoration of vision after surgery

With the removal of the lens a large part of the refractive power of the eye is lost. As a result the child cannot focus

With the removal of the lens a large part of the refractive power of the eye is lost. As a result the child cannot focus on images of the environment to the retina and has a very blurry vision.

The restoration of the eye’s visual function after the removal of the lens can be made either with glasses, contact lenses, or with intraocular lenses, that are specially built artificial lenses placed within the eye during surgery and remain there for the remainder of the patient's life.

Glasses and contact lenses

Such is the refractive power of the lens of the normal eye, that, if we try to restore it with lenses, the glasses will be thick and very heavy. Apart from the glasses being uncomfortable for the child, by a certain age the child understands that he looks different from the other children and wants another  solution to the problem, such as wearing contact lenses.
Glasses are usually prescribed to children who are too young to get contact lenses, but old enough to resist when their parents try to put them or remove them from their eyes.

Sometimes we prescribe lower degree glasses, to be thinner and lighter, and they often are bifocals with the upper part of the set for distance vision and lower part for close up vision.

Contact lenses require special attention and care, and also proper maintenance. Therefore in most cases we wait for the child to develop a certain level of responsibility before granting contact lenses.

In the previous chapter of the book we have extensively reported the types of contact lenses.


Intraocular lenses

Although in cases of senile cataract placing an intraocular lens (a transparent lens) to its normal place (behind the iris) is the stable choice, it is not  always the preferred option for infants or very young children.

The problem has to do with the size of the child’s eyes increasing as the child grows, and thus changing its refractive ability. Because of the intraocular lenses having a constant refractive power, a lens, which is suitable for the child at a given time, does not also mean that it is the right one after a certain time.

Thus, although the rule is to place the intraocular lens in the same surgery along with the removal of cataract, in very young children where we expect significant changes in the size of their eye, we prefer to wait. The placement of the intraocular lens occurs in a secondary phase, after the completion of the first rapid eye growth change, which is completed after the second to third year of life.

Blurring of the posterior circumlental
The lens is located behind the iris into a transparent bag, which is called circumlental. During the removal operation of the lens, the anterior part of the circumlental is removed, in order for the cloudy lens to come out, but the rest of the bag remains in its place.

Although the cataract does not "reset" and does not recur if lens has been removed, it is however possible for the posterior surface to blur and respectively cause a blurred vision.

This may occur in surgical patients of all ages, but it seems to be more frequent in children. As a result, the clear image obtained immediately after the operation has a gradual decline in the following months.

The treatment of the posterior circumlental clouding is not made by a new surgery, but with special Laser (YAG Laser) in the clinic, only with local anesthesia (drops), provided that the child can sit still for a few minutes.

Alternatively an opening in the posterior circumlental can be done preventively during the first surgery to remove the cataract. The circumlental, which remains around the posterior opening, may blur again, but usually the diameter of the opening is enough to not cause problems in the child's vision.