Simultaneous Bilateral Surgery in Congenital Cataract

1. Renuka Srinivasan
2. Anjali A
3. Shivaprasad
2. Debasish Mohanty

1. Jawarhalal Institute Of Medical Education And Research (JIPMER) Pondicherry India

Purpose :
To evaluate the risks and benefits involved in simultaneous surgery in bilateral congenital cataract .

Materials and methods :
We retrospectively evaluated the postoperative course of 64 eyes of 32 children who underwent bilateral cataract surgery in single sitting at our hospital from January 2005 to December 2009. There were 20 cases of congenital rubella syndrome, 8 with heart diseases, 2 galactosemia, 2 very low birth weight and one case each with homocystinuria and hemophilia. Age of the patients ranged from 2 months to 7 years with most being under 2 years of age.

Results :
No major intraoperative complication was noted.On postoperative follow up for 6 months, none of the cases developed endophthalmitis. One case developed traumatic hyphaema at 2nd postoperative week. Two cases developed grade 4 uveitis in both eyes which was relieved with topical steroid medication.

Conclusion :
Simultaneous bilateral congenital cataract surgery is a useful option for cases with high systemic risk profile like associated heart diseases as to avoids a second general anesthesia. It also reduces the risk of amblyopia in the other eye.

Some pediatric ophthalmologists are opposed to the idea of performing bilateral cataract surgery in children in the same sitting because of the risk of bilateral endophthalmitis.

In selected cases of bilateral cataracts, the benefits of cataract surgery in single sitting outweighs the potential risks and should be considered the primary option.