If all cortical material is adequately removed, postoperative inflammation is usually mild in a child without a lens implant. Topical antibiotics, corticosteroids, and cycloplegics are commonly applied for a few weeks after surgery. Topical corticosteroids should be used more aggressively in children who have undergone IOL implantation. Some surgeons administer intracameral corticosteroids at the time of surgery, and others use oral corticosteroids postoperatively, especially in very young children and in children with heavily pigmented irides. Some surgeons administer intracameral antibiotics in addition to topical antibiotics.
Amblyopia therapy should begin as soon as possible after surgery. For aphakic patients, contact lenses or glasses should be dispensed within a few weeks of surgery.
For infants with bilateral aphakia, glasses are the safest and simplest method of correction. They can be easily changed according to the refractive shifts that occur with growth of the eye. Until the child can use a bifocal lens properly, the power selected should make the eye myopic, because most of an infant’s visual activity occurs at near. Contact lenses may also be used in bilaterally aphakic patients, but they require more effort on the part of both the caregiver and the physician than do glasses.
For infants with unilateral aphakia, contact lenses are the most common method of correction. Advantages of contact lenses include relatively easy power changes and the potential for extended wear with certain lenses. Disadvantages include easy displacement by eye rubbing, the expense of replacement, and the risk of microbial keratitis. Aphakic glasses are occasionally used in infants with unilateral aphakia who are unable to tolerate contact lenses, but these glasses are suboptimal owing to the amblyogenic effect of aniseikonia and the difficulty of wearing glasses that are much heavier on one side.
After optical correction of aphakia, patching of the better eye is necessary in patients with unilateral cataract and in some patients with bilateral cataracts if the visual acuity is asymmetric. The amount of patching is based on the degree of amblyopia and the age of the child. Avoidance of full-time occlusion in the neonatal period may allow stimulation of binocular vision and may help prevent strabismus.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.