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Congenital cataract in both eyes, signs of squint. First squint surgery or intraocular implantation ?

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Practicing since : 1977
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Helllo doctor,
My son is 9 months old. He showed signs of squint and then was diagnosed of congenital cataract in both the eyes at the age of 4.5
months. He underwent cataract removal surgery on both eyes. The specs power is +20 on left eye and +21 on right eye. Doctor said after 2.5 years, he can get intraocular lens in both the eyes. Now for the squint (turns both eyes inwards and keeps moving,
supposedly due to lesser fixation achieved because of cataract), doctor has adviced to put patch on both the eyes everyday, 2 hrs each on right and left eye. We are told squint removal surgery can be performed after the intraoccular implantation, which can be done after about 2 years. It is very difficult to manage the small baby with the patch, till then for 2.5 years we have to put the patch everyday. So I just thought of having second opinion, if squint surgery can be done now (9 months old) prior to the intraoccular implantation and will it help? Are there any other measures we can take to reduce squint in particular and to improve his vision in general? He seems to be developing vision well as he crawls, picks objects around, identifies all of us at home and loves going and watching things outdoors, though there is still visible squint.
Please advice me.
Thanks in advance
Posted Thu, 3 May 2012 in Vision and Eye Disorders
Answered by Dr. N. K. Misra 17 hours later

Thanks for the query.

You have to understand, the basic behavior of the eyes in such situation.The cataract removal surgery is to done early but rest of the surgeries are to be delayed a little.

Squint surgery is not to be hastened, as we have to allow nature to play it's role.There are 4 horizontal muscles which control lateral, (IN OR OUT) squint one or two muscles are to tackled to begin with. That does not leave us with too much of margin for any requirement later on.
Since the eye is growing at the moment (up to 2-2.5 yrs), the power keeps on changing, so intraocular lens implantation is to be done at that stage so the child is able to lead rest of life with minimal lens power.

Till this period of 2-2.5 yrs, you have to take care of the patching of the eye. We follow the routine of 2 hrs for each eye. The squinting eye is to be patched to prevent suppression of non squinting eye which is the master eye as the child at the moment is doing everything with the non squinting eye.

Non squinting eye is patched to allow the squinting eye to develop proper fixation.
The reason why the squint surgery is not done before IOL implantation is that, after IOL implantation when the image on the retina is well focused, there is improvement of fixation and the squint may improve.

I am glad to tell you that you appear to be in good hands and advises given to you appear to be up to the XXXXXXX

I hope, I have answered all your queries, but in case there is any query please do get back to me.

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