Pediatric Cataract Surgery

Pediatric cataract surgery is a critical vision-saving procedure performed at Moolchand Hospital, recognized among the top ophthalmology hospitals in Delhi. Childhood cataracts — clouding of the eye's natural crystalline lens — are the most common treatable cause of childhood blindness worldwide. Unlike adult cataracts, which develop slowly and are managed electively, pediatric cataracts demand urgent treatment because the visual system undergoes critical development during the first 8–10 years of life. Any obstruction to visual input during this sensitive period causes amblyopia — irreversible suppression of visual processing in the affected eye — which cannot be fully corrected once the critical developmental window closes.

Pediatric cataracts may be congenital (present from birth — bilateral in up to 25% of cases, often with a genetic or systemic cause), developmental (appearing in infancy or childhood), or traumatic (following eye injury). Bilateral dense cataracts present at birth require surgery within the first 6–10 weeks of life — dense bilateral opacities blocking visual axis for even a few weeks can cause profound, permanent visual loss (nystagmus, amblyopia) if surgery is delayed. Unilateral cataracts should be operated within the first 6–8 weeks if visually significant.

The surgical technique in children differs significantly from adult cataract surgery. Under general anaesthesia, the anterior capsule is opened using a continuous curvilinear capsulorhexis (in older children) or vitrectorhexis (in infants — where the elastic capsule requires a different technique). The lens material is carefully aspirated using the irrigation-aspiration system. Because the posterior capsule invariably opacifies (posterior capsular opacification — PCO) in young children from lens epithelial cell proliferation, primary posterior capsulectomy (opening of the back capsule) combined with anterior vitrectomy is routinely performed at the time of the initial surgery in children below 6 years, to maintain a clear visual axis.

Intraocular lens (IOL) implantation is performed in children over 1 year of age — using age-specific biometric calculations (partial coherence interferometry or ultrasound A-scan), selecting an IOL power intentionally undercorrected to account for continued eye growth, targeting emmetropia at adult eye size. In infants under 1 year, contact lenses or aphakic spectacles are used for optical rehabilitation until the eye is sufficiently developed for IOL implantation.

Post-operative amblyopia treatment — patching the fellow eye to force visual use of the operated eye — is mandatory and is arguably as important as the surgery itself for final visual outcome. At Moolchand Hospital in Lajpat Nagar Delhi, our paediatric ophthalmologists provide comprehensive cataract evaluation, urgent surgery, IOL selection, and long-term visual rehabilitation including patching therapy and refractive correction.