pediatricaphakiatreatment（ pediatricaphakiatreatment）.docVIP

Good visual acuity and binocular vision in children with unilateral and bilateral cataracts may be attained nowadays, in much greater percentage of children following the removal of the congenital cataracts.(16,39,48,56,63) The best outcomes after surgery depend on several variables. This includes the extend of cataract, associated ocular or systemic abnormalities, early diagnosis and removal of cataract, optimum optical correction, and aggressive visual rehabilitation for several years.(40,). Understanding of amblyopia development and reversal, especially in the early sensitive period of life, is much improved. Surgical techniques of cataract removal and possibility of the optical correction of aphakic eyes have also been refined. Critical period of visual development are the first few months of life. Visual areas in the brain are developing rapidly in response to the visual stimuli from the eyes( 9,13,53).. One should however remember that not every cataract is amblyogenic since birth. If the cataract is not complete and central, even nuclear cataract and increases gradually with the child’s age, prognosis for the improvement of vision is much better. This is why progressive cataract, such as lamellar cataracts, PHPV, posterior lenticonus, and bilateral cataracts without nystagmus, have quite a good prognosis, also when the surgery is performed a little later, after the critical period of visual development.(60) In case of the complete cataract, it is better to operate in the first weeks of child’s life, up to 2 months of age. It is true for both monocular and binocular cataracts. Appropriate conditions for the development of a good visual acuity and binocular vision are thus created. Now, many clinicians choose the primary monocular lens implantation (IOL) technique, which was routinely performed in the older children, over 2 years of age at least. However, it is still controversial surgery in newborns as it is associated with several com