Microphthalmia and Cataract in Baby

[Kirstie228]

Hi there, my 14 week old baby had eye surgery at 7 weeks for what the Eye Surgeons thought was PHPV, however once the operation was done the Surgeon said that the eye was all developed and it looked more like a cataract in a microphthalmia eye, so the natural lens was removed.  We were told at his check up today that he would have to wear a contact lens all his life in that eye and also wear bifocal glasses.  What I'm wanting to know is if it is possible to have surgery done when his vision has developed to the full potential (at about 8 we were told) to insert a new lens (an IOL I think they are called).  I asked today but the Surgeon didn't think it would be possible because he has a small eye and we are not sure how much matter he has left in his eye to attach a lens to it as that Surgeon who did the operation is on holiday.  Because we are in NZ and there are not a lot of cases like this over here I just wanted to know if it would be at all possible to have a IOL inserted into a small eye and if an operation has been done like this before? Also I read today about bifocal contact lenses and was just wondering if he would ever be able to wear one of these?

[peepsmom]

hi Kirstie,

My name is Cheryl and I live in Tampa, FL.  I just came across your post from 2010 while searching online to answers for my 4 1/2 year old son and possible surgery.  He was born with micropthalmia in the right eye and also has cataracts in that eye (as well as a tiny pupil that was slightly enlarged via surgery but is very still very off center - overall he has very limited vision in that eye).  Our opthamologist asked us to consider surgery to re-center the pupil, put in an artificial lense, and realign the muscles to give him some chance for more than limited vision.  Your questions are exactly the questions I have been asking and struggling with.  What goal are we really striving for? Is it realistic to have decent vision in a pretty "messed up" small right eye, or are we trying to get some improved vision in the bad eye in case something happens to the good eye.  How are things going in your situation now?  It sounds like we are dealing with very similar situations.  On one hand I am so fearful of doing surgery and then dealing with all of the follow up care, patching, drops, etc...but then I ask myself if I will one day regret not doing it.  I would love to hear how your child is doign now and what you decided.  Thank you so very much.

[Anfalhelu]

hi my 4 month old son was born diagnosed with bilateral micropathilmia with hazy cornea,partial aniridia,congenital cataract. Noone saw how his eyes were different but i noticed from first sight. the doctor just said that we wouldnt know anything till he turned 3 months. I'm out of the states and i have so many questions i want to ask. He also has a lazy eye i think because his eyes dont move together and he keeps rolling his eyes up. i never actually seen him look at me straight. i just want to know is there an operation for all of those syndromes>?

[Kirstie228]

Thank you, that answers my question and now at least I have some idea what we should be realistically working towards.  I just have to be thankful that his left eye seems to be all good.  
Regards
Kirstie

[John C Hagan III, MD, FACS, FAAO]

I don't want to be pessimistic but the likelihood of the eye having good vision, being aligned with the other eye and working together to have perfect depth perception is very small.  A realistic goal is to have enough vision so that if something terrible happened to the good eye in his lifetime that the "bad" eye would allow him to do most things he needed to do.

JCH MD

[Kirstie228]

Thank you for your reply, yes you are right the advances in technology will hopefully create something for him.  The Surgeons had mentioned a new operation of clipping on a lens instead of sewing them in so that could be an option for him one day.  When I come away from meeting with the Surgeon I always end up wanting to ask more questions so another one I have for you (as I won't be seeing the surgeon until end of Aug) is that if we work on the bad eye over the years with patching and get good enough vision is there a chance that both eyes would work together?  I think we would need eye alignment surgery as well to help but I'm not sure if we are working toward that goal or working toward just getting some vision in the bad eye just in case something happens to the good eye.  I haven't been told about safety glasses etc, but I will definitely look into it when he's older and up and walking. Thank you for your time.

[John C Hagan III, MD, FACS, FAAO]

The answer give you buy your surgeon is correct. However things change fast and by the time your child is 8-14 years of age there will be whole new technology.

Yes it is possible that when the child is older that a bifocal contact lens might work.

REMEMBER: the most important eye is the OTHER eye and it needs to be protected from disease and INJURY>

Discuss safety glasses and avoiding activities that have high risk of eye injury.

JCH MD