unilateral cataract ,should it be treated aggressively?

[jain822]

This is regarding my daughter, unilateral congenital cataract treatment,she is now 6yr 10 month old.  At 9 month of age she was seen by eye doctor due to rigt eye esotropiasquint.On examination time she was found to have Right eye milsd squint ,microcornea  and a small wedge shaped  off centre Lens Opacity,Fundus appeared Myopic.Retinoscopy revealed High Myopia in Right(Affected)Eye.Left eye is normal,advised occlusion of good eye and use of glasses.

After 3 months it was decided to do Rt eye unilateral cataract surgery and IOL to be put later on(EUA showed ?lenticonus Rt Eye).So she had Rt eye Lens aspiration done (when one year old),and posterior capsulorrhexix and anterior vitrectomy done.Left eye is normal.Post surgery Rt eye refraction was +11.50.Patching good eye and glasses for right eye contd.however contact lens was difficult to put so hardly used.
After 2 yrs visual acuity rt eye 6/24P  and Left eye6/12.Refraction Rt eye +11.0 and Left eye+1.25.IOL still not decided  to put ,was considered to be put when she is 4 yrs. old.
After another 1 year she unfortunately had RETINAL DETACHMENT in Right eye--Rt eye showed total RD with anterior PVR and corrected visual acuity of hand movement close to face.Lt. eye6/9 with +0.5 Dsph.Left eye retina normal.
she underwent RD surgery including scleral buckling ,vitrectomy,silicone oil injection.Left Eye Retina was Normal.
One year back she underwent Silicone OIL REMOVAL in Right Eye.An IOL with scleral Fixation was also discussed but deferred as we were very apprehensive regarding scleral fixation,also there is now no capsule to hold the IOL...so IOL was not put, only OIL REMOVAL done at this visit.
Examination on 02/01/2008 showed Rt eye corrected VA 6/36  and Left eye corrected vision6/9.she was again adv. occlusion of good eye--but this was difficult now as child grown up and not co-operative also due to schooling,so infrequent occlusion could only be done.
Last visit in july 2008 --showed best corrected vision of 6/60N24 in Right eye and 6/6P N5 in Left eye and right convergent squint with eccentric Fixation.Retina in Right eye is attached and Left eye Retina is normal.she is further advised patching good eye for another 9-10 months.She is now 6 years and 10 month  old.

Inspite of treating her unilateral eye condition aggresively,she continues to have poor visual outcome in the affected eye and has pending  IOL and Squint surgery.As for IOL placement she does not have any capsule left now,Dr. suggesting scleral fixation.But how successful all this will be.we are still confused regarding visual outcome of her affected eye ,will she ever have good vision in Right eye even if IOL is put.And any chances of Binocularity? and what else could be done.Please advice.

Best regards and Thanks

Worried Parents

[jain822]

Dear Dr
please advice regarding best centre in philedelphia to carry out IOL implant /scleral fixation ,as i have a relative in usa at above place.Also please mention name of doctor.
thanking you

[Joan M Pernoud, MD]

Placing an IOL in experienced surgeon's hands when sclerally fixated is usually a good idea because the visual image will be much closer to the retina and should give the best possible visual outcome.

Children's eyes are somewhat more sensitive from an inflammation standpoint and may need some fairly intensive anti-inflammatory or other medical treatment but I think it is worth it.

[jain822]

DEAR DR
Thanks for your prompt and sincere advice.We would like to know advantage of putting IOL at this stage,will it not help in improving vision? and how good is scleral fixation outcome? OR  we should leave it as it is and let her live with monocular vision and only squint correction at later age.
Best regards and thanks
mother

[Joan M Pernoud, MD]

Dear Worried,

Congratulations on your perseverence and it sounds like your doctors have done a very good job of giving your child every possible treatment.

Several thoughts:

1) The pliability of the brain to "pay attention" to the image from the eye tapers off after age 7 fairly quickly so your efforts in the next few months to years are very important, although that eye is far from normal and it will be just making the best of a suboptimal situation. Follow you doctor's directions carefully. They are working hard for your daughter to maximize her outcome.

2) There will never be perfect binocularity but there are other clues to depth perception
which your daughter will have.

3) PROTECT her good eye with shatter resistant glasses and other common sense efforts.