Question

A child has a congenital cataract involving the visual axis which was detected by the parents right at birth. This child should be operated:

• A. Immediately
• B. At 2 months of age
• C. At 1 year of age when the globe becomes normal sized
• D. After 4 years when entire ocular and orbital growth becomes normal

Hint:

Dense visual-axis congenital cataract risks deprivation amblyopia; operate as early as possible.

Answer 1

The Correct Option is A

Step 1: A congenital cataract that involves the visual axis blocks the formation of a clear retinal image. In an infant this rapidly causes stimulus deprivation amblyopia, which becomes irreversible if vision is not restored early.

Step 2: The critical period for developing the fixation reflex is between 2 and 4 months of age. Any cataract dense enough to impair vision must be dealt with before this window, and the earliest possible time is preferred. A dense visual-axis cataract detected at birth therefore needs urgent surgery, so option (a) immediately is correct.

Step 3: Waiting until 2 months, 1 year or 4 years allows irreversible deprivation amblyopia to set in, so options (b), (c) and (d) would result in permanent poor vision and are wrong.

Step 4: Bilateral dense cataracts are operated by about 6 weeks of age and unilateral dense cataracts within days, followed by aggressive anti-amblyopia therapy. The principle is to clear the visual axis as early as possible.