Cataract surgery in children is a different operation from cataract surgery in adults. The eye is still growing, the lens capsule is more elastic, and the visual brain is still developing — meaning the success of surgery depends as much on the long-term follow-up and amblyopia therapy as on the procedure itself. At Suraj Eye Institute, paediatric cataract surgery is performed by surgeons experienced specifically in this field, working closely with our paediatric ophthalmology and orthoptic team.

Timing

For visually significant congenital cataracts:

• Unilateral cataract — surgery between 4–6 weeks of age, before the critical period of visual development closes
• Bilateral cataracts — surgery between 6–10 weeks of age; the second eye usually within a week of the first
• Acquired cataracts in older children — operate when the cataract is visually significant and amblyopia risk is identified

For background and causes of paediatric cataract, see our paediatric cataract page.

How Surgery Differs from Adult Cataract Surgery

General anaesthesia

All paediatric cataract surgery at SEI is performed under general anaesthesia, with a paediatric anaesthetist and full monitoring in our NABH-accredited operating theatres.

Anterior and primary posterior capsulotomy

In adults, only the front capsule is opened. In children, the back capsule is also opened during the same operation — because the back capsule rapidly opacifies (PCO) in children, and they cannot lie still for a YAG laser later.

Anterior vitrectomy

A limited vitrectomy is performed during paediatric cataract surgery to prevent vitreous from coming forward through the posterior capsule opening and to reduce the risk of secondary visual axis opacification.

IOL implantation — selective

Whether to place an IOL at the time of cataract surgery is one of the most important decisions:

• Under 6 months — IOL implantation is generally avoided. Aphakia is corrected with high-power contact lenses or aphakic glasses, and an IOL is placed later (secondary IOL) when the eye has grown
• 6 months to 2 years — case-by-case decision based on axial length, surgeon judgement and family circumstances
• Over 2 years — primary IOL implantation is standard, with the IOL power chosen to match the expected adult refraction

IOL power calculation

The eye is still growing, so we deliberately under-correct the IOL power so that the eye becomes emmetropic (or close to it) in adulthood. The exact target depends on the child’s age — younger children are left with more hyperopia, knowing that myopic shift will occur as they grow.

Post-operative Care

• Intense topical steroids and antibiotics — paediatric eyes inflame more than adult eyes
• Refraction at 1 week and regularly thereafter — the focus of the eye changes as it grows
• Aphakia correction with contact lenses or glasses if no IOL was implanted
• Patching therapy for the unaffected eye in unilateral cases — the cornerstone of amblyopia treatment
• Orthoptic assessment — squint, suppression and stereopsis are tracked
• Long-term IOP monitoring — paediatric cataract eyes carry a lifetime risk of secondary glaucoma

Long-term Risks We Watch For

• Visual axis opacification — the most common complication; managed by primary posterior capsulotomy and anterior vitrectomy at first surgery
• Secondary glaucoma — can develop years later; lifelong IOP checks are essential
• Amblyopia — the central long-term challenge; addressed by refraction and patching
• Refractive change — myopic shift as the eye grows, sometimes requiring IOL exchange in adulthood
• Strabismus — squint is common in unilateral paediatric cataract; managed by our paediatric ophthalmology team
• Retinal detachment — small lifelong elevated risk

Frequently Asked Questions