Cataracts - Treatment

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Treatment for Patients with Accompanying Eye Conditions

Cataracts in the Second Eye. If a person has a cataract in a second eye, the issues for decision making are the same as for the first eye. The timing of the procedure in the case of two cataracts is unclear. Doctors have long recommended postponing surgery on the second eye until the first eye has healed and the results are known. However, many patients have trouble reading and performing ordinary tasks while waiting for a second surgery. Patients with double cataracts should discuss all options with their eye surgeon.

Cataracts and Glaucoma. For patients with both glaucoma and cataracts, doctors recommend:

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• In patients with cataracts and poorly controlled glaucoma, a two-step procedure for both eye conditions may be used. The patient first receives a trabeculectomy for glaucoma, followed by cataract surgery. Fluid leakage and the presence of blood in the back chamber of the eye are potential complications of this combined procedure. Phacoemulsification has improved success rates and reduced high complication rates of the double procedure compared with extracapsular cataract extraction. New advances that replace trabeculectomy with nonpenetrating glaucoma surgery may prove to be beneficial.
• In patients who have cataracts plus either closed-angle glaucoma or open angle glaucoma that is stabilized with medication, the cataract may be extracted and medication continued for the glaucoma.

Cataracts and Corneal Disease. Patients with both cataracts and corneal disease may have one of the following procedures:

• Combination Procedure. A single operation that combines three procedures, extracapsular cataract extraction and intraocular lens insertion with corneal transplantation (called penetrating keratoplasty).
• Sequential Procedure. An operation that uses two procedures sequentially. The sequential option performs the cataract procedures and the corneal transplantation separately.

Treating Cataracts in Children

Infants. Treatment of infants first depends on whether one or both eyes are affected:

• For infants born with cataracts in one eye, the American Academy of Ophthalmology recommends surgery as soon as possible, by 4 months or ideally even earlier. The procedure is followed by contact lens correction and patching of the unaffected eye. Although this approach is successful in many cases, some children still become blind in the affected eye. There is also a high risk for glaucoma after surgery.
• In infants with cataracts in both eyes, surgery is not always an option. Sometimes surgery may be performed sequentially, with the second eye operated on a few days after the first. Phacoemulsification appears to pose a much higher risk for secondary cataracts than standard lens removal.

Toddlers and Older Children. Intraocular lens replacement is now standard treatment for children age 2 years and older.

Review Date: 06/23/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).