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Is it safe to administer anaesthesia for cataract surgery in a child?

Q: My 3 & a 1/2 months old daughter has cynotic heart disease and Down's syndorme. She was operated for congenital bilateral cataract 2 months ago. Bilateral lense aspiration with PCC with ant vitrectomy was done. Her first follow up has been done. She is using +23D glasses. On indirect ophthalmoscopy, her posterior pole was examined without anaesthesia and was found within normal limit. Visual axis was clear. She is fixing light. She is advised to be examined under anaesthesia. Being a case of cynotic heart disease with Down's syndrome. Giving anaesthesia is difficult & her cardiac operation is not decided yet. What is the cost of examination under anaesthesia, considering her cynotic heart disease? Is EUA necessary or there are other alternatives available for eye evaluation? How many times is examination under anaesthesia necessary? For how long will she will be examined under anaesthesia?

A:In all infants it is not possible to do a complete examination without anasthesia and so we have to do EUA so that we can detect complications if any. There are many problems that can develop after cataract surgery: secondary glaucoma, after cataract, retinal detachment, cystoid macular edema to name a few. Also the vision and refractive error of both eyes needs to be determined as there is always the risk of amblyopia (lazy eye). If the posterior pole is visible and your daughter is fixing well with both eyes then she seems to be doing well. Your ophthalmologist is the best judge of the number of EUAs required. I am sure he/she will keep in mind the systemic condition of the child before asking for an EUA. It is possible to do some parts of the exam without anasthesia but your doctor is the best judge. EUA will be required till the doctor is able to complete his/her exam without anaesthesia.

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