An 8-year-old child undergoes cataract surgery in the left eye for a dense unilateral congenital cataract. Primary posterior capsulotomy and anterior vitrectomy are performed. Postoperatively, the most critical management to prevent amblyopia is:

• A Prescribing bifocal spectacles only
• B Observation until the child can cooperate with subjective refraction
• C Optical correction with contact lens or IOL plus patching of the fellow eye for prolonged periods each day ✓
• D Prescribing atropine penalisation of the fellow eye alone without optical correction

Explanation

Amblyopia prevention after unilateral pediatric cataract surgery requires two simultaneous strategies: (1) early optical correction of the aphakia or pseudophakia to provide a focused retinal image during the critical period of visual development (0–7 years), and (2) patching or penalisation of the normal fellow eye to force use of the operated eye. Without aggressive patching, the child will always prefer the better eye, and the operated eye will develop dense deprivation amblyopia. The IATS trial showed contact lens correction with patching starting immediately postoperatively provides the best outcomes.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.