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PEDIATRIC CATARACT SURGERY CONSENT FORM(Ninbil Pagli in Dagbanle)You child has a cataract in both eyes. It means that the lens inside the eyes became cloudy. The only way to improve your child’s eyesight is to wash out the cataracts. Glasses, eye drops or drugs are not going to help. We can remove the cataracts and place a new clear plastic lens into both eyes. If you would like for us to do this we can book it.Your child needs to be put to sleep for the surgery, which is called “general anesthesia”. You will need to get laboratory tests and an anesthesia clearance. Afterwards we will put eye pads on your child’s eyes and he/she will have to return to the eye clinic the next morning for an exam. We will remove the eye pad and give you eye drops to give to your child for 6 weeks. You will need to return for an exam a few more times. There is a chance that your child will need one or two more surgeries to get the best result. Also, your child will probably need eyeglasses and need to come for eye exams every year for the rest of his/her life. Your child’s vision might not get perfect even after the surgery, and it is possible that he/she will not be able to attend regular school. If you have health insurance the operation is free except for anesthesia 125 GhC and medicines 50 GhC. Please let us know if you have any questions.I understand the above and I am consenting for my child to have cataract surgery in RIGHT LEFT eye.Name:……………………………………….. Date: ……………………Signature: …………………………………..If you decided to book your eye for surgery, please, call our surgical coordinator, Dokorugu Fusheini at 024-112-9878 from 9 am to 3 pm.You can also contact him if you have any question.Thank you very much! ................
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