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Cataracts in Paediatric patients. (With acknowledgements to the Online Journal of Ophthalmology: www.onjoph.com). Introduction. Opacity in lens Can be: Visually significant or not Stable or Progressive Congenital or Acquired

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cataracts in paediatric patients

Cataracts in Paediatric patients

(With acknowledgements to the Online Journal of Ophthalmology: www.onjoph.com)

introduction
Introduction
  • Opacity in lens
  • Can be: Visually significant or not

Stable or Progressive

Congenital or Acquired

Unilateral or Bilateral

Partial or Complete

  • Congenital: incidence 6/10 000

10% of childhood blindness

classification acquired cataracts
Classification : Acquired cataracts
  • Systemic diseases : Diabetes mellitus

: Myotonic dystrophy

: Atopic dermatitis

: Neurofibromatosis 2

  • Ocular diseases : Chronic anterior uveitis

: High myopia

: Fundus dystrophies eg Retinitis

pigmentosa

  • Drugs : Corticosteroids

: Chlorpromazine

  • Trauma : Blunt

: Sharp

congenital cataracts bilateral
Congenital cataracts: Bilateral
  • Genetic Mutation : Autosomal Dominant
  • Metabolic : Galactosaemia

: Lowe

: Hypoparathyroidism

: Fabry

  • Infective : TORCH organisms
  • Chromosomal : Trisomy 21 (Down)

: Trisomy 18 (Edward)

: Trisomy 13 (Patau)

  • Skeletal : Hallerman-Streiff

: Nance-Horan

  • Ocular anomalies : Aniridia

: Anterior segment dysgenesis syndrome

  • Idiopathic : in 50%
congenital cataracts unilateral
Congenital cataracts: Unilateral
  • Sporadic, no family history
  • Ocular anomalies : Persistent foetal vasculature
  • Cause identified in only 10%
evaluation
Evaluation
  • Screen newborns with red reflex test
  • History : Family

Maternal infections

  • Examination: systemic diseases or syndromes
  • Workup: Bilateral cases without known hereditary basis

TORCH screen

s-glucose

s-calcium, phosphate

Urine: reducing substances (galactosaemia)

amino acids ( Lowe syndrome)

haematuria (Alport syndrome)

ocular examination
Ocular examination
  • Formal estimate of vision not possible in neonate

Special tests: Preferential looking test, visually evoked potentials

  • Density and position of cataract
  • Morphology
  • Associated ocular pathology
  • Indicators of severe visual impairment : No fixation

Nystagmus

Strabismus

the visually significant cataract
The visually significant cataract
  • In central visual axis, bigger than 3mm
  • Posterior cataract
  • No clear zones in between
  • Retinal details not visible with direct ophthalmoscope
  • Nystagmus or strabismus present
  • Poor central fixation after 8 weeks
treatment
Treatment
  • Surgery: Cataract extraction and intraocular lens

implantation for visually significant cataract

  • By 6 weeks of age
  • Bilateral cases: 1 week apart
  • Non visually significant cases : careful observation, possible pupillary dilation
considerations regarding surgery
Considerations regarding surgery
  • Intraocular lens : Power of lens – Myopic shift of the

growing eye

  • Surgical technique
  • Postoperative intraocular inflammation (uveitis)
  • Glaucoma and retinal detachment may develop
postoperative considerations
Postoperative considerations
  • Clear vision for distance and near
  • Intraocular lens: regular refraction
  • Spectacles
  • Contact lenses
  • Treatment of amblyopia : Occlusion therapy
conclusion congenital cataracts
Conclusion: Congenital cataracts
  • Correct management essential to prevent permanent visual loss
  • Team effort ophthalmologist, paediatrician, geneticist,family
  • Early detection within the first month of life is very important
  • Knowledge of systemic conditions associated with cataract