Cataracts in Paediatric patients

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Cataracts in Paediatric patients
(With acknowledgements to the Online Journal of
Ophthalmology www.onjoph.com)
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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

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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
• 
  

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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

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Congenital cataracts Unilateral

• Sporadic, no family history
• Ocular anomalies Persistent foetal vasculature
• Cause identified in only 10

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Morphology Examples
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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)

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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

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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

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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

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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

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Pseudophakic eye
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Postoperative considerations

• Clear vision for distance and near
• Intraocular lens regular refraction
• Spectacles
• Contact lenses
• Treatment of amblyopia Occlusion therapy

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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