Paediatric%20cataract

1
Paediatric cataract

• Tony Quinn
• Consultant Ophthalmologist
• West of England Eye Unit
• Royal Devon Exeter Hospital

2
Outline

• What sort of cataract?
• Why do children get cataracts?
• What else could it be?
• What else occurs in association?
• Should we operate? What options are there?
• How soon should we treat?
• Complications?
• Controversies? IOL Implants?
• Outcomes?
• Our local results?

3
What sort of cataract?

• Nuclear, lamellar, powdery, subcapsular,
  sutural, total
• Can start off mild and become more dense
• Obscures retinal image
• May cause amblyopia

4
Why do children get cataracts?

• Gene mistake
• Inherited
• Associated with other genetic conditions
• (Paediatrician workup)
• Trauma
• Uveitis
• Intrauterine infections

5
What else could it be?

• white pupil differential diagnosis
• Retinoblastoma
• Retinopathy of prematurity
• Coats disease
• Persistent fetal circulation

6
What else occurs in association?

• Main problem is amblyopia
• Eye growth
• Strabismus

7
Should we operate? What options are there?

• Unilateral cataract ? treatment
• Bilateral cataract Treat if visually
  significant
• Can you see in?
• Is opacity gt3mm?
• anterior or posterior
• ? Amblyopia, abnormal eye growth

8
How soon should we treat?

• lt4 weeks may cause more glaucoma
• More than 10 weeks may cause irreversible
  amblyopia, nystagmus
• Unilateral about 6 weeks
• Depends on how dense

9
Surgery
10
Complications?

• Infection, bleeding, GA risk, loss of eye
• Big risks Re-op
• Glaucoma
• Retinal detachment
• Amblyopia
• Strabismus
• Glasses(bifocals) or Contact lens for sure

11
What do we tell the parents?

• Lifetime journey
• Very hard work
• Lots of drops early, then glasses and patching
  for years
• May not work well (unilateral)
• Long term risks
• Risk to other eye (sympathetic)

12
Controversies? IOL Implants?

• IOL implants when to use?
• Minimum age
• Minimum corneal diameter
• How long will they last?
• Rigid (?Heparin coated) or foldable?
• Where to place the lens?
• Dealing with posterior capsule

13
Outcomes?

• Excellent results possible
• IOLs may be better overall than contact lenses.
  Not much in it
• Refract, Refract, Refract!!!
• May need EUA
• Tonopen for awake IOP

14
Our local results? Methods

• Consecutive infant cataract surgery 00 - 03
• 9 infants, 15 eyes
• Mean age at surgery 21 weeks (4-42w)
• All posterior chamber, 13 in bag, 2 in sulcus
• 1 lost to follow up after 6 weeks

15
Methods

• primary pars plana Vx
• IOL Heparin PMMA in 5, Acrysof MA 60 BM in 10
  (both 6 mm optic)
• Healon 5 in 14, Healon GV in 1
• CCC in 14, MVR 1
• 1 patient corneal diam 9.5
• 2 patients (4 eyes) nystagmus and strabismus
  pre-op

16
Refractive target

• 4 to 8D, (SRK-T) but max 30D IOL
• Unilat Down 1.8D

17
Refractive outcomes mean followup 26.5 mo
18
Vision outcomes mean 26.5 mo
19
Complications of surgery

• Strabismus in 6 of 8 (1 lost to follow-up)
• Iris capture 1/14
• Repeat posterior capsulectomy 6/14
• Anterior capsule phimosis 1/14
• Glaucoma nil mean 33 mo f/u. Mean IOP 14, range
  10-17mmHg
• Retinal detachment nil
• IOL decentred nil

20
Conclusions

• IOL implants in infants are possible with good
  visual and refractive outcomes
• Myopic shift with time in most ?emmetropisation
• Mildly microphthalmic child showed almost no
  reduction in initial hypermetropia with time
• High rate of strabismus
• Nearly half re-op for PCO