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

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Presentation on theme: "Cataracts in Paediatric patients (With acknowledgements to the Online Journal of Ophthalmology: www.onjoph.com)"— Presentation transcript:

1 Cataracts in Paediatric patients (With acknowledgements to the Online Journal of Ophthalmology:

2 Introduction  Opacity in lens  Can be: Visually significant or not Stable or Progressive Stable or Progressive Congenital or Acquired Congenital or Acquired Unilateral or Bilateral Unilateral or Bilateral Partial or Complete Partial or Complete  Congenital: incidence 6/ % of childhood blindness 10% of childhood blindness

3 Classification : Acquired cataracts  Systemic diseases : Diabetes mellitus : Myotonic dystrophy : Myotonic dystrophy : Atopic dermatitis : Atopic dermatitis : Neurofibromatosis 2 : Neurofibromatosis 2  Ocular diseases : Chronic anterior uveitis : High myopia : High myopia : Fundus dystrophies eg Retinitis : Fundus dystrophies eg Retinitis pigmentosa pigmentosa  Drugs : Corticosteroids : Chlorpromazine : Chlorpromazine  Trauma : Blunt : Sharp : Sharp

4 Congenital cataracts: Bilateral  Genetic Mutation : Autosomal Dominant  Metabolic : Galactosaemia : Lowe : Lowe : Hypoparathyroidism : Hypoparathyroidism : Fabry : Fabry  Infective : TORCH organisms  Chromosomal : Trisomy 21 (Down) : Trisomy 18 (Edward) : Trisomy 18 (Edward) : Trisomy 13 (Patau) : Trisomy 13 (Patau)  Skeletal : Hallerman-Streiff : Nance-Horan : Nance-Horan  Ocular anomalies : Aniridia : Anterior segment dysgenesis syndrome : Anterior segment dysgenesis syndrome  Idiopathic : in 50%

5 Congenital cataracts: Unilateral  Sporadic, no family history  Ocular anomalies : Persistent foetal vasculature  Cause identified in only 10%

6 Morphology : Examples

7 Evaluation  Screen newborns with red reflex test  History : Family Maternal infections Maternal infections  Examination: systemic diseases or syndromes  Workup: Bilateral cases without known hereditary basis TORCH screen TORCH screen s-glucose s-glucose s-calcium, phosphate s-calcium, phosphate Urine: reducing substances (galactosaemia) Urine: reducing substances (galactosaemia) amino acids ( Lowe syndrome) amino acids ( Lowe syndrome) haematuria (Alport syndrome) haematuria (Alport syndrome)

8 Ocular examination  Formal estimate of vision not possible in neonate Special tests: Preferential looking test, visually evoked potentials 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 Nystagmus Strabismus Strabismus

9 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

10 Treatment  Surgery: Cataract extraction and intraocular lens implantation for visually significant cataract implantation for visually significant cataract  By 6 weeks of age  Bilateral cases: 1 week apart  Non visually significant cases : careful observation, possible pupillary dilation

11 Considerations regarding surgery  Intraocular lens : Power of lens – Myopic shift of the growing eye growing eye  Surgical technique  Postoperative intraocular inflammation (uveitis)  Glaucoma and retinal detachment may develop

12 Pseudophakic eye

13 Postoperative considerations  Clear vision for distance and near  Intraocular lens: regular refraction  Spectacles  Contact lenses  Treatment of amblyopia : Occlusion therapy

14 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


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