Congenital Cataracts

congenital cataract1

 

 

 





Definition : –  A cataract is an opacity of the lens.
Cataracts occur infrequently in childhood but early diagnosis and management is essential   

Common Aetiological Factors


- Hereditary – Dominant, recessive or x-linked
- Infective    – Intrauterine Rubella,
- Cytomegalic Virus
- Metabolic – Diabetes, Galactosaemia
- Trauma

Diagnosis:
Altered red reflex on ophthalmoscopic examination.congenital cataract ;

This examination is essential, in all infants, in the first week of life.

Management Of Congenital Cataracts 


In recent years the importance of early extraction of congenital cataracts has been emphasized.  Dense cataracts cause dense deprivational amblyopia.  If relatively normal foveal vision is to be obtained these cataracts must be extracted and vision corrected with appropriate lenses by 3 months of age if possible. This management today includes simultaneous cataract extraction and implantation of an intraocular lens.

 Early DIAGNOSIS, SURGERY and CORRECTIVE LENSES are essential for good vision.

 Unilateral Cataracts present a major problem of anisometropia.  Again early extraction, correction with Intraocular lens, contact lens together with therapy to overcome deprivational amblyopia results in an occasional moderate visual result.  But, the road is long and difficult for the child, the parent and the physician!  Surgery for unilateral cataracts should not be recommended lightly.

 Note: Examine all neonates for cataracts.  Extract and refract by 2 months.

Dislocated (Subluxated)Lenses

If the Lens zonule (ligament which holds the lens in place) is disturbed dislocation partial or complete may occur.

This results in reduction of vision and sometimes secondary glaucoma.  Lens dislocation may occur following trauma but it is associated with a number of systemic conditions-

MARFAN’S SYNDROME    
Marfan’MARCHESANI’S SYNDROME
EHLERS-DANLOS’ SYNDROME
HOMOCYSTINUREA
SULFITE OXIDASE Deficiency

marfans l subluxated lensMARFANS SUBLUXATED LENS

 













Right Image as seen against the red reflex. Left Image as viewed with slit-lamp

Management

Refract and prescribe contact lenses or glasses.

If vision is not satisfactory for daily life Lens Extraction and IOL should be considered.

Optimum Procedure: 1. Capsulotomy; 2. Insertion of Cianni ring to centre capsule; 3.Aspiraion of lens; 4. Insert IOL into bag. 

A video is being prepared. under-construction