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approach and management of congenital cataract

This to teach about approach and adequate management of the congenital cataract. This presentation highlights the common casues of the congenital cataract. Early treatment prevents amblyopia. Delayed causes loss of vision.

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approach and management of congenital cataract

  1. 1. 20/11/2012
  2. 2.  R, 6mth, Mch  R/O Hamirpur  Himachal pradesh
  3. 3.  Whitish eyes since birth  Not properly following to light  Poor response to sounds (Noted subsequently)
  4. 4.  Delivered vaginally at term at home, cried after birth  Antenatal period not supervised but uneventful  Peri – postnatal period uneventful  Breastfed exclusively  Immunization started at ~6 wk of age  No significant family history
  5. 5.  Vitals stable  Lt – 64 cm (~50th centile)  Wt - 5.5 kg ( <3rd centile)  OFC - 42cm ( > 15th centile - < 50th centile)  Eyes  B/L aphakia  No proper fixation  Follows light  Nystagmus b/l  No obvious dysmorphism
  6. 6.  Abdomen- soft, no organomegaly  CVS - S1S2 normal, no murmur  Respiratory system - normal  CNS  Alert, consolable  Poor response to sound  Tone & reflexes normal
  7. 7.  5 mth, M  B/L aphakia  Impaired hearing
  8. 8.  Congenital cataract  Retinoblastoma  Retinopathy of prematurity  Persistent hyperplastic primary vitreous •EUA •Dilated pupils •Direct ophthalmoscopy •USG of eye and orbit
  9. 9.  Post operative case of bilateral congenital cataract with impaired hearing under evaluation  Cause of impaired hearing ?  Rubella  Retinitis pigmentosa  Craniofacial dysplasia  Alports syndrome
  10. 10.  Opacity in lens  Can be:  Congenital or Acquired  Unilateral or Bilateral  Partial or Complete Congenital: 6/10,000 (10% of childhood blindness)
  11. 11. Maternal Factors  Malnutrition  Infection  TORCHS (50% cases with rubella has cataract at birth)  Measles  Varicella Zoster  Influenza  Drugs  Corticosteroids, Thalidomide  Radiation Fetal / Infantile Factors  Fetal malnutrition  Deficient oxygenation  Metabolic disorder  Galactosemia  Neonatal hypoglycemia  Associated with other congenital anomalies  Lowe’s syndrome  Myotonic dystrophy  Birth trauma Hereditary / Genetic: ~1/3rd of cases Idiopathic: ~50% of cases
  12. 12. Systemic Diseases  Diabetes mellitus  Atopic dermatitis  Neurofibromatosis 2 Ocular Diseases  Chronic anterior uveitis  High myopia  Retinitis pigmentosa Drugs •Chlorpromazine Trauma
  13. 13. •Sporadic, no family history •Ocular anomalies : Persistent foetal vasculature •Cause identified in only 10%
  14. 14.  Disturbances in normal growth of lens  Opacity of lens at various locations  White pupillary reflex  Impaired refraction of lens  Focusing of image elsewhere than retina  Amblyopia
  15. 15.  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
  16. 16.  Screening of newborns with red reflex test  History  Family  Maternal infections  Maternal drugs  Maternal radiation exposure  Examination of newborn / infant / child  Associated systemic diseases or syndromes  TORCHS screen Index case
  17. 17.  Metabolic  Blood glucose (Hyperglycemia)  Serum calcium, phosphate, X-ray skull (Hypoparathyroidism)  Urine- reducing substances (Galactosaemia)  Haematuria (Alport syndrome)  Urine chromatography for amino acids ( Lowe syndrome)  Detail ophthalmologic evaluation  EUA, ophthalmoscopy with dilated pupil, USG Index case hearing assessment planned
  18. 18.  Visually significant cataract  Cataract extraction and  IOL implantation  Non visually significant cases  Careful observation,  Possible pupillary dilation Index case: Cataract extracted B/L Spectacles – prescribed IOL implantation planned after 2 yrs of age
  19. 19.  Bilateral dense cataracts  Within six weeks of birth  1 week apart  Unilateral dense cataracts  ASAP (within days)
  20. 20.  In 1st yr axial length increases very fast  It causes myopic shift of growing eye  Goal  Undercorrect the refraction  20% in neonate and 10% in toddlers
  21. 21.  Retrobulbar hemorrage  Oculocardiac reflex  Muscle lacerations  Corneal / uveal injury  Vitreous loss  Nucleous drops into vitreous cavity  Hyphaema  Cystoid macular edema  Endopthalmitis  After cataract
  22. 22. 6wk 4mth 5mth 6mth White eyes Enucleation of lens done Left eye Right eye conjunctivitis Topical antibiotics Plan
  23. 23.  Possible  Many centers across the globe  Cataract  PHPV
  24. 24.  Early recognition and detection – most important  Correct management is essential to prevent permanent visual loss  Evaluation and treatment should go side by side  Knowledge of common associated systemic conditions  Team effort is essential (ophthalmologist, pediatrician, geneticist)  Counseling of parents and family members

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