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Evaluation of Paediatric Cataract

Evaluation of Paediatric Cataract . Dr Sunayana Bhat Consultant Paediatric Ophthalmology ,Strabismus and Neuro Ophthalmology. Vasan Eye Care , Mangalore Ex faculty , Father Muller Medical College chanyn9@gmail.com . Epidemiological Data .

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Evaluation of Paediatric Cataract

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  1. Evaluation of Paediatric Cataract Dr SunayanaBhat Consultant Paediatric Ophthalmology ,Strabismus and Neuro Ophthalmology. Vasan Eye Care , Mangalore Ex faculty , Father Muller Medical College chanyn9@gmail.com

  2. Epidemiological Data • True prevalence of congenital cataracts is probably 2.5 - 3 per 10,000 live births • Although some sort of cataract is present in 1 in 250 newborns • Accounts for 10% of all visual loss in children worldwide

  3. Quick Revision : Lens Embryology Thickened ectodermal layer : lens plate 28 th day Invaginates : lens vescicle 5 weeks post epithelium elongation 7 weeks (embryonic nucleus ) Ant / post Y sutures 12-14 weeks (fetal nucleus )

  4. Quick Revision : Lens Anatomy

  5. Evaluation • History • General physical exam • Ocular exam • Laboratory investigations • Screening

  6. History • Laterality • Present since birth /acquired congenital and unilateral cataract : usually not associated with metabolic disease • H/O trauma : Postnatal • Noticed due to …. - Leucocoria … - Diminished vision …. - Squinting …. - Nystagmus ….

  7. History • Family history : Trace atleast 3 generations

  8. Birth History • Antenatal : TORCH infections Drug intake • Natal : Prematurity Birth asphyxia Neonatal hypoglycaemia • Postnatal : Systemic diseases Chromosomal disorders

  9. Etiology Congenital infections • Congenital herpes simplex • Congenital syphilis • Cytomegalic inclusion disease • Rubella Others • Cysticercosis • Leprosy • Onchocerciasis • Toxoplasmosis Chromosomal disorders • Patau's syndrome • Schmid-Fraccaro syndrome • Trisomy 18 (Edward's syndrome) • Turner's syndrome Disease of the skin and mucous membranes • Atopic dermatitis • Basal-cell nevus syndrome • Ichthyosis • Pemphigus

  10. Etiology Metabolic and nutrition diseases • Aminoaciduria(Lowe's syndrome • Diabetes mellitus • Fabry's disease • Galactosemia / Galactosemic Cataract • Homocystinuria • Hypervitaminosis D • Hyperparathyroidism • Hypothyroidism Other multisystem disorders • Alport's syndrome • Conradi's syndrome • Myotonic dystrophy • Mucopolysaccharidoses • Wilson's disease • Infectious diseases Toxic substances introduced systemically • Corticosteroids • Haloperidol • Miotics • Triparanol

  11. Physical Evaluation • Physician / Paediatrician evaluation

  12. Ophthalmic Evaluation Visual Significance : Concept of “ functional cataract ” • Assessment of red reflex ( before and after dilatation ) • Visual improvement after dilation

  13. Ophthalmic Evaluation

  14. Ophthalmic Evaluation – EUA • Axial length for prognosis / IOL calculation • Keratometry • Morphological evaluation of cataract with slit lamp under EUA whenever possible • B scan to assess posterior segment

  15. Zonular Cataract • Opacification of lens material • between clear nucleus • and cortex • Intrauterine insult • Bilateral • Progressive

  16. Nuclear cataract • Opacification of nucleus • Bilateral • Dense • Associated with AS dysgenesis

  17. Anterior Polar Cataract • Dense, usually circular and well-defined opacity on the anterior pole of the lens • Usually symmetric and bilateral but doesn't have to be • May protrude slightly into the anterior chamber like a small pyramid

  18. Posterior Lenticonus • Dense, usually circular and • well-defined opacity on • the posterior pole of the lens • Usually symmetric; may be • misdiagnosed as posterior • subcapsular cataract • May protrude into the lens like a pyramid

  19. Cerulean Cataract • Small, bluish punctate opacities • of the peripheral cortex • (anterior, posterior or both) • Often associated with • other cataract types • May exhibit sectoral • distribution but tends to • be symmetric OU

  20. Coronary Cataract • Single or multiple • finger- or bowling pin-shaped • opacities that ring the • peripheral cortex • Often associated with • cerulean cataracts

  21. Mittendorf Dot • Mittendorf's dot is an embryological • remnant of the hyaloid artery that is attached to the posterior surface of the lens • appears as a small punctate opacity • As shown in the cross-section diagram above, the lens may also have a • corkscrew "tail" of hyaloid artery • remnant attached to it.

  22. Epicapsular stars • Small light brown or tan dots or star-shaped deposits on the anterior capsule • single or multiple • unilateral or bilateral • Are remnants of the tunica vasculosa lentis

  23. Sutural Cataract • Dense opacity that "gloves" • the Y-suture • May involve the anterior • or posterior Y-suture or both; • however, the anterior is the • most common

  24. Pulverulent Cataract • Hollow sphere of • punctate opacities involving • the fetal nucleus • Subtle "bull's eye" may be • noted with ophthalmoscope • retro-illumination • Usually bilateral

  25. Total Cataract • Often indicate natural progression from other cataracts

  26. Others …

  27. Laboratory Evaluation • Urine - reducing substance - amino acids - microscopy - protein • RBC galactokinase • Antibody titres – TORCH , VDRL • Serum - calcium, phosphorus, alkaline phosphatase, ceruloplasmin

  28. Management decisions • Age • Visual disability • Lateraliy • Prognostic indicators

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