congenital cataract ppt

Glasses or contact lenses are prescribed as early as possible, preferably within the first week for aphakic correction and within 4 weeks for residual refractive error in pseudophakic children. Cataracts may be unilateral or bilateral and can vary widely in size, morphology and degree of opacification from a small white dot on the anterior capsule to total opacification of the lens. 224-230. Lens. Amblyopia, strabismus, and nystagmus which may have developed prior to cataract surgery may continue despite removal of the cataract(s) and must also be addressed. Measurement of visual acuity Strabismus and nystagmus are noted in wide of congenital cataracts and gives a clue about amblyopia. CONGENITAL CATARACT . Supplemental O2 therapy in perinatal period. Pediatric Cataract Surgery: Lippincott, Walters Kluwer 2014. p. 1-8. Epidemiology Incidence is ~3 per 100,000 in the United Kingdom 1. The skills needed to perform adult cataract surgery are also important for performing pediatric cataract surgery, but additional skills are needed for the pediatric surgery. Lens aspiration - the lens in pediatric cataract is generally soft. Punctate (blue-dot) Various laboratory tests in bilateral cataract include: A unilateral cataract does not typically require extensive diagnostic evaluation, as most of them are isolated, non hereditary with no systemic and genetic abnormality. High myopia in pseudophakic eyes can be treated using spectacles or contact lens. Background A cataract is an opacification of the lens. The visual outcome in cases of congenital cataract, managed both surgically and conservatively, is outlined. Correction of aphakia with spectacles may be preferred for infants and young children in whom IOL implantation is not possible or is purposely delayed. Homatropine or atropine eye drops are sometimes used postoperatively as cycloplegics. 2. Shanon M White. Such membranes can be peeled off of the anterior lens capsule at the time of surgery to facilitate lens removal. Alternatively, IOL exchange, piggyback IOL implantation, or corneal refractive surgery may be required. lens of the eye that is present It can also occur because of traumatic zonular loss and/or inadequate capsular support. Gestational age & birth weight Spontaneous rupture of the lens can rarely occur, leading to abrupt progression to total cataract. In addition a 4. (Basak, SK., 2007), It is sharply demarcated opacity at the scattered all over the lens, especially If a cataract goes undetected in an infant, permanent visual loss may ensue. In older children, a lensectomy (with or without primary posterior capsulotomy and anterior vitrectomy) and potentially a lens implant can be considered. Axial length is often measured in children by A-scan ultrasound, with the immersion method being more accurate than the contact method.6,7 Often, these measurements are not possible in clinic and examination under anesthesia is required. dispersion of light, in the same way Gillespie RL, O'Sullivan J, Ashworth J, Bhaskar S, Williams S, Biswas S, et al. If they are interested in performing pediatric cataract surgery, they should seek out opportunities to learn its best practices either by observation or by taking instructional courses. Ocular abnormalities (10%) 1 2 Genetic mutations account for the majority of cases of bilateral cataract, and the most frequent mode of inheritance is autosomal dominant seen in 44% of families. Mild cataracts may cause photophobia only in bright lights. Contact Lens Angle-closure glaucoma can result from anterior synechiae leading to pupillary block, which can be treated with a peripheral iridectomy. They are usually the result of local dysgenesis and may be associated with other ocular dysgenesis such as persistent fetal vasculature (PFV), posterior lenticonus or lentiglobus. If the exam reveals the classic appearance of a specific diagnosis such as persistent fetal vasculature (PFV) or posterior lenticonus, no further evaluation is necessary. However, correction for distance vision and a bifocal correction for near viewing should be offered after the age of 2 or 3 years, or by pre-kindergarten. Associated with ocular disorders DR. NITA SHANBHAG DR.SUJIT DESAI. B-scan ultrasound if fundus is not visible. Birch and Stager10 evaluated the relationship between the age at cataract surgery and visual outcomes in newborns with a dense unilateral congenital cataract. the most frequent cause of with the slit lamp. Introduction. Newer tests- DNA sequencing technologies, so-called Next Generation Sequencing (NGS) are not performed commonly but are seen as a future testing to improve the diagnosis of congenital cataract especially for genetically heterogeneous conditions. The incidence is in the range of 1.8 to 3.6/10,000 per year and the prevalence is about 1.03 per 10,000 children (0.32-22.9/10,000). Uveitis Cataracts develop in patients with uveitis as a result of the chronic ocular inflammation or secondary to the chronic use of steroids. Baseline characteristics of the infant aphakia treatment study population: predicting recognition acuity at 4.5 years of age. Congenital cataracts are also -If no IOL is implanted, contact lenses are given as early as possible to prevent stimulus deprivation amblyopia. Dense cataracts also may be discovered if they lead to the development of sensory nystagmus. They can be dominantly inherited, especially in bilateral cases. Recent advances in genetic testing, including next generation sequencing, allow the determination of the precise genetic cause of isolated congenital cataracts in 75% of individual families and 63% of those with syndromic congenital cataracts.4 Mutations in crystallins account for 50% of isolated (no associated systemic abnormalities) cataracts, while mutations in the gap junction protein connexins account for 25% of cases and mutations in genes for heat shock transcription factor-4, aquaporin-0, and beaded filament structural protein-2 account for the remaining 25%. Developmental milestone Biometry if the child is old enough to cooperate. There were more additional intraocular surgeries in the IOL group (63% IOL vs. 12% CL), mainly because of clearing the visual axis. This is a serious complication because it can lead to amblyopia. Unlike in adults, the management of a pediatric patient is not complete when the post-operative period is over. In this type of cataract, the opacity is in the capsule itself. Maternal drug ingestion/ This category can be confusing. A cataract is any light scattering opacity of the lens. Inadvertent excessive hydrodissection in patients with pre-existing posterior capsular rupture can lead to drop of lens matter in vitreous cavity. . Scribd is the world's largest social reading and publishing site. Measuring and interpreting the incidence of congenital ocular anomalies: lessons from a national study of congenital cataract in the UK. Others have suggested captruring the optic by placing the haptics in the bag and pushing the optic through the posterior capsularhexis may prevent opacification. However, after age 6 weeks, there was a linear decline in visual outcomes related to the age at cataract surgery. Secondary glaucoma is the most sight threatening complication of pediatric cataract surgery. Cycloplegic drops should be avoided as they can cause loss of accommodation and can lead to amblyopia by themselves. 2. - persistent hyperplastic primary vitreous (PHPV) Vision screening programs and improved education of primary health care workers and the public will help with this evolution. impairment. Comparison of contact lens and intraocular lens correction of monocular aphakia during infancy: a randomized clinical trial of HOTV optotype acuity at age 4.5 years and clinical findings at age 5 years. -Lens aspiration with Primary Posterior Capsulotomy (PPC) and IOL Anterior lenticonus is said to be characteristic of Alport syndrome. (PCOC) at, or develops shortly after Serafino M, Trivedi RH, Levin AV, Wilson ME, Nucci P, Lambert SR, et al. -Density of cataract during presentation Most inherited cataracts are autosomal dominant. Open-angle glaucoma can develop months to many years after the surgery, and children must be followed for this regularly for their entire life. Patching of the sound eye is the mainstay of treatment. anterior lens capsule, & usually the size of a Apart from routine blood check up for anaesthetic and operative purposes other tests are specific and chosen according to history and morphology of cataract. The critical period for surgical treatment of dense congenital bilateral cataracts. Therefore, one of the most critical steps is recognizing congenital cataract at an early age through postnatal eye screening. Other times, they're diagnosed during a well-child checkup, or after a parent notices one of the baby's eyes doesn't look right. 3. Due to the continuous growth of the eyes after surgery and the difficulty in obtaining parameters required for IOL calculation in younger children, IOL power calculations are a challenging task in pediatric age group. -pyramidal One advantage of contact lens wear is easy adjustment in power for the rapidly changing refractions encountered in young children. Some cataracts are static, but some are progressive. General anesthesia is required to perform pediatric cataract surgery. Additional refractive correction was achieved with spectacles. This can be done either before or after an IOL is placed and can be done anteriorly through the corneal tunnel or posteriorly through the pars plana. done under anaesthesia For older children, of more than 10 years age, who can understand and cooperate for local anaesthesia, peribulbar block with or without sedation can be used. Postcataract surgery endophthalmitis after introduction of the ESCRS protocol: a 5-year study. Magnetic resonance imaging (MRI) studies are contraindicated if the foreign body is suspected to be metallic. Not. Interference with vision can be the result of optical distortion or of capsular opacification. The risk of developing glaucoma is life-long; hence, regular monitoring of IOP is necessary. Many patients will have a pupillary membrane that covers the lens and attaches to the iris, making surgery more difficult. Rahi JS, Dezateux C: British Congenital Cataract Interest Group. Posterior lentiglobus (lenticonus) cataract. -Lens aspiration with PPC, Anterior Vitrectomy (AV) and IOL Ophthalmic Epidemiol 2003 Apr:10:67-74. Examination of siblings and parents might indicate inherited cataracts. Invest Ophthalmol Vis Sci 2001 June:42:1444-8. These tests can usually be done at age 3 years and above. Visual status: Ambulation in familiar & unfamiliar surroundings. Toxic anterior segment syndrome (TASS) is a rare inflammatory condition usually observed during the early postoperative period. Refractive aim was 6D under-correction in those older than six weeks. (Basak, SK., 2007), Consist of concentric, sharply (The Royal College of Ophthalmologists, 2010), outcome depends on: ASCRS white paper. ocular anomaly. Patients with radiation cataracts can have significant ocular surface dryness and will not tolerate contact lenses, hence the need for intraocular lens (IOL) implantation. If cataracts are less than 3 mm in diameter or are of partial density, they may be observed or treated with dilating drops. If the posterior capsule is left intact at the time of cataract surgery in children, posterior capsule opacification (PCO) is inevitable. Preoperative preparation is typically done using povidone-iodine. Differential Diagnosis The younger the child, the better the effect of amblyopia treatment per hour of occlusion. At the same time, the loss of accommodation that occurs when a childs lens is removed should be taken into account when making a surgical decision. Safety of intracameral antibiotic use after cataract surgery. Treatments of the tumor such as radiotherapy may lead to the development of cataracts, in which case timing of cataract removal has to be very carefully considered and surgery only performed when all tumor in the eye has been eradicated. In PNAS, Banerjee et al. regional differences.It is more common in areas. In contrast, most unilateral cataracts are not inherited or associated with a systemic disease and are of unknown etiology although they do not rule out the possibility of an associated systemic disease. Decision about surgery depends upon age of patient at presentation, extent of opacity and associated conditions. -There is a reasonable prospect that surgery will lead to a significant improvement in vision. Trypan also reduces the elasticity of capsule which aids in making a continuous capsulotomy. Not all pediatric cataracts require surgery. In the younger age groups, general anesthesia is often necessary and a surgical membranectomy may be indicated if the Nd:YAG laser is not effective or available. Figure 10. -Inflammation Management Table 2. Abstract. prescribed when the child is about to start school. If congenital cataracts are mild and do not affect vision, they may not need to be treated, especially if they are in both eyes. A urine test for reducing sugars, TORCH (toxoplasmosis, rubella, cytomegalovirus, varicella) screening, a Venereal Disease Research Laboratory (VDRL) test for syphilis, and a blood test for calcium, phosphorus, glucose, and galactokinase levels can be checked. Congenital cataract Al-Shifa College of Paramedical Science,Perinthalmanna 7.5K views Lens induced glaucoma, glaucoma after intraocular surgeries Bipin Bista 5K views Lens induced glaucoma KumarSingh44 1.3K views myopia & hypermetropia.pptx In this group of conditions, the central and sometimes paracentral posterior capsule is thin and bulges posteriorly. -iridodenesis/ phacodonesis JAMA Ophthalmol. 7. It is estimated that congenital cataracts are responsible for 5% to 20% of blindness in children worldwide. A small, partial or paracentral cataract can be managed by observation. Surgery is associated with good visual outcomes in most cases. [1] This is a similar rate to a U.K. study which showed 3.18 per 10,000. -Lens aspiration with IOL The prevalence of cataract varies widely with striking. -The critical period for development of fixation reflex is between 6 weeks & 6 months of age. The course and prognosis of pediatric cataracts is highly variable. Dilated examination of the cataract and fundus . (Joseph, E., 2006), - Deposition of pigment on lens Pediatric cataract surgery should only be performed by ophthalmic surgeons who perform them on a weekly or biweekly basis so that they can perform them with a high level of competency.8 For this reason, most large group practices assign only one surgeon in their practice to perform these surgeries.

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