Congenital cataract – types and causes in children

Congenital cataract – types and causes in children

Congenital cataract is a disease in which at birth there is a partial or complete clouding of the natural lens of the eye. Loss of transparency of the lens interferes with the normal development of vision and is fraught with complete loss of vision if left untreated. It can be observed in one or both eyes of the baby.

How to recognize the development of a primary cataract of the eye?

Visual impairment can go unnoticed – after all, children are not able to assess how well they see, because they are still small and they have nothing to compare with. Therefore, it is important to carefully monitor the eyesight of children. Full-term babies should be shown to an ophthalmologist already in the first month of life, then at six months and a year.

  • If you notice clouding or a dot in the pupil area, this is a reason to contact an ophthalmologist;
  • Another call may be strabismus and nystagmus (uncontrolled movements of the eyeballs);
  • At the age of two months, the child should already focus on the faces of familiar people, toys. If this is not the case, the baby turns his head towards the object that he wants to examine or reacts to objects with only one eye – you should also see a specialist as soon as possible to exclude congenital cataracts.

What can cause congenital cataracts?

  • Diseases transferred by the mother during pregnancy (rubella, chickenpox, herpes virus, toxoplasmosis);
  • Lack of folic acid, vitamins A and E;
  • genetic predisposition;
  • Metabolic disorders;
  • Rhesus conflict;
  • Maternal diabetes.

What is congenital cataract in children?

Depending on the location and degree of clouding, ophthalmologists distinguish the following forms of congenital cataract:

  • Capsular . As a rule, with this type of disease, the lens capsule of only one of the eyes becomes cloudy. This type of pathology develops in utero due to adverse effects (antibiotics, viral infections, diabetes);
  • Layered. Usually affects both eyes of the newborn and is localized in the center;
  • Polar. With this form, the lens capsules of both eyes become cloudy, while the disease can progress faster on one of them;
  • Nuclear (central). It is characterized by extensive clouding of the lens nucleus and is caused by a genetic predisposition;
  • Complete, when a child is born completely blind, the lens is completely cloudy, gray spots are visible on the pupils. Accompanied by nystagmus, strabismus, lack of blood vessels on the iris;
  • The complicated form is considered the most severe and develops as a complication after diseases suffered during pregnancy. The child may also have heart failure, hearing impairment, speech problems.

Diagnosis and treatment of congenital cataract in children

Cataracts can sometimes be noticed already during routine ultrasound diagnostics. If all is well, in the second trimester the lens is visible as a dark spot. Of course, at this stage it is impossible to make an accurate diagnosis, but deviations from the norm are a reason to examine the baby and exclude defects.

is impossible to diagnose cataracts in an infant during a simple examination by a pediatrician, so it is imperative to show newborns to an ophthalmologist. The doctor will perform the following examinations:

  • Ophthalmoscopy
  • Biomicroscopy (slit lamp examination) to determine the localization of turbidity, the degree of development of the pathology;
  • Ultrasound of the eyeball to assess the structural features of the eye.

The good news is that congenital cataracts in children can be treated surgically. Opinions of experts about when it is worth resorting to surgery differ. Some do not see the need for it if the clouding of the lens does not interfere with normal vision, while others recommend surgical treatment at the age of 6 to 12 weeks. Concerns may be related to the effect of anesthesia on the child’s body and the risk of complications such as glaucoma. At the same time, it is worth remembering that timely treatment will help to avoid the unpleasant consequences of cataracts – the development of amblyopia (lazy eye syndrome) or irreversible loss of vision.

In cases where the degree of turbidity is insignificant and does not prevent the child from seeing, and the visual system develops normally, the patient is put on a dispensary record, and the dynamics are regularly monitored. If the degree of damage to the lens is significant and affects visual acuity, the question of its removal is raised.

In childhood, lensvitrectomy is most often performed to treat congenital cataracts . This is a non- traumatic operation, which involves the removal of a cloudy lens and part of the vitreous body of the eye. The procedure usually takes no more than a couple of hours and is performed under general anesthesia. After the intervention, the doctor may prescribe eye drops with corticosteroids ( glucocorticosteroids ) and a local antibiotic.

During the recovery period, it is necessary to carefully monitor the condition of the child, go to routine examinations, strictly follow all the doctor’s recommendations and completely eliminate physical activity. All this will help minimize the risk of inflammation, swelling and other side effects.

Treatment of cataracts in children is a long step-by-step process. Children do not install an intraocular lens (IOL, artificial lens) immediately after removal, so spectacle correction will be required before implantation. The fact is that as the eyeball develops and grows, the refraction of the eyeball changes, and because of this it is difficult to choose the appropriate optical power of the IOL. The condition in which there is no lens in the eye is called aphakia. It requires close dynamic observation.

It is believed that the monocular lesion of the lens is less treatable and most often gives complications. Also, cataracts are most often combined with other pathologies of the organ of vision – this directly affects the outcome of therapy. In most cases, the prognosis for timely surgical treatment for primary cataract is positive. Further vision correction guarantees the child a good quality of life without problems with adaptation.

Prevention of congenital cataract

There are no specific measures that could reduce the risk of developing cataracts. General recommendations for expectant mothers are to exclude the use of alcohol, smoking, and to abandon radiation methods of diagnosis and therapy. Women with diabetes need to monitor their sugar levels and see an endocrinologist throughout their pregnancy.

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