Why is clouding of the lens dangerous with congenital cataracts in children? Congenital or acquired cataracts in a child Cloudiness of the lens of the eye in a child
Cataract is clouding of the lens. Unfortunately, it happens that a similar pathology is diagnosed in newborns. The consequence of cataracts is a sharp decrease in vision, which can only be returned to normal values through surgery. Without appropriate treatment, this condition can lead to disability. What are the main symptoms of congenital cataracts, as well as which treatment method is most suitable for children, will be discussed in this article.
Statistics show that congenital cataracts are diagnosed in 0.5% of all newborns every year. In this case, most often the degree of clouding of the lens is such that other treatment methods, except surgery, will not be effective. It happens that the clouding affects only the peripheral area of the lens and does not affect the quality of central vision. In such cases, drug therapy can be used.
Causes of congenital cataracts:
- genetic predisposition (disturbances in the normal formation of protein structure during embryonic development);
- metabolic disorders (including diabetes mellitus);
- the expectant mother's use of certain types of medications (for example, antibiotics);
- intrauterine infection (rubella, measles, cytomegalovirus, chickenpox, herpes simplex and herpes zoster, polio, influenza, Epstein-Barr virus, syphilis, toxoplasmosis and others).
Sometimes congenital cataracts are diagnosed in older children, but the causes of its occurrence remain the same.
There are several types of congenital cataracts, depending on the location of the pathological process in the structure of the lens:
- Anterior polar cataract. Pinpoint opacities are localized in the anterior part of the lens. This type of disease is associated with a genetic predisposition. It is considered a mild form of cataract, since it has virtually no effect on the child’s visual acuity and does not require surgical treatment;
- Posterior polar cataract. In this case, the pathological process is localized in the posterior part of the lens;
- Nuclear cataract. This is the most common type of cataract. Here the clouding is localized in the central part of the lens;
- Layered cataract. This is also a common form of this disease. Cloudiness of the lens is localized in its central part around the transparent or cloudy nucleus. With this pathology, vision may decrease to minimal levels;
- Complete cataract. The cloudiness spreads to all layers of the lens.
The first thing you need to pay attention to is the appearance of a small area of discoloration in the pupil area. During a routine examination, the ophthalmologist may notice the development of strabismus in one or both eyes, as well as nystagmus (uncontrolled periodic movement of the eyeballs).
From about two months old, a newborn baby begins to fixate his gaze on objects and people around him. If this does not happen, then most likely the baby’s vision is significantly reduced. At an older age, you can notice that every time, trying to look at an object, the child tries to turn to it with the same eye.
Without timely treatment, cataracts can cause formation amblyopia (“lazy eye”). Such a violation of visual function in a child inevitably leads to certain problems during development.
Therefore, it is important to undergo all ophthalmological examinations required for a newborn child (especially routine preventive examinations for children under 1 year of age) so that, in the case of such a pathology, effective measures to solve this problem can be taken at an early stage of the development of the disease.
If the degree of clouding in the lens does not have a negative impact on the formation of central vision, then such pathology does not require a radical solution and the child is registered at the dispensary. If the area of opacity in the thickness of the lens is quite extensive and negatively affects central visual acuity, then An ophthalmologist raises the question of surgical removal of cataracts.
Of course, any surgical intervention carries a certain risk of complications associated primarily with the effect of general anesthesia on the child’s body. Also, such manipulation can provoke the development of secondary glaucoma, which is characterized by a persistent increase in intraocular pressure.
It is believed that the most optimal age for surgical removal of congenital cataracts is from 6 weeks after birth to 3 months.
One of the main conditions for the full development of the visual apparatus in a child who has undergone cataract surgery is correct glasses or contact vision correction. If parents and an ophthalmologist come to the conclusion that wearing contact lenses for a particular child is the most acceptable method of correction, in most such cases lenses are prescribed for long-term wear. The increased demand for them is associated with simplified operating rules.
The timing of implantation of an artificial lens, after removal of the clouded one, is set individually for each child, since there is a possibility that the intraocular lens will create additional difficulties during the growth of the eyeball.
It is quite difficult to accurately calculate the optical power of the lens due to the enlarged eyeball and, accordingly, its changing refractive power. But, if you still managed to correctly determine this parameter, then you can avoid the development of postoperative complications, for example, such as aphakia (complete absence of the lens in the eye)
Potential complications after cataract surgery include:
- change in the normal shape of the pupil;
- strabismus;
- increased intraocular pressure;
- secondary cataract;
- retinal damage;
- the development of a severe inflammatory process in any part of the eye.
Strabismus
Such phenomena occur quite rarely, however, if one of the above symptoms appears, another operation is performed to eliminate the defect that has appeared.
To remove a clouded lens in a child, a microsurgical operation is used, which is performed under general anesthesia. Laser correction is not used to treat childhood cataracts.
For some time after the operation, the child will need vision correction, which consists of correctly focusing light rays on the surface of the retina. This can be achieved in several ways:
- constant wearing of glasses;
- constant wearing of contact lenses;
- implantation of an artificial intraocular lens.
Glass correction is the simplest and most affordable way to improve visual acuity in a child with a removed lens. After the operation, you will have to wear glasses constantly, since without them the baby will not be able to clearly see objects and freely navigate in space. Wearing glasses is an ideal method of post-operative correction for children whose cloudy lenses have been removed in both eyes.
An ophthalmologist may prescribe multifocal (allowing you to clearly distinguish between objects at a far, medium and close distance) or bifocal (allowing you to see objects at a distance and near) glasses.
If the baby had surgery on only one eye, the ophthalmologist will most likely prescribe implantation of an artificial intraocular lens or contact correction. So-called “breathable” contact lenses are quite popular. They have powerful optical power and remain invisible when worn.
To select the correct lenses, you must consult an ophthalmologist., who will determine the exact parameters of the lenses and help you choose the model that is best suited for your child. In addition, he must explain in detail and show how to properly put on and remove lenses, as well as talk about other nuances of using these optical products, since the child will have to wear them constantly.
As your baby gets older, he will need to replace his contact lenses.
An artificial intraocular lens can be implanted during the operation itself to remove the cloudy natural lens or some time after it. It must fully compensate for the refractive function of the natural lens.
The artificial intraocular lens has a fairly powerful refractive power, due to which it does not require replacement as the eyeball grows.
To see what cataracts are like in children, see the following video.
Source: http://www.o-krohe.ru/zrenie/vrozhdennaya-katarakta/
Congenital cataract
Congenital cataract– partial or complete clouding of the lens of the eye that develops in utero. It manifests itself to varying degrees from the moment the child is born: from a barely noticeable whitish spot to a completely affected lens.
Congenital cataracts are characterized by decreased vision or its complete loss; children also experience strabismus and nystagmus. Primary diagnosis is carried out prenatally, after birth the diagnosis is confirmed by ophthalmoscopy and slit biomicroscopy.
Surgical treatment is indicated; Lensvitrectomy is performed in the first months of life in uncomplicated cases.
Congenital cataract is a pathology of the organ of vision, often encountered in the clinic of many childhood diseases. In 36% of cases it occurs as a result of intrauterine infections. The overall incidence of congenital cataracts in the population is 1-9 cases per 10,000 births. The share of this disease among all visual defects is 60%.
No gender differences in incidence have been found, with the exception of genetic mutations, which are more common in boys, while girls often remain asymptomatic carriers of the altered gene. Currently, the problem of congenital cataracts in pediatrics is receiving special attention. The disease is caused by many reasons, so the efforts of doctors are aimed at prevention and early diagnosis of cataracts.
Methods of surgical treatment are being improved. All measures are aimed at preserving the child’s vision for better social adaptation.
Causes of congenital cataracts
Most often, congenital cataracts accompany the group of TORCH infections, which includes rubella, toxoplasmosis, herpes virus and cytomegalovirus infection. However, it is not the only symptom. Each disease has its own special symptoms.
The second most common cause of congenital cataracts is metabolic disorders in a child: galactosemia, Wilson's disease, hypocalcemia, diabetes mellitus and others. Rarely, the disease occurs in connection with genetic mutations of the autosomal dominant and autosomal recessive type.
Mutations linked to the X chromosome are even less common.
In the case of chromosomal pathologies (Down syndrome, cry-the-cat syndrome, punctate chondrodysplasia, Hallerman-Streiff-Francois syndrome, etc.), congenital cataracts are also not the only symptom.
As a rule, it is accompanied by disorders of physical and mental development and other manifestations specific to a particular nosology.
Exogenously affecting causes of the disease can be antibiotic therapy of a pregnant woman, steroid hormone therapy, radiation therapy and the influence of other teratogenic factors. Separately, congenital cataracts of prematurity are distinguished.
Lens opacification occurs through one of two mechanisms. Firstly, the organ of vision is initially incorrect. It is typical for intrauterine infections in the early stages of pregnancy, chromosomal pathologies and, in general, any teratogenic effect if it occurs in the first weeks of pregnancy, when the fetus’s visual organ system is formed.
The second mechanism is damage to the already formed lens. Often occurs with metabolic disorders (galactosemia, diabetes mellitus, etc.), exposure to external damaging factors during pregnancy (second-third trimester).
In any case, the structure of the lens protein changes, due to which it gradually becomes hydrated and then loses its transparency, as a result of which congenital cataracts develop.
The disease is divided into types depending on the location of the clouding zone and its extent. The following types of cataracts are distinguished: capsular, polar (anterior and posterior), layered (membranous), nuclear, complete.
Capsular congenital cataract is a decrease in the transparency of the anterior or posterior capsule of the lens. The lens itself is not affected. Visual impairment is often minor, but blindness also occurs if the damage to the capsule is extensive, or if both the anterior and posterior capsules are affected simultaneously.
With polar cataracts, changes affect the anterior or posterior surface of the lens. The capsule is most often also involved in the process. This species is characterized by bilateral lesions. The degree of visual impairment varies greatly.
Layered cataract is clouding of one or more central layers of the lens. The most common type of congenital cataract is usually bilateral. Vision is usually significantly reduced.
Nuclear cataracts are cloudiness of the central part of the lens - its nucleus. This type occurs in all hereditary causes of the disease. The lesion is bilateral, vision is reduced until complete blindness.
Complete congenital cataracts are characterized by clouding of the entire lens. The degree of clouding varies, but more often this form of the disease completely deprives the child of vision. The defeat is two-sided.
By origin, congenital cataracts are divided into hereditary and intrauterine. The first of them is transmitted to the child from one of the parents, the second develops in the fetus directly during pregnancy. Cataracts of complex shape are considered atypical (polymorphic).
There are unilateral and bilateral cataracts, and the disease is classified according to the degree of vision loss (classified as I-III degrees).
Some classifications separately designate a complicated form of cataract, but this can be called any clouding of the lens, accompanied by diseases of other organs.
The main symptom is clouding of the lens of varying degrees. In the clinical picture, it may appear as a noticeable white spot on the background of the iris, but more often there are cases of congenital cataracts when this sign is absent. With a unilateral lesion, strabismus is noted, usually converging.
Sometimes, instead, pathological rhythmic trembling of the eyeball is detected. Almost all children with bilateral congenital cataracts have nystagmus.
At about two months of age, healthy children can already follow an object with their eyes, but with illness this does not happen, or the baby always turns towards the object only with the healthy eye.
Diagnosis of congenital cataracts
Primary diagnosis is carried out during routine ultrasound screening of pregnant women. Already in the second trimester, the lens is visualized on ultrasound as a dark spot (normal). There are cases when the second ultrasound still cannot reliably exclude or confirm the diagnosis, and then this can be done in the third trimester. It is important to understand that at this stage the diagnosis cannot be 100% confirmed, but the disease can be suspected, and statistics show that the method is highly reliable.
After the birth of the child, the pediatrician will only be able to notice intense clouding of the central lens. Most often, cataracts cannot be diagnosed by physical examination. An examination by a pediatric ophthalmologist is mandatory for all newborns.
A specialist will be able to suspect and confirm the diagnosis of congenital cataracts by noticing even a slight impairment in the passage of light through the lens. The doctor will also detect strabismus and nystagmus.
Since congenital cataracts accompany many intrauterine infections, metabolic disorders, and chromosomal pathologies, when diagnosing these diseases, the child will be examined to exclude eye defects.
To diagnose congenital cataracts, the following instrumental methods are used: ophthalmoscopy, slit biomicroscopy, ultrasound of the eyeball. All of them make it possible to verify changes in the transparency of the lens and exclude clinically similar diseases.
In particular, retinopathy in children is also characterized by blurred vision and strabismus, but in this case the cause is damage to the retina, and examination with an ophthalmoscope will allow this to be determined. Tumors of the outer part of the eye can significantly reduce vision, as can congenital cataracts.
Visual examination, ophthalmoscopy, ultrasound and x-ray diagnostic methods help to differentiate them.
Treatment of congenital cataracts
Conservative treatment methods are justified only for slight clouding of the lens. Cytoprotectors and vitamins are used in therapy. However, most often congenital cataracts are treated surgically.
Surgical removal should be performed as early as possible to ensure proper development of the eyes. Cataract surgery - lensvitrectomy - is considered the least traumatic in childhood, and therefore is performed most often.
The condition after removal of the lens is called aphakia and requires long-term follow-up and vision correction.
Aphakia is corrected with glasses or contact or intraocular lenses. Observation by an ophthalmologist is necessary to exclude possible postoperative complications, in particular glaucoma. Several decades ago, the list of complications was more extensive, but with the introduction of lensvitrectomy, most of them were reduced to a minimum. Thus, cases of retinal detachment, corneal edema, endophthalmitis and amblyopia are extremely rare.
Forecast and prevention of congenital cataracts
Modern methods of surgical treatment provide a favorable prognosis in most cases. Removal of the affected lens before the age of six months (preferably in the first weeks and months) and further vision correction contribute to good social adaptation of children in adulthood.
It is worth noting that monocular congenital cataracts are much less treatable and currently produce the greatest number of all complications associated with this disease.
In addition, cataracts are extremely rare in isolation, so the prognosis is also determined by concomitant diseases: infections, metabolic disorders, chromosomal pathologies, etc.
Prevention of congenital cataracts is carried out during pregnancy. It is necessary to exclude a woman’s contact with infectious patients, to minimize the impact of teratogenic factors (alcohol, smoking, radiation methods of diagnosis and therapy, etc.).
Women suffering from diabetes are advised to be monitored by an endocrinologist throughout pregnancy. Chromosomal pathologies in most cases are diagnosed before childbirth, and then the woman can decide to terminate the pregnancy or deliberately carry the child to term.
There is no specific prevention of congenital cataracts.
Source: http://www.krasotaimedicina.ru/diseases/children/congenital-cataract
Causes of development and methods of treatment of congenital cataracts in children
Congenital cataract is a clouding of the lens that occurs in a newborn child. However, quite often this pathology is not detected immediately, but after a time after a detailed examination.
If any signs appear that indicate cataracts in a child, you should seek help from an ophthalmologist.
The lens of a healthy child is a transparent biconvex lens, which is a refractive medium. There is no innervation or blood supply, and nutrition is provided due to the watery structure of the organ of vision.
There are factors that lead to disruption of the protein composition of the lens fibers, as a result of which it loses its transparency.
According to statistics, this disease is diagnosed in one newborn child out of two thousand. Moreover, the defeat is usually one-sided.
Classification
This pathology has quite a few varieties, each of which has certain characteristics:
Capsular cataract- This is an isolated lesion of the posterior or anterior lens capsule. In such a situation, vision may be slightly blurred or completely absent - it all depends on the area of the lesion. The development of this pathology is caused by metabolic disorders in the mother’s body or inflammation during intrauterine development.
Polar cataract– damage not only to the capsule, but also to the surface of the lens. As a rule, this form of pathology is characterized by bilateral damage. The quality of vision is affected by the intensity and area of the lesion.
Layered cataract– damage to the central region of the lens. This form of the disease is the most common; its danger is that the child almost completely loses his vision. The main reason for the development of pathology lies in hereditary predisposition.
Complete cataract– this pathology develops in both eyes at once, and it is characterized by such a strong degree of clouding that, as a rule, children are born blind. In addition, complete cataracts are accompanied by other eye diseases - strabismus, macular hypoplasia.
Complicated cataract– this disease is a consequence of infection with viral or bacterial infections in the early stages of pregnancy. In this case, two eyes are affected at once, and other diseases are almost always present. Moreover, concomitant pathologies do not necessarily affect the eyes specifically - disorders can affect the hearing organs, speech apparatus, heart or nervous system.
Reasons for the development of the disease
There is a whole group of risk factors that increase the risk of developing congenital cataracts:
Genetic predisposition - this disease can be inherited in an autosomal dominant manner.
Metabolic disorders– hypocalcemia, myotonic dystrophy, diabetes mellitus.
Genetically determined pathologies in a child - this may be Down, Lowe or Marfan syndrome.
Intrauterine infectious diseases– the development of congenital cataracts is often provoked by syphilis, rubella, toxoplasmosis, herpes, and chickenpox.
Intrauterine inflammatory processes of the organs of vision - for example, iritis.
Diagnosis at an early stage
Diagnosis of this disease begins with a visit to an ophthalmologist. In order to promptly identify pathology, you need to know what symptoms it is accompanied by:
- clouding of the pupil;
- lack of gaze fixation at the age of two months;
- strabismus;
- viewing objects with one eye;
- nystagmus;
- Severe amblyopia is blindness associated with lack of treatment.
In addition, the pediatric ophthalmologist must conduct the following types of studies that will help detect the disease:
- Ophthalmoscopy.
- Optical coherence tomography.
- Slit biomicroscopy.
- Echoophthalmoscopy - ultrasound of the eyeball.
Features of surgical treatment
There are various approaches to the treatment of congenital cataracts.
- If it negatively affects central visual acuity, the cataract should be removed as soon as possible.
- If the location of the opacity does not affect the clarity of central vision, such a cataract does not require surgical treatment, but requires dynamic monitoring.
Moreover, the operation is also associated with the threat of complications – in particular, increased intraocular pressure. General anesthesia used for surgery is also a risk factor.
Many doctors claim that The appropriate age of a child for surgical correction is from 6 weeks to 3 months. Today there are several types of interventions:
- extracapsular cataract extraction;
- cryoextraction;
- intracapsular cataract extraction;
- phacoemulsification.
Rehabilitation and development of vision in children
After surgery, it is very important to carry out special treatment to ensure the baby’s visual perception. Thanks to this it will be possible maximize his visual acuity.
After cataract removal, the condition in which the lens is missing from the eye is called aphakia. It is determined by the trembling of the iris and the deep anterior chamber. This condition needs correction, which is carried out through positive lenses.
For this the following can be used:
- Contact lenses are indicated for children under two years of age.
- Glasses – used for bilateral pathology in older people.
- Epikeratoplasty is indicated for the correction of aphakia.
- Intraocular lens implantation is the least suitable method for young children. But for older children it is used quite often.
Congenital cataracts are an extremely serious disorder that can cause deterioration or even loss of vision. To prevent this from happening, it is important to identify the disease in a timely manner and take measures to eliminate it.
Sometimes it is impossible to do without surgery. If such a need arises, priority attention should be paid to postoperative rehabilitation.
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Source: http://www.help-eyes.ru/zabolevanie/katarakta/ktr-vrozhdennaja-u-detej.html
Cataracts in children under one year of age and older (congenital, etc.): causes, symptoms, treatment, etc.
Vision plays a very important role in the processes of learning and adaptation in the world around us; for a child it is an extremely valuable mechanism for development.
Unfortunately, many eye diseases have become much younger; experts attribute this to the deterioration of environmental conditions, the unhealthy lifestyle that many people lead, and high stress due to constant contact with phones and computers.
During a visit to the doctor, the diagnosis of “cataract” puts many parents in a state of shock, all because of the fear that the child may forever lose the joy of seeing the world around him in all its colors.
Such fears often turn out to be groundless - modern technologies make it possible to slow down the destructive processes occurring in the organ, but this is subject to timely seeking help. In infants, this disease is extremely rare - only a few cases per 10 thousand newborns, but under the influence of certain factors, the disease can develop at any age as an acquired pathology.
Congenital cataract: causes and symptoms
Many people mistakenly believe that cataracts are the formation of a film on the lens, which interferes with the normal perception of surrounding objects through vision.
In fact, the disease is not located outside, but inside the eye, that is, cataract is a clouding of the substance in the lens, which prevents the normal passage of light.
A healthy lens is completely transparent, but clouding causes a decrease in visual acuity and, without appropriate treatment, can lead to its complete loss.
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Lens opacities- cataracts, accompanied by a decrease in visual acuity from a slight weakening to light perception. There are congenital and acquired - complicated (sequential) and traumatic.
Congenital cataracts are relatively rare: 5 cases per 100,000 children, according to E.I. Kovalevsky and E.G. Sidorov (1968), however, they account for about 10% of cataracts of various etiologies. Among the causes of blindness in children, congenital cataracts account for 13.2-24.1%, among the causes of low vision - 12.1-13.4%.
Etiology and pathogenesis
Congenital cataracts can be hereditary or arise due to the influence of various teratogenic factors on the lens of the embryo or fetus in the prenatal period.Hereditary cataracts are the result of gene, genomic and chromosomal mutations. They are most often inherited in an autosomal dominant manner, less often in an autosomal recessive manner. Sex-linked recessive inheritance can be observed, when predominantly men are affected, or dominant inheritance, in which women are affected. Hereditary forms account for 25-33% of congenital cataracts and often occur in several members of the same family.
According to A.V. Khvatova et al. (1985), 16% of patients with hereditary cataracts had syndromes in which clouding of the lenses was one of the symptoms of genetically determined metabolic disorders. Cataracts can occur due to disturbances in carbohydrate metabolism. Thus, congenital cataracts are an early sign of galactosemia, in which the synthesis of the enzyme galactose-1-phosphate uridine transferase, contained in red blood cells and the lens, is impaired.
In addition to cataracts, which usually develop in the first half of life, this disease causes jaundice, hepatosplenomegaly, liver cirrhosis, mental retardation, etc. The occurrence of pathological symptoms in galactosemia can be prevented by promptly eliminating milk and dairy products from the child’s diet. With early implementation of these measures in the initial period of cataract development (in children under 3 months), lens opacification may regress.
With hypoglycemia, cataracts usually occur in the 2-3rd month of life. Cloudiness of the lens is observed in 1-4% of patients with diabetes, which usually develops between the ages of 6 and 13 years, but also occurs in young children, even infants. Cataracts in diabetes progress rapidly, which indicates a severe course of the disease. Cloudiness of the lens, along with clouding of the cornea, damage to the optic nerve, and strabismus, is one of the symptoms of mannosidosis, a metabolic disorder associated with a deficiency of active acid mannosidase A and B. The disease is characterized by multiple dysostoses, hearing loss, hepatosplenomegaly, delayed psychomotor development, etc.
In cases of calcium metabolism disorders, the so-called tetanic cataract (usually zonular), tetany, spasmophilia, rickets, and renal failure may be observed simultaneously. Treatment started at an early stage of the disease (intravenous injections of 5-10% calcium chloride solution, thyroid medications) can stop the development of lens opacification.
Cataracts are one of the symptoms of hereditary changes in connective tissue and abnormalities of the skeletal system. Together with other ocular and general somatic manifestations, it is observed in Marfan and Marchesani syndromes. Cataract is one of the constant symptoms of congenital chondrodystrophy, characterized by slowing of the epiphyseal growth of long bones with normal periosteal growth, which leads to shortening and thickening of the bones.
Cloudiness of the lens is often observed in Apert syndrome, the signs of which are a “tower” skull, syndactyly, polydactyly, hypoplasia of the upper jaw, heart disease, mental retardation, flattening of the orbits, exophthalmos, divergent strabismus, nystagmus, damage to the optic nerve (congestive discs, atrophy), Colobomas of the choroid, retinal damage. Congenital or developing in the first year of life, cataracts are often found in Conradie syndrome, characterized by disproportionate dwarfism, finger abnormalities, scoliosis, and damage to the ligaments of the joints.
Cloudiness of the lens in hereditary skin lesions is explained by the fact that it is a derivative of the ectoderm. Cataracts develop with Rothmund syndrome, characterized by dermatosis, hypogenitalism, as well as congenital ichthyosis, which is a combination of hyperkeratosis with damage to the organ of vision. With Schaefer syndrome, along with follicular keratosis of the skin, foci of baldness, microcephaly, dwarfism, hypogenitalism, and mental retardation, congenital cataracts are observed.
Cloudiness of the lens is also typical for infantile pigmentous dermatosis Bloch-Sulzberger, in which skin pigmentation, baldness, dental anomaly, and other eye lesions are noted - optic nerve atrophy, strabismus, nystagmus. Congenital cataract, together with microphthalmos, heterochromia, ectopia of the pupil, corneal opacities, color blindness, is observed in constitutional spherical cell hemolytic anemia, the general somatic manifestations of which are hemolytic jaundice, splenomegaly, bone abnormalities, impaired skin pigmentation, otosclerosis, polydactyly, etc.
Of the chromosomal diseases affecting the lens, the most common is Down's disease, which is caused by trisomy of chromosome 21 and is observed mainly in children of middle-aged mothers. This disease causes severe impairment of physical and mental development.
Characteristic signs of Down's disease are idiocy or imbecility, micro- and brachycephaly, a wide sunken bridge of the nose, a “geographical” tongue, underdevelopment of the upper jaw, short stature or acromegaly, hypothyroidism, ichthyosis, keratosis, alopecia, hypogenitalism, syndactyly, polydactyly, congenital heart disease and other anomalies. About half of the patients die, mainly in the first year of life due to their body’s reduced resistance to infections, some live to a ripe old age. Ocular manifestations of Down's disease include epicanthus, nystagmus, strabismus, and corneal opacity; Cataracts occur in 15-50% of patients.
Chromosomal diseases that cause cataracts and other eye abnormalities include: Marinescu-Sjögren syndrome, characterized by congenital cerebellar spinal ataxia, delayed physical and mental development, dwarfism; Shereshevsky-Turner-Bonnevie-Ulrich syndrome (pterygium neck syndrome); Lowe's syndrome; Norrie's disease.
There are numerous other syndromes, one of the manifestations of which is congenital cataract: Axenfeld, Alport, Cockayne, Rieger, etc. Cataracts have been described in the syndromes of Martin-Albright, Bassen Kornzweig, Knapp-Comrover, Sabouraud, etc.
Most congenital cataracts arise as a result of disturbances in intrauterine development due to the influence of various unfavorable factors (physical, chemical, biological) of both the external and internal environment on the lens of the embryo or fetus. These can be various intoxications (alcohol, ether, some contraceptives and abortifacients, sleeping pills), ionizing radiation, hypovitaminosis (deficiency of vitamins A, E, folic and pantothenic acids), Rh incompatibility of mother and fetus, oxygen starvation of the fetus due to circulatory disorders and etc.
The cause of the development of congenital cataracts, as well as other anomalies, can be various diseases of the mother during pregnancy: cardiovascular (for example, rheumatic heart defects with circulatory failure), endocrine disorders, etc. Of particular importance are infectious diseases caused by bacteria, protozoa (Toxoplasma), viruses. Most viruses are able to penetrate the placental barrier and infect the embryo and fetus, causing the development of cataracts and other anomalies that can occur with rubella, cytomegaly, chickenpox, herpes, and influenza. Infectious diseases of the mother during pregnancy, in particular rubella, often occur without characteristic symptoms, which subsequently complicates the etiological diagnosis of cataracts.
Depending on the time of exposure to the teratogenic factor, the nature and degree of its influence on the organ of vision of the embryo and fetus, various forms of cataracts and accompanying changes in the organ of vision arise. The most dangerous period of exposure to teratogenic factors on the organ of vision is the 3rd-7th week of pregnancy.
Clinical features of congenital cataracts. The clinical picture of congenital cataracts is characterized by significant variability depending on the intensity, shape and location of lens opacification, as well as the presence or absence of other eye defects (Table 24, Fig. 105).
Rice. 105. Scheme of various forms of congenital cataracts: 1 - complete; 2 - semi-resolved; 3 - central; 4 - zonular; 5 - spindle-shaped; 6 - anterior and posterior polar; 7 - pyramidal
Table 24. Classification of congenital cataracts
Complete (diffuse) cataract is characterized by total opacification of the lens, the shape and size of which are preserved (Fig. 106). The reflex from the fundus of the eye is absent both with a narrow and dilated pupil. Vision is reduced to light perception. A type of complete cataract is the so-called milky cataract, the peculiarity of which is the liquefaction of the clouded substance of the lens.
Zonular cataract is a partial opacification of the lens in the form of separate layers (or layers) located between the embryonic nucleus and the cortical layers (Fig. 107), the rest of the lens is transparent, sometimes two or three layers of opacification are observed, separated by the transparent substance of the lens. The opacities have the shape of a disk of various diameters (usually 3-9 mm) with clear, even edges. Along the equator, the disk is usually surrounded by so-called riders - opacities of the perinuclear zone, shaped like a loop or hook. Their number varies.
Rice. 107. Zonular cataract
When illuminated from the side, a layered cataract appears as a gray disc. When examined in transmitted light, against the background of a pink-red reflex, a dark disk of opacification is visible from the fundus. With its relatively small size, through the transparent periphery of the lens, it is possible to examine the fundus of the eye and even study refraction. Visual acuity in zonular cataracts, depending on the size of the disc and the intensity of the clouding, as well as the severity of the accompanying changes in the organ of vision, ranges from several hundredths to several tenths, reaching in some cases 0.3-0.5. When the pupil dilates, visual acuity usually increases.
Nuclear (central) cataract is characterized by opacification of the embryonic nucleus of the lens, the transparency of the remaining parts of which is preserved. When illuminated from the side, the cataract looks like a small gray disc in the center of the lens; in transmitted light, against the background of a pink-red reflex from the fundus, a central dark disc is visible. Visual acuity is significantly reduced, but may increase with pupil dilation.
Semi-resolved cataract manifests itself in a decrease in the volume of the lens due to its partial spontaneous resorption, which occurs in the prenatal or postnatal period. Semi-resolved cataract is most often formed from a complete cataract and is a diffuse opacification of the flattened lens (its anteroposterior size is reduced with a normal diameter), accompanied by a decrease in vision to light perception.
In cases of the formation of semi-resolved cataracts from zonular ones, destruction of the transparent zone is observed; at the same time, formal vision may be preserved, which decreases as the process of lens resorption progresses.
Membranous cataract is a flat membrane consisting of an opacified anterior capsule (often with fibrous deposits on it) and a posterior capsule of the lens, between which there may be remnants of the lens substance. Cataracts are formed as a result of intrauterine or postnatal resorption of the lens substance or are an anomaly in the development of the lens.
Membranous cataracts can be of varying densities, often of uneven thickness. The reflex from the fundus of the eye is often absent, in some cases it is faintly pink (through thinned areas of the cataract). Vision is usually reduced to light perception or a few hundredths.
Atypical (polymorphic) cataract characterized by partial clouding of the lens of various shapes, locations and sizes (Fig. 108). Depending on this, vision is reduced to varying degrees. Cataracts can be lenticular or capsulolenticular.
Rice. 108. Atypical (polymorphic) cataracts (a, b)
Polar cataract- limited capsulolenticular opacification at the anterior (anterior polar cataract) or posterior (posterior polar cataract) pole of the lens. This localization of opacification is explained by the fact that the poles at which the seams of the lens meet are the places of least resistance. The formation of anterior polar cataract is associated with the presence of remnants of the pupillary membrane and a disruption in the process of detachment of the lens vesicle from the outer ectoderm in the early period of embryonic development.
In the pathogenesis of posterior polar cataract, importance is attached to the weakness of the lens capsule at the posterior pole, due to which its rupture may occur, accompanied by protrusion and limited opacification of the lens substance, as well as penetration of mesenchymal elements through the rupture. Capsular ruptures can occur due to posterior traction during the process of reverse development of the vitreous artery.
Polar cataract (anterior or posterior) is a round, dense or layered whitish-gray opacification of the capsule and adjacent layers of the lens. In transmitted light, against the background of a pink-red reflex, a round, dark, usually slight turbidity is visible from the fundus.
Posterior polar cataract should be differentiated from false cataract, which is the remnants of a reduced vitreous artery and vitreous (cloquet) canal. False cataracts are typically located medial to the posterior pole and the opacities are located on the posterior capsule on the outside of the lens, whereas in polar cataracts they fit into the lens bevel.
Polar cataracts either do not affect visual acuity or do not significantly reduce it. With unilateral congenital cataracts, obstructive amblyopia may develop; in these cases, visual acuity does not correspond to the amount of opacification.
A type of anterior polar cataract is: pyramidal cataract, in which a homogeneous or layered opacification has the shape of a cone facing the anterior chamber.
Anterior and posterior capsulolenticular opacities can be connected by fusiform opacities, resulting in the formation of a fusiform cataract, in which visual acuity is reduced more significantly than with polar cataracts, but, as a rule, remains at a fairly high level.
There are a large number of other forms of congenital cataracts with partial, limited opacities, which usually do not affect visual acuity (or do not significantly reduce it); they are usually detected during routine examinations. These cataracts include coronary (coronary), characterized by numerous limited opacities, greenish-bluish in color, which are located in the middle and deep layers along the periphery of the lens like a wreath. With anterior axial embryonic cataract, there is clouding of the lens near its anteroposterior axis in the region of the anterior upsilon-shaped suture of the embryonic nucleus.
Suture star cataract is characterized by opacification in the area of the anterior or posterior sutures of the lens. Multiple very small opacities of a grayish-blue color, diffusely scattered in the region of the embryonic nucleus, are observed with punctate cataracts. Nuclear powder cataract is characterized by diffuse opacification of the embryonic nucleus, consisting of dust-like elements.
Congenital cataracts are relatively rarely an isolated lesion of the lens; they are often combined with other pathological changes in the organ of vision, as well as other organs and systems of the child’s body. Various visual defects are observed in 36.8-77.3% of children with congenital cataracts: strabismus, nystagmus, microphthalmos, microcornea, pathology of the cornea, vitreous body, retina and optic nerve.
Strabismus is observed in a large number of children (up to 83%) with congenital cataracts. In some cases, it can be a complication of cataracts, a consequence of a sharp decrease in vision and profound disturbances in the sensory-motor connections of the visual analyzer. In others, strabismus is a congenital pathology accompanying cataracts. Strabismus with congenital cataracts is often converging, alternating, and predominantly permanent. The angle of deviation of the eye varies from 5 to 60%, most often 15-20°.
Nystagmus, observed in children with congenital cataracts, can be congenital or acquired, associated with a sharp decrease in vision. Pendulum-like and mixed type nystagmus is more common, jerk-like is less common, it is predominantly horizontal, small-caliber. Most often, nystagmus is observed in complete, membranous cataracts, combined with other defects of the organ of vision, such as microphthalmos, microcornea, etc.
Microphthalmos, characterized by a decrease in the size of the eyeball and functional inferiority of the organ of vision, is observed in children with congenital cataracts. The causes of congenital microphthalmia can be hereditary genetic factors, as well as intrauterine inflammatory and degenerative processes that retard the growth of the eyeball. The degree of reduction of the eye varies. With microphthalmia, other malformations of the eye may be observed: colobomas of the vascular tract and optic nerve, macular aplasia, etc.
Microcornea or small cornea, in most cases, is noted with microphthalmia, but can also occur independently. With congenital cataracts, other corneal anomalies may be observed: opacities, dermoid cysts, megalocornea.
Congenital cataracts are often combined with various changes in the vitreous body, in particular with its opacities of varying severity - from small to severe fibrous. A common finding is the remains of an incompletely reduced vitreous artery.
Anomalies of the choroid in congenital cataracts are colobomas of the iris and choroid, polycoria, and pupil displacement. Hypoplasia and aplasia of the dilator, hypoplasia of the iris are often observed. Less common is dysgenesis of the iris and cornea, the manifestations of which are posterior embryotoxon, hyaline films and thickenings on the posterior surface of the cornea, and peripheral anterior adhesions.
Fundus changes detected after removal of congenital cataracts include partial atrophy of the optic nerve, myelin fibers, chorioretinal lesions, macular hypoplasia, retinal dystrophy, pigment redistribution, etc.
Obscurational amblyopia, or more precisely, underdevelopment of the visual analyzer as a result of the absence of a light stimulus to the retina, is a severe complication of congenital lens opacities, which is the most common cause of low visual acuity after cataract removal and the discrepancy between the functional results and the optical effect of the operation.
The most severe obscurational amblyopia develops with complete (diffuse) lens opacities. In order to prevent damage to the visual analyzer, a method has been proposed that consists of permanent dilation of the pupils with the help of mydriatics and subsequent irritation of the eyes with light stimuli. These manipulations should be performed in the first 6 months of life, if surgery (cataract extraction) has not been performed by this time.
Treatment
Treatment of congenital cataracts is surgical. Most authors recommend removing congenital cataracts when visual acuity is below 0.3. After cataract extraction, correction of aphakia, pleoptic and, if indicated, ortopic treatment are carried out, measures aimed at eliminating strabismus, and treating nystagmus.The question of the timing of removal of congenital cataracts is decided individually based on the clinical form of the cataract, residual visual acuity, etiology of the cataract, and the general condition of the child. Due to the danger of obscuration (deprivation) amblyopia with long-term existence of congenital cataracts, as well as the need to increase visual acuity, in order for the child to develop, it is advisable to perform the operation in the early stages.
According to most authors who have studied changes in the visual analyzer under conditions of deprivation, the sensitive period of vision development occurs in the period from the 2nd to the 6th month of a child’s life. In this regard, this age is optimal for the removal of congenital cataracts in children if there are indications for early surgery.
Early surgery is indicated for: 1) complete, semi-resolved, membranous cataracts; 2) zonular, central, atypical cataracts with an opacification diameter of more than 3 mm, when retinoscopy cannot be performed under conditions of mydriasis; 3) the presence of a rigid pupil in all forms of congenital cataracts due to the fact that in these cases it is impossible to achieve mydriasis necessary for preoperative measures to prevent amblyopia and retinal underdevelopment; 4) the appearance of nystagmus in any form of cataract, which indicates a violation of the development of the oculomotor reflex.
Early surgery is not indicated for zonular cataracts with a disk of opacification less than 3 mm, in which retinoscopy can be performed due to the presence in these cases, as a rule, of relatively high residual visual acuity and the absence of the risk of developing severe amblyopia. In such patients, surgery can be performed at a later period.
It should be borne in mind that with congenital cataracts, the development of which is associated with intrauterine infection (rubella, etc.), complications (iridocyclitis) may occur after early surgery.
Unilateral congenital cataracts should be removed at almost the same time as bilateral ones.
For any form of cataract, surgery should be postponed in cases where there are general contraindications to surgery and anesthesia (acute infections, chronic diseases in the acute stage and decompensation, the presence of foci of focal infection, allergic status, enlarged thymus gland, etc.). The operation in these cases is carried out after treatment with the permission of the relevant specialists. For cataracts, the origin of which is associated with hereditary metabolic disorders (galactosemia, homocystinuria, etc.), corrective treatment must be carried out before surgery.
Contraindications to removal of congenital cataracts there may be extensive inoperable retinal detachment, severe fibrosis of the vitreous body in combination with damage to the retina, etc. However, indications and contraindications for surgery in these cases are established individually based on the results of a clinical and functional study of the organ of vision.
Due to age-related characteristics (strength of the ligamentous apparatus of the lens), the extracapsular method is used to remove cataracts in children. Intracapsular extraction in childhood is not used due to the high traumatic nature of the operation and the possibility of developing severe complications due to the strength of the fibers of the ciliary girdle and the hyaloid-capsular ligament, the close connection between the posterior capsule of the lens and the anterior limiting membrane of the vitreous body. The use of zonulolytic agents to dissolve ciliary girdle fibers in children is not recommended.
One of the oldest methods of treating congenital cataracts- discretion. The principle of the operation is to dissect the anterior capsule of the lens with a discision needle, as a result of which the lens substance comes out into the anterior chamber, swells and resolves. The disadvantages of the method are the frequent complications associated with leaving the lens substance in the eye: the formation of secondary cataracts, secondary glaucoma, phacogenic iridocyclitis, as well as the slow resorption of cataracts, and therefore the visual effect of the operation appears after several months, during which conditions for increasing obscuration amblyopia.
Due to these disadvantages, discision is not currently used for soft cataracts. A two-stage operation, in which discision is first performed, and after 2-3 weeks, when swelling of the lens substance occurs, it is removed or aspirated, is also not without these disadvantages, and therefore cannot be recommended.
For zonular cataracts with a small (no more than 5.0-5.5 mm) disk of opacification and a significant increase in visual acuity when dilating the pupil using mydriatic means, an optical iridectomy is performed, the advantage of which is the preservation of accommodation. However, the method has a number of significant disadvantages: vision is not fully restored due to the persistence of an optical obstacle in the form of central clouding of the lens, the shape of the pupil changes, so it is not advisable to use it.
For congenital cataracts, various modifications of extracapsular (linear) extraction are used. The principle of the operation is the extracapsular removal of cataracts through a small (2.5-3.0 mm) incision in the cornea.
In the surgical treatment of congenital cataracts, they are widely used. aspiration method. The principle of the operation is to suction the lens substance. The advantage of aspiration is the ability to remove congenital cataracts through a small incision (1.5-2.0 mm), which ensures the safety of the method. With a cystotome inserted into the anterior chamber through an incision in the cornea, limbus, or in the limbus under the conjunctival flap, the anterior capsule of the lens is opened, the substance of which is sucked out through a cannula connected to a syringe.
It is advisable to use aspiration-irrigation technique, which ensures greater efficiency and less traumatic operation. Thanks to the irrigation of liquid carried out simultaneously with aspiration (most often isotonic sodium chloride solution), a constant depth of the anterior chamber is maintained, and therefore the possibility of injury to the endothelium of the cornea and iris by instruments is eliminated.
Vision plays a vital role in the development of a child from the first days. The eyes, along with other sense organs, are one of the channels for the every second receipt of information about the world around us. Images of people, objects and the environment around the child are necessary for the process of mental formation. Accordingly, any visual impairment negatively affects the formation of reactions, prevents full contacts with loved ones, and inhibits the development of cognitive functions.
Most often, visual impairment in childhood is caused by genetic predisposition or infection during fetal development. In this case, the pathology is detected at birth. If blindness or partial loss of vision due to cataracts is diagnosed, there is still a chance for surgical treatment. And although surgery for congenital lens opacification in most cases does not lead to complete restoration of vision, significant improvement is still possible - therefore, as a rule, the ophthalmologist recommends microsurgical intervention. In early childhood, even partial restoration of vision in combination with adequate developmental techniques allows the child to fully develop.
The structure of the eye has a complex structure. The optical properties of its elements are such that incoming light rays are first refracted and then focused by the lens on the retina. Any disruption of these physical processes makes vision blurry. If the lens of the eye loses its transparency and elasticity, light rays are refracted at incorrect angles and/or focused in front of or behind the desired point. In this case (when the reason is precisely a change in the optical properties of the lens), cataract is diagnosed - a disease that does not develop back and is subject only to surgical treatment.
Types of lens opacities in children
In childhood, as in adults, there are two types of cataracts: partial and complete. Already at the moment of birth, complete blindness can be diagnosed. If a child is born with partial clouding, it will inevitably continue to progress. In both cases, surgical treatment is the only chance for complete or partial restoration of vision.
Congenital cataract
The causes of congenital cataracts are not entirely clear. Bilateral congenital cataracts are more often diagnosed, and the fact that both lenses are affected suggests the systemic nature of the reasons that caused the pathology. It was noted that in 25% of cases of congenital cataracts, parents had a predisposition to this disease, therefore, a genetic factor is involved in the development of cataracts. In addition, the incidence of congenital lens opacities is higher in newborns who have had intrauterine infection. The statistical connection with influenza, rubella and toxoplasmosis suffered by mothers during pregnancy is especially significant. Risk factors are also considered:
- uncontrolled medications taken, self-medication during pregnancy;
- injuries to mother and fetus;
- Metabolic disorders, calcium deficiency.
Complete congenital cataracts are diagnosed without specific tests by the milky white color of the pupil. Clouding of the lens, which rapidly develops in the first three months after birth, is also considered congenital. The color of the pupil begins to change (lighten), it becomes clear that the baby only reacts to light, but does not distinguish objects.
Signs that should be a cause for concern in the first months of a child’s life:
- visible clouding on the pupil (light disk, dot);
- the child does not even briefly fix his gaze on objects;
- the baby does not follow the toy or the mother’s face with his eyes, and reacts only to sound stimuli;
- strabismus (asymmetrical arrangement of pupils);
- the tendency to always turn the same eye towards the object being examined.
Partial and punctate cataracts
Partial cataracts are quite rare, and their manifestations are not so obvious. For example, only a slight decrease in visual acuity may be observed. However, when the child enters school, i.e. As eye strain increases, the disease begins to have a noticeable negative impact on the quality of life. Cataracts in this form develop pointwise and have a number of symptoms:
- the focus of opacification on the lens looks like individual dots or scattered heterogeneous areas;
- The protein may not change in color or be slightly lighter;
- Vision is partially reduced and may be manifested by blurred images or visible darkening in the field of view.
It has been proven that the development of partial cataracts is, to one degree or another, associated with one of the following factors:
- chromosomal pathologies;
- prematurity;
- intrauterine infection;
- background systemic diseases (diabetes mellitus, calcium metabolism disorders, Wilson's disease, autosomal recessive syndrome, hypoglycemia).
Also, the formation of partial cataracts can be caused by the action of toxins. One of the mechanisms contributing to chemical damage to the eye is the formation of free radicals. The structure of the eye allows light rays to penetrate inside; this factor is decisive for the passage of chemical reactions with the formation of free radicals. A side effect of such processes is constant intoxication of the eye, especially with reduced immunity and metabolic disorders.
Cataracts in adolescence
The development of cataracts in adolescence is an exception to the rule rather than a pattern. Usually the process at this age begins under the influence of serious negative factors. They could be:
- Drinking alcohol and smoking;
- prolonged exposure to the sun without protective glasses;
- chemical poisoning, irradiation;
- Constant stay in an unfavorable ecological environment.
Treatment of childhood cataracts
Cataracts in children, as in any other age categories, can only be treated surgically, however, in pediatric ophthalmic surgery this process has some peculiarities. When a newborn is completely blind, first of all, an accurate and reliable diagnosis is necessary, confirming that the cause is cataracts and not other congenital pathologies.
It is recommended to perform surgery for congenital cataracts between the ages of one and two years. Surgery at an earlier age is undesirable, however, you should not delay treatment. It is known that in the first months and years a person receives up to 95% of the total amount of information about the world around him that he will accumulate throughout his life. It is obvious that blindness irreparably impoverishes the process of cognition and deprives the child of full development; Delayed restoration of vision for too long will have time to negatively affect the formation of cognitive functions and the development of the baby’s psyche. Therefore, in children operated on at 3 or 4 years of age, there is some developmental delay, which requires the use of special training programs.
If the congenital cataract is bilateral, then surgical treatment is performed in two stages, but the interval between implantation of artificial lenses (first in one eye, then in the other eye) should not exceed three months, otherwise uneven vision restoration is possible.
After surgery, the child should be regularly monitored by an ophthalmologist for two years.
Video of cataract removal surgery in a child
Prevention of congenital and acquired cataracts
To reduce the risk of developing congenital cataracts, it is necessary to exclude harmful influences, stress and infections during pregnancy. If there is information about a hereditary predisposition to the disease, the pregnancy is carried out taking this into account, and the vision of the newborn is examined immediately after birth.
To reduce the likelihood of cataracts occurring throughout your life, you need to protect your eyes from prolonged exposure to sunlight, avoid exposure to radiation and intoxication, including direct contact of harmful substances with your eyes. Needless to say, it is necessary to be attentive to any changes in visual acuity, regularly undergo preventive examinations by an ophthalmologist, and also promptly seek medical help for injuries and infectious diseases of the eyes.
Cataracts in children can appear at any age. In children, a deviation in which the lens becomes cloudy does not cause any pain or discomfort, which is especially dangerous. Parents are often unaware of the problem, and developing cataracts in a child can lead, if not to loss of vision, then to its deterioration. More often, the pathology is observed in the form of a congenital anomaly. Changes in the eyeball are usually eliminated surgically. If the clouding of the lens is localized in the periphery and central vision is not affected, no intervention is required. Acquired cataracts are detected less frequently in children.
It is not always possible to determine what factors contributed to the development of cataracts. The reasons are different. Congenital pathology in most cases is hereditary.
The occurrence of abnormalities in the baby's eyeball could be provoked by infectious diseases of the mother during pregnancy in the form of influenza, measles, rubella, syphilis, tocoplasmosis, as well as the presence of herpes and cytomegalovirus in her body.
Congenital cataracts sometimes appear in premature babies. The cause of the abnormality in the baby may be the use of antibiotics by a pregnant woman. Often children are born with pathology whose mothers have diabetes.
The development of deviation in newborns is associated with internal factors. Acquired cataracts in a child occur due to external causes such as:
- increased radiation;
- bad environment;
- mechanical injury;
- unsuccessful operation;
- infectious disease;
- inflammatory process;
- metabolic problems;
Abnormal development of the eyeball can be triggered by brain injury, prolonged use of medications, the presence of toxacariasis, or a failure in the production of galactose.
Features and types of congenital pathology
A newborn baby may have cataracts in the front of the lens. Its appearance is associated with a genetic factor. With this type of pathology, vision is not impaired. Treatment does not require surgical intervention.
A deviation in a child is sometimes detected in the back of the lens. Nuclear cataract is diagnosed at its center. It is rare in children. With a layered bilateral appearance, the visual pathology falls below 0.1, and opacification is detected around the nucleus. The danger comes from complete cataracts, since the anomaly affects all layers.
The fact that the baby has a deviation is indicated by a whitish or gray tint of the pupil.
He rubs his eyes with his hands, unable to focus on the toy. The child does not watch a moving object or looks at it with one eye. With congenital cataracts, you may notice opacities in the form of dots on the pupil or on both.
Lack of timely intervention in such a disorder threatens the development of amblyopia or strabismus. And this often leads to problems at school in the future and affects the development of the child’s personality. If symptoms are observed that indicate a deviation, an examination by an ophthalmologist is necessary. Using special equipment and drops that dilate the pupil, the doctor will see the condition of the eyeball.
Experts believe that if central vision decreases due to clouding of the lens, then cataracts that arose at the birth of the baby must be removed no later than the date when the child turns 3 months old. However, there is a risk of increased intracranial pressure. At this age, it is difficult for a baby to endure anesthesia.
If there is a small area of opacity and there is no problem with central visual acuity, surgery is not required, but the condition of the eyeball is constantly monitored.
Symptoms of the disorder in older children
Developing cataracts prevent the baby from perceiving normally the world that surrounds him. Older children have even more problems. If there is a deviation, which is associated with clouding of the lens, they experience:
- Flashing dots in the eyes.
- Blurred look.
- Decreased visual acuity.
- Splitting of objects.
Acquired cataracts, like congenital ones, can develop in different ways. Each type of pathology has its own characteristics in treatment.
With the subcapsular form, which occurs in children with diabetes, the back surface of the lens is damaged, with the polar form - the entire area in both eyes. The development of secondary cataracts is facilitated by chronic illness or unsuccessful surgery. The traumatic type is preceded by exposure to chemicals. Bilateral damage to the lens with layered cataracts threatens complete loss of vision.
Sometimes the pupil does not take on a different color. The baby sees normally and does not turn to look at the object. Parents do not notice anything abnormal. And already at school, straining his eyes, the child will complain that a spot near the pupil is bothering him.
Point cataract, which is diagnosed quite rarely, occurs:
- due to intrauterine infection;
- in premature infants;
- with chromosomal disorders.
Diabetes and Wilson's disease can provoke changes in the lens. The cause of this type of cataract can be a decrease in calcium in the blood plasma, as well as hypoglycemia, in which the glucose level decreases. A child with such a deviation sometimes has not one, but several dots on the pupil. The protein takes on a milky hue. The cloudiness is localized in different parts of it. The baby often has the urge to rub his eye.
In adolescents, it provokes the development of cataracts:
- Smoking.
- Drinking alcohol.
- Unhealthy environmental situation.
Sun radiation and exposure to chemicals contribute to the disorder. It gets to the lens when the eye is injured.
Diagnosis and treatment
Before the procedures, a solution is instilled into the pupil, which helps to dilate it. Schoolchildren are checked for angle and visual acuity, the retina is examined, and the pressure inside the eye is measured.
Having identified the degree of clouding, the stage of cataract is diagnosed - from initial to overripe. The absence of deviation is indicated by a transparent lens. Pathology is not treated by resorting to folk recipes or physiotherapeutic procedures. Pharmaceutical drugs do not help with this disorder. In case of peripheral damage, monitor the condition of the eyeball.
The operation is performed when clouding of the lens spreads over its entire surface and vision deteriorates.
The type of intervention depends on the age of the baby; the general condition and the presence of other pathologies are taken into account. The lens can be removed together or without a capsule. Using cryoextraction, they freeze it and then remove it. During phacoemulsification, ultrasound is applied to the eye. Now special lenses are produced that can replace the affected element. They perform the function of a lens.
Ignoring such a disease in a child can lead to serious consequences in the form of:
- glaucoma;
- myopia;
- swelling of the eyeball;
- inflammatory process;
- blindness.
