Cataracts in children: symptoms, causes, treatment methods, prevention. Urgent treatment of cataracts in children Pinpoint cataracts in children
The congenital form is a special type of cataract in a child. The cause of the disease in 30% of cases is due to the effect of some toxin or infection on the fetus in the early stages of pregnancy. Congenital cataracts in children also occur with Down syndrome. Scientists have identified a hereditary predisposition to this visual impairment. After birth in the hospital, each newborn is examined to rule out cataracts.
Cloudiness in the pupil area is one of the main signs of cataracts. Pathology can be unilateral or bilateral. In addition, the shape and size of the lens changes. Doctors often diagnose several other visual anomalies along with cataracts in children. This may include strabismus, nystagmus, microophthalmos.
The clouding of the lens appears as a dot, a disk, or takes on a diffuse form. With nuclear cataracts, the pathological area is located in the center of the eye. In the case of the polar variety of the disease, the lens capsule is mainly affected. Foci of cloudiness of the substance may occur at its poles. If the lens is completely cloudy, then the child is born blind.
The choice of treatment method depends on the shape and size of the cataract. Therapy can be medication or surgery. Occasionally, spontaneous resorption of congenital cataracts occurs with the formation of a film.
Why does the pupil of the eye turn white?
Health problems in children and adults are caused by a large group of reasons. Experts name among the negative factors affecting the organ of vision, poor ecology, water pollution, infections, and dietary errors. In addition, pregnant women are careless about the health of their unborn baby.
Causes of cataracts in children (congenital)
- metabolic disorders in the body;
- infections during fetal development;
- chromosomal diseases (Down syndrome and others);
- congenital predisposition to lens pathology;
- use of medications or products with toxic substances by a pregnant woman.
Congenital cataracts are detected in an infant immediately after birth or during the first days of life. An acquired form of this disease is considered to be one in which clouding of the lens occurs after the age of two months. The development of congenital cataracts is influenced by radiation exposure and diseases suffered by a pregnant woman. Infections such as rubella, toxoplasmosis, chicken pox, cytomegalovirus, and herpes are especially dangerous in the early stages of gestation.
Causes of acquired cataracts
- Atopic eczema.
- Excessive sun exposure.
- Infectious diseases.
- Long-term treatment with steroid drugs.
- Serious internal diseases, such as diabetes.
- Eye injuries, damage after surgery.
- Drug therapy with corticosteroids, sulfonamides.
- Galactosemia (inability of the child’s body to break down galactose).
Early diagnosis of congenital cataracts is carried out in the maternity hospital. Then, in the first year of life, the child’s vision is checked by an ophthalmologist during a preventive examination. If a child is suspected of having cataracts, a liquid is instilled to dilate the pupil. The doctor then examines the eye using an ophthalmoscope. The absence of a red reflex, as well as clouding of the lens, makes it possible to diagnose cataracts.
Symptoms and treatment of the disease
With cataracts, the pupil becomes cloudy or white, and almost no light rays penetrate the lens. Vision deteriorates significantly, the child sees objects unclearly, and colors fade for him. Cataract is a serious eye pathology that requires immediate treatment. The choice of therapeutic method is influenced by damage to one or both pupils, location and degree of lens opacification.
How to recognize cataracts in a child:
- the pupil of one or both eyes becomes gray or white;
- the baby is unable to focus his gaze on the toy;
- the baby does not show interest in moving objects;
- the eyes make uncontrolled movements.
You can suspect cataracts in a baby if a baby in a crib or stroller always follows bright rattles with his head tilted to the side. Cloudiness of the lens in children over 6 years of age leads to learning problems. The visual system continues to develop until the age of 18, so treatment of cataracts in children before adulthood is in most cases carried out with medications. Apply eye drops "Taufon", "Taurine" or "Quinax".
The ophthalmologist prescribes the drug Taufon to the child, although the instructions indicate its use from the age of 18. The fact is that no studies have been conducted on drops under this trade name, although the active substance taurine has been well studied. This is an amino acid that has anti-cataract and metabolic effects. The compound normalizes the functions of cell membranes and stops dystrophic changes in eye tissues.
Folk remedies
Alternative medicine recipes are also used to treat after consultation with the doctor. The most effective folk remedies are infusions of dill seeds and calendula flowers. Prepare the solution in the standard way, then moisten cotton pads and apply as a compress or wash the eyes. It is also recommended to drink tea with calendula flowers - an anti-inflammatory and antioxidant agent.
Vegetable juices - from carrots, parsley and spinach - improve the functioning of the visual system. Red and green vegetables are rich in vitamins A, B1, B2, B12, E, C, and flavonoids. Back in 1998, data on the beneficial effects of multivitamins on reducing the incidence of cataracts were published in the English edition of the journal Ophthalmology.
Surgery
If congenital cataracts interfere with the development of the visual organ, they are removed at the age of 3–17 weeks. Carrying out the operation before the child reaches 2 months will avoid further deterioration and loss of vision. Surgery is performed under general anesthesia. The affected lens masses are removed using an irrigation-aspiration device through a tiny incision.
After lens surgery, the doctor prescribes glasses for the child, but not immediately. Various complications are possible - increased intraocular pressure, secondary cataracts. The resulting inflammatory changes and intraocular pressure are treated with medication. Secondary cataracts are removed with a laser. Children over 1–4 years old can have lenses or artificial lenses implanted.
Why is clouding of the lens dangerous with congenital cataracts in children? updated: September 19, 2016 by: admin
Consisting of partial or complete clouding of the lens, it develops when the baby is still in the mother’s womb. The manifestation can be noticeable at the time of birth - local, in the form of a small whitish spot, or the lens is completely damaged. The disease causes loss of vision, ranging from partial to complete.
Rare birth defect
Low vision or childhood blindness occurs due to the fact that due to pathology, various deformations and shifts of the lens occur in shape, size, and location. This is the first common reason. The second is considered to be a cataract, which entails clouding of a segment of the lens or its entire body.
By the way. Statistically, ½ of all congenital defects of the visual organs are cataracts, which can affect one side of the visual apparatus or occur in both at once.
If this pathology is detected in a baby, it means that the degree of transparency of the lens is pathologically impaired. The disease cannot be called common - it affects up to four percent of children, but the importance of the problem makes it necessary to take the pathology seriously, since in many cases early surgery is required to preserve vision.
By the way. In 36% of episodes, the disease occurs as a consequence of infections acquired by the baby in utero.
The pathology occurs equally in male and female infants, but one difference is observed. In men, genetic mutations are more often detected, while girls can be carriers of the gene without the occurrence of pathological symptoms.
Causes
First of all, among the causes of occurrence it is worth mentioning infections such as cytomegalovirus, toxoplasmosis, herpes virus and rubella. Cataract opacification is not the only one, but only one of multiple infectious symptoms that have individual characteristics for each pathology. The second place is occupied by metabolic destruction. The reasons that caused them could be:
- Wilson-Konovalov disease;
- diabetic disease;
- galactosemia disease;
- hypocalcemia disease.
Rarely, the pathology is the result of chromosomal abnormalities due to mutated genes. It is accompanied by mental defects and problems of physical development (Down syndrome and chondrodysplasia punctata). Exogenous causes of the disease are:
- antibiotic therapy incorrectly administered during pregnancy (tetracycline group);
- hormone therapy;
- irradiation;
- influence of teratogenic factors (viral, chemical, physical, drugs) on a pregnant woman.
May stalk a child:
- if the pregnant woman has had measles or rubella;
- suffered from chickenpox and cytomegavirus during pregnancy;
- has a herpes virus in the body, both simple and shingles;
- was sick with polio;
- suffered from toxoplasmosis or syphilis;
- has the Epstein-Barr virus in the body.
By the way. All these reasons can cause cataracts in older children.
Mechanism of occurrence
The lens has two mechanisms of opacification, due to which the child becomes a carrier of the disease. The first is the initial pathology that is present during the formation of the visual organs. It is precisely this that occurs as a result of infections introduced into the body of a pregnant woman at an early stage of gestation. Also stimulate the occurrence of chromosomal pathologies and external influence of any pathological property, carried out in the first weeks of pregnancy - the stage of formation of the baby’s visual organs.
Infections during pregnancy can lead to cataracts
The second is that the defeat occurs when the lens has already completely completed its formation. Caused by the presence of exchange problems. Similarly, a child can acquire pathology under the influence of external factors, even in the last trimesters.
Important! In all of these cases, the structure of the lens is damaged. Due to these violations, it loses its transparency.
Kinds
It is customary to classify cataracts depending on the segment of opacification and its extent. There are seven classification types.
Table. Species classification.
| Type | Characteristic |
|---|---|
| Capsular | In isolation, only the transparency of the capsule decreases. A cloudy halo can be localized in front or behind, but it does not affect the lens itself. Vision depends on the size of the halo, but blindness occurs only in exceptional cases if both capsules are affected simultaneously. It is caused by infections suffered by the mother during pregnancy or by an inflammatory process that has arisen. |
| Layered | Also called zonular, it is more common than others. Almost always bilateral, localized in the center of the nucleus, surrounding it, depriving the layers of the lens of transparency. Vision with the zonular form is always reduced, and significantly. |
| Polar | Cloudiness occurs both in the capsule and in the lens at both poles. The nature is bilateral, with variations in size and shape, and the degree of decrease in visual function depending on them. |
| Full | The lenses in both eyes become cloudy, and if they are completely damaged, blindness is almost absolute, with residual light perception. In other cases, the pathological clouding resolves spontaneously, forming a film in the pupil, which is called membranous cataract. |
| Nuclear | Development occurs in both eyes. Visual ability is reduced to a minimum level, but if only the embryonic nucleus becomes cloudy, its loss may be insignificant. The peculiarity of the pathology is its hereditary nature. |
| Membranous | The lens is affected in any area or completely, and the process, if not stopped, leads to its disintegration. Only the capsule, anterior and posterior, remains intact. They grow together to form a dense scar. In this case, vision is seriously impaired. |
| Complicated | Develops as a result of a serious illness, such as rubella or diabetes. Complicated by numerous defects. |
There is also a classification of the disease according to other characteristics.
- Hereditary, transmitted from parents, and intrauterine, formed in the fetus during pregnancy.
- Simple and complex forms (polymorphic).
- Single or double sided.
- First, second and third degrees, according to the severity of vision loss.
- Front and back. The first is formed in the anterior sector of the lens and has a hereditary etiology. Posterior – in the posterior segment, with acquired etiology.
Symptomatic features
Especially in the first days of a baby’s life, it is quite difficult to notice the disease without being an ophthalmologist. However, there are signs by which cataracts can be recognized.
- Cloudiness of the pupil or both, shaped like a disk or large dot.
- Diffusion of the pupil.
- Trembling of the eyeballs, called nystagmus.
- Severe strabismus.
- Inability to fixate gaze, which should normally be developed by two months.
- No eye tracking.
- With a one-sided form, the baby turns to one side of the toy and looks at it with one eye.
Advice. There may be no visible signs of the disease. In order not to miss congenital cataracts, it is necessary to show the baby to an ophthalmologist and subsequently undergo monthly examinations.
Even with a slight decrease in vision, cataracts become a likely cause of amblyopia and related pathologies, so diagnosis should be carried out within a few days after birth.
- The main symptom is clouding of the lens, expressed as a spot.
- The second diagnostic sign is convergent strabismus.
- The third is an impulse twitching of the eyeball.
How is diagnostics carried out?
Most often, pathology can be detected while the child is in the womb using a routine ultrasound examination. Ultrasound screening, carried out in the second trimester, allows you to see the formed lens, which, in the absence of pathology, is a dark spot without light inclusions.
By the way. In some cases, if it is not possible to make an accurate diagnosis, confirmation or exclusion is postponed to a second ultrasound.
Of course, it is impossible to make a 100% diagnosis in this way; there is only a suspicion of congenital cataract. When examining a newborn child, a pediatrician may notice a change in the lens only if it is localized in the center and has an intensity above average. But a pediatric ophthalmologist will notice even the initial clouding and conduct further examination to identify eye defects.
The next stage is instrumental. The following methods exist.
- Ophthalmoscopy – analysis of the condition of the fundus using an ophthalmoscope.
- Biomicroscopy - analysis of the condition of the membranes and transparent structures of the organ of vision using a slit lamp.
- Ultrasound – an ultrasound examination of the eyeball is performed.
All these methods will allow not only to detect even a slight decrease in transparency, but also to exclude pathologies with a similar clinical picture.
Treatment options
After thorough examinations have been carried out and the diagnosis has been confirmed, determining the type and form of the pathology, the pediatric ophthalmologist draws up an individual treatment plan for each small patient.
Important! If the clouding does not inhibit the development of normal visual function, surgical intervention is not required, but the pathology must be constantly monitored.
If a decrease in central vision or an obstacle to its development is detected, surgical removal of the pathology will be required, which will allow the child’s visual ability to function and develop within normal limits.
Operation
In which cases surgical intervention is necessary, and when you can wait, the doctor decides. But if visual acuity decreases dynamically, the need for surgery arises immediately. Ophthalmological surgeons have different opinions regarding the tactics of surgery for pediatric congenital cataracts. This operation has a certain degree of risk, since a complication of the intervention is increased pressure inside the eye. This in turn makes it possible for secondary glaucoma to develop. General anesthesia, which is used for the operation, is also dangerous.
Important! Experts believe that the optimal age for lens replacement for congenital infant cataracts is from one and a half to three months.
The most balanced operation in terms of safety and effectiveness is phacoemulsification. It is performed on children from the age of two. It is rarely done to infants. This is an effective way to save a child from the vision loss that awaits him due to dynamically developing cataracts. The lens is completely removed and replaced with an intraocular lens.
By the way. The implant is made from modern anatomical material that is biocompatible with the human body, so the patient does not experience discomfort in the postoperative period due to the invasion of a foreign body.
They operate with ultrasound or laser. With these devices, the pathological lens is liquefied and removed from the eye through a microscopic incision, which subsequently closes itself, without stitches.
By the way. For this type of operation in an adult, general anesthesia is not required, but a small child is mobile and uncontrollable, it is difficult to immobilize him, so it is necessary here.
Once the operation is completed and the anesthesia has worn off, the patient can be taken home.
There is an opinion among some experts that after liquefying and removing the lens, you should not immediately implant an implant, since the eyeball continues to grow and increase in size. But the sooner the artificial substitute is in the eye, the more correctly and within the limits of the eye vision will develop in the future. To solve this problem, artificial lenses that stretch to suit the growth of the eyeball were invented. After the intervention, optical vision correction may be necessary, which is performed after the micro-incision has healed.
Important! Treatment and implantation should be carried out early, since there is a high probability of developing amblyopia that cannot be further corrected.
Newborn babies undergo a lensvitrectomy on the closed eye. This surgical procedure can be performed in the first months of a child’s life, since technically the risk of retinal detachment is negligible. But in the postoperative period, the small patient needs to be monitored for a long time and carefully.
As for conservative methods of treating congenital cataracts, they can only be used to correct minor opacities that do not cause global visual impairment. Vitamin preparations and cytoprotectors are used for therapy.
Prevention and prognosis
Thanks to modern surgical discoveries, the postoperative prognosis is favorable. If the lens is removed and replaced in the first weeks or months (up to six), and then vision correction is performed, the child’s adaptation proceeds without problems. But congenital cataracts are rarely isolated and are not accompanied by complications. Because of this, the prognosis is not always good if it is accompanied by concomitant pathologies.
Preventive measures should be taken by the mother during pregnancy.
- Avoid contact with infected people.
- Teratogenic factors are minimized, among which smoking and alcohol are not the least important.
- Radiation diagnostic and therapeutic methods are excluded.
- If a pregnant woman has diabetes, she should be under the supervision of an endocrinologist for the entire period.
Important! If the pathology is of chromosomal origin, it is diagnosed before birth, and parents can decide whether to carry the pregnancy or terminate it based on the diagnostic results.
Congenital cataract is a large-scale pathology that must be detected as early as possible. Therefore, if risk factors were present at any stage of pregnancy, it is necessary to pay attention to the possibility of developing pathology during a diagnostic examination of the pregnant woman, and also immediately after the birth of the child, carry out a full ophthalmological examination.
Video - Removal of congenital cataracts
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 given 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 bilateral.
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.
Congenital or acquired cataracts are a fairly common disease in children, which is not entirely correctly defined by many as senile. This is a pathology associated with clouding of the lens and causing visual disturbances including blindness. It develops due to changes in the chemical composition of the eye proteins. The problems lie in the difficulties of diagnosis.
An insidious deviation does not cause pain to the child, parents may not suspect anything, and the process can ultimately lead to loss of vision. So information awareness is the right step towards preventing the development of such serious complications.
Most often, children are diagnosed with congenital cataracts, much less often - acquired ones. The reasons for the development of diseases in both cases are pathologies of pregnancy, deviations in the health of the mother, or some external factors. Parents should know about them in order to protect their baby from this pathology even at the stage of conception.
Causes of congenital disease:
- hereditary factor (triggered in 23% of cases);
- prematurity;
- mother's diabetes;
- taking certain medications during pregnancy (for example, tetracycline antibiotics);
- infections and inflammatory diseases suffered during pregnancy: rubella, cytomegalovirus, measles, chicken pox, polio, Epstein-Barr virus, influenza, syphilis, toxoplasmosis, etc.
Causes of the acquired disease:
- radiation, beam radiation;
- traumatic brain injury;
- mechanical damage to the eye: trauma or surgery;
- diabetes mellitus (culpable for cataracts in 30% of cases);
- long-term use of powerful medications;
- infectious and inflammatory diseases;
- impaired metabolism;
- galactosemia;
- toxocariasis;
- unfavorable environment;
- smoking and alcoholism among teenagers;
- not using sunglasses.
As a rule, the causes of cataracts in children depend on its form. If it is congenital, it is caused by internal factors. Acquired - often a consequence of external ones.
One way or another, in most cases, with the exception of genetics, parents are able to protect their child from such a dangerous and insidious disease. Insidious because it is quite difficult to recognize it in infancy.
Origin of name. The term “cataract” comes from the ancient Greek word “καταρράκτης,” which translates as “waterfall, splash.”
Symptoms
In a newborn, the symptoms of cataracts cannot be seen with the naked eye. The diagnosis is made either already in the parental home (if the pathology is congenital), or after some time at the next preventive examination by a local pediatrician. Less often, parents themselves may suspect the disease based on some behavioral characteristics of the baby.
The clinical picture is determined by several factors: one or both eyes are affected, how cloudy the lens is, where the lesion is located.
Signs in newborns:
- pupils (one or both) of an unnatural color - white or gray;
- rapid and uncontrolled eye movements;
- inability to focus on an object;
- lack of active monitoring of moving objects (people, cars, animals);
- viewing an object primarily with one eye;
- strabismus;
- The baby often rubs his eyes with his hands.
Symptoms in older children:
- visual acuity decreases;
- blurred vision;
- weakened vision in the evening and at night;
- discomfort when wearing glasses and lenses;
- “blurring” of objects;
- flashing stripes, dots, spots in the eyes;
- when viewed for a long time, objects split into two;
- pain, profuse lacrimation in bright light and looking at the sun;
- impaired color perception;
- problems with reading.
If the child is small, cataracts prevent him from fully seeing the world around him. At an older age, it may cause learning problems. If there is any suspicion, parents should immediately make an appointment with an ophthalmologist. The hospital will conduct a full diagnosis and determine the characteristics of the disease.
Note to parents. Pay attention to how your newborn reacts to rattles and silent toys. If he is at first frightened of the first ones, and then rejoices at them, and rarely pays attention to the second ones, this may be a sign of cataracts.
Kinds
Cataracts can develop and progress in different ways. Depending on its characteristics, ophthalmologists distinguish several types of the disease. Each of them requires special treatment or correction.
- Nuclear
Rarely diagnosed in children, as it is considered a disease of old age: the center (nucleus) of the lens is damaged, which becomes cloudy, yellowish, and denser.
- Cortical
Cloudiness of the cortex or outer part of the lens.
- Subcapsular
Damage to the posterior surface of the lens, under the capsule where it is located, usually develops in.
- Layered
Bilateral severe damage to the lenses, which often results in blindness.
- Polar
Damage to the entire surface of the lens, most often in both eyes.
- Secondary
It develops against the background of some diseases, surgery, or injuries.
- Traumatic
Formed after eye injury or exposure to strong chemicals.
- Radial
Rare cataract caused by radiation, ultraviolet light.
Well, accordingly, in children a distinction is made between congenital and acquired cataracts, depending on the time and reasons for its development. Each type of disease is characterized by its own characteristics of course and development. All this will be revealed during the diagnosis.
Interesting fact. Despite the fact that cataracts are considered an age-related disease and are diagnosed mainly in older people, they are the most common congenital vision pathology.
Diagnostics
In some cases, a congenital disease is detected already in the maternity hospital during the first vision check of a newborn. But since this examination is quite superficial, not all pediatricians are able to notice it in the first days of a new little person’s life.
But at the next preventive visits to the doctor, cataracts in an infant are detected in 85%. The following diagnostic methods are used for this:
- taking anamnesis;
- ophthalmoscopy: before the procedure, the child may receive special drops that dilate the pupil;
- optical coherence tomography;
- slit biomicroscopy;
- echoophthalmoscopy (ultrasound of the eyeball);
- basic vision test for older children.
During the diagnosis, the child’s visual acuity and field of vision are determined, intraocular pressure is measured, and studies of the optic nerve and retina are performed. And most importantly, the degree of clouding of the lens and the maturity of the cataract is revealed.
As a result of additional examinations, other disorders may be noticed - glaucoma or retinal detachment. Based on these data, treatment is prescribed.
Statistics. According to data, about 7% of the world's population suffers from cataracts.
Treatment
There are no medications, physiotherapy or folk recipes for cataracts. Despite the fact that research is still underway, the only way out of this situation is surgery at eye microsurgery institutes.
If only the periphery is affected, which does not affect the child’s vision, there are no indications for surgical intervention - doctors and parents in such cases take a wait-and-see approach. If the lens becomes cloudy over its entire surface and serious vision problems are diagnosed, a date is set for removal of the affected part of the eye.
Surgical treatment of congenital cataracts can be carried out from the first month of a baby’s life. It all depends on the state of his health. The therapy includes three stages.
Survey
Before the operation, the child undergoes a complete eye examination to exclude any other pathologies associated with cataracts. This allows you to assess all possible risks during surgery and avoid complications.
Operation
Surgery for cataract removal in childhood is performed using general anesthesia. If both eyes are affected, operations are performed separately. A special microsurgical instrument allows this to be done in just 15 minutes, promises complete elimination of the pathology and eliminates relapse.
Depending on the child’s health condition and age, the following types of operations may be prescribed:
- intracapsular extraction - removal of the lens along with the capsule;
- extracapsular extraction - removal of the lens without a capsule;
- cryoextraction - freezing the lens to an instrument and its subsequent removal;
- phacoemulsification - exposure of the lens to ultrasonic pulses through small incisions, which turns it into an emulsion, which is then removed by doctors.
Instead of a lens, a special lens is inserted into the eye, which performs the function of the extracted element. If cataracts have been treated in children under one year of age, an inpatient stay is possible. The rest of the children return home on the day of the operation.
Rehabilitation
After cataract surgery, children are prescribed special drops. In addition, the doctor must tell parents what to do and what is contraindicated during this period.
You are not allowed to rub your eyes or swim for 1 month. On the recommendation of a specialist, it is possible to wear glasses or lenses that correct the visual perception of many objects. Throughout the recovery period, be sure to regularly visit your doctor. It evaluates the degree of rehabilitation and correction of deviations.
After the operation, slight redness of the mucous membrane and slight squint are possible. In this case, you need to see a doctor to rule out infection and weakening of the eye muscles. Surgical treatment of cataracts in children promises a quick recovery and return to a full life without any complications.
Myths. Cataracts cannot be cured with folk remedies. The only correct treatment for such a diagnosis is surgery.
Complications
Complications of cataracts in children can be no less terrible than the disease itself. The most common among them are:
- inflammatory processes: iridocyclitis, uveitis - will have to be treated with antibiotics;
- increased intraocular pressure;
- glaucoma;
- complete blindness;
- secondary cataract;
- retinal detachment;
- decreased visual acuity - progressive myopia;
- swelling of the eyeball;
- lens luxation.
However, timely contact with an ophthalmologist and consent to surgery can save a child’s vision with any form of cataract. Postoperative pathologies are diagnosed only in 1.5% of cases.
It is always much easier to treat an initial disease than to later deal with its harmful consequences. And it’s even better to engage in prevention, starting from the moment the child is conceived.
Unfortunately... According to WHO, 45% of blind people lost their sight only because they did not undergo surgery on time when diagnosed with cataracts.
Prevention
To prevent a newborn child from having to undergo cataract surgery at such a young age, which in itself is unnatural and undesirable, parents should initially think about how to protect him from such a pathology.
Prevention of the disease involves the following measures:
- If one of the parents suffered from cataracts, before conception (or at least during pregnancy) it is necessary to inform the gynecologist about this and undergo appropriate genetic examinations.
- Eliminate the risk of prematurity.
- The mother should promptly treat any diseases she contracted during pregnancy.
- Do not take or give your child powerful medications without a doctor’s prescription.
- Protect it from any type of radiation and injury, especially to the head.
- Try to live or at least spend more time in environmentally friendly areas.
- Avoid smoking and alcoholism during adolescence.
- From a very young age, teach your child to wear sunglasses.
Keep in mind. Cataracts are one of the most dangerous diseases, since they do not cause pain, but at the same time they lead to the most serious consequence if left untreated - blindness.
Parents should be extremely attentive to the development of their child’s vision from the first days of his life. Much depends on pediatricians who constantly monitor young patients. Cataracts detected in time are a guarantee of recovery and continued health in the future.
There is no need to naively believe that this is a disease of old age: recently, such a diagnosis is increasingly being made to newborns due to the changed ecology and the rather low standard of living in some countries. The vigilance and attentiveness of adults in this matter is a bright future for children.
