Congenital cataract is a complete or partial clouding of the lens that develops in the fetus inside the womb. It manifests itself to varying degrees since the birth of the baby: from a barely noticeable whitish spot to a completely affected crystalline lens. Congenital cataract in a child is distinguished by impaired vision or its complete loss, and children also have nystagmus and strabismus.
Causes of pathology
Congenital cataract in a child is most often accompanied by a combination of TORCH infections, which include toxoplasmosis, rubella, cytomegalovirus infection and herpes virus. She is not the only sign. Each disease is characterized by special symptoms. The second most frequent source of congenital cataracts is metabolic disorders in the child: diabetes mellitus, hypocalcemia, Wilson’s disease, galactosemia, etc. In some cases, pathology occurs due to hereditary mutations of the autosomal recessive and autosomal dominant type.
Congenital cataract in a child with chromosomal abnormalities also does not become the only sign. As a rule, she is accompanied by defects in mental and physical development and other symptoms specific to a particular nosology. The causes of exogenous exposure can be steroid hormone therapy, antibiotic therapy, radiation therapy, and other teratogenic factors. Congenital cataract in premature babies is also noted separately.
Lens clouding mechanisms
The clouding of the lens is carried out by one of two mechanisms. First of all, an initially incorrect eye bookmark. It is characteristic of intrauterine infections in the early stages of pregnancy, teratogenic effects and chromosomal abnormalities that occur in the first trimester of pregnancy during the formation of the organs of vision. Another mechanism is damage to the lens of an already formed lens. Often characteristic of metabolic disorders (diabetes mellitus, galactosemia, etc.), the influence of external factors during pregnancy (in the second and third trimesters).
Symptoms of congenital cataract
The main sign of congenital cataract in a child is a clouding of the lens of a certain degree. It can appear in the clinical picture as a noticeable white spot against the background of the iris, but cases of congenital cataract, in which this symptom is absent, are more common. If the lesion is unilateral, strabismus is observed, most often converging. In some cases, a rhythmic pathological trembling of the eyeball is found instead. Almost all children with congenital bilateral cataracts have nystagmus. At about two months old, a healthy child is able to follow the subject with his eyes, but this does not happen in case of illness, or the baby always turns in one direction with only a healthy eye.
Are children with disabilities for congenital cataracts? About it below.
Diagnosis of the disease
Primary diagnosis is carried out with planned ultrasound screening of women during pregnancy. The lens is normal in the second trimester visualized by a dark spot on an ultrasound scan. It happens that at the second ultrasound it is not possible to reliably confirm or exclude the diagnosis, and then this can be done in the third trimester. It is very important to understand that the diagnosis at this stage cannot be confirmed with absolute probability, however, the disease can be suspected, and according to statistics, this method is highly reliable.
After the baby is born, the pediatrician can only see intense clouding of the lens of the eye of central localization. It is most often impossible to diagnose cataracts during a physical examination. For all newborns, a visit to a pediatric ophthalmologist is mandatory. The doctor may suspect and diagnose congenital cataracts, having seen even a slight defect in the passage of light through the lens. The specialist will also detect nystagmus and strabismus. Since congenital cataract accompanies various intrauterine infections, chromosomal and metabolic disorders, when diagnosing these pathologies, the child will be examined so that visual defects are excluded.
Instrumental diagnostic methods
The following instrumental methods are used to diagnose cataracts in a 1-year-old child: slit biomicroscopy, ophthalmoscopy, ultrasound of the eyeball. All of them make it possible to verify changes in the transparency of the lens, the exclusion of diseases similar to the clinic.
For example, in children, retinopathies are also characterized by strabismus and visual impairment, however, the cause in this case is damage to the eye retina, and examination with an ophthalmoscope makes it possible to diagnose it. Tumors of the external ocular region can significantly reduce vision, as well as congenital cataracts. They can be differentiated by visual inspection, methods of X-ray diagnostics and ultrasound, ophthalmoscopy.
What are the means for clarifying cataracts in a child?
Congenital-type cataract therapy
For each child, after a thorough examination of his visual system, it is necessary to draw up an individual treatment plan. If the size of the opacification and localization of the lens does not interfere with the normal development of the visual functions, cataracts do not need surgical therapy, but the disease should be monitored by a specialist.
If clouding in the lens reduces central visual acuity and interferes with its proper development, cataracts should be removed as soon as possible.
What is the surgical treatment for cataracts in children?
About operation
The operation is based on the removal of the lens.
On the other hand, surgical therapy is accompanied by a certain probability of complications, for example, an increase in pressure inside the eye, which can cause secondary glaucoma. The general anesthesia used during the operation also becomes a significant risk factor.
For the normal development of the children's visual system after surgery, a complete correction of the eyes through contact lenses or glasses becomes an indispensable condition. If an ophthalmologist advises contact correction, it will usually be long-term lenses in order to simplify their use and handling.
The question of the time of implantation of an artificial lens after cataract elimination in a one-year-old child is rather complicated. This is due to fears that the intraocular lens will interfere with the normal growth of the eyeball. The calculation of the optical power of the lens cannot be accurate, since the refractive power and size of the eye change. However, a correctly calculated intraocular lens, that is, an IOL, is the most physiological method for correcting aphakia after surgery.
What to do with cataracts in a child is interesting to many.
In a situation if the baby does not see at all, specialists prescribe him a surgical intervention. It is carried out at the same time in the second year of the baby’s life, because by this time the eye is completing its intensive development, but in size it is almost identical to the organ of vision of an adult. Among other things, by the year of life, the child begins to walk, and it is very difficult to do this without vision. Parents of children with complete cataract quite often ask for surgery at the age of 3-4 months, but the experience of several institutes of eye pathology suggests that children under one year of age are not recommended to do such operations. However, it is also not necessary to postpone the intervention until 4-5 years, because the eye simply cannot develop correctly, having spent a long period without visual irritants. We must not forget about the development of the baby, which will greatly slow down if he can not see the world around him.
Currently, cataracts are removed by the methods described below.
Extracapsular removal
Under this method, the complete elimination of the lens, which is replaced by an artificial one, is supposed. During the operation, the patient is cut an ocular membrane, which is subsequently sutured. The presence of a suture (which is a disadvantage of the method) may affect the child’s vision. Another disadvantage is the long recovery process.
There are also contraindications: the presence of inflammation, infections, cancer and breast age.
Phacoemulsification
A small incision is made in the ocular membrane, through which an ultrasound probe is conducted that destroys and removes the lens. In this case, an artificial lens is inserted into the patient. Such an operation is not performed for children with diabetes mellitus, as well as conjunctivitis and corneal dystrophy.
Intracapsular extraction
In this case, the lens is removed simultaneously with the capsule. The lens is removed by freezing it. Intervention is not carried out for young children (such a contraindication is due to the anatomical structure of the child’s eyes).
Femtosecond Laser
The lens is removed by a laser beam, while the cornea is not damaged. For the only indications are: overripe cataract, clouding of the cornea of the eye, a special anatomical structure of the eye.
If therapy of congenital cataract does not lead to a final restoration of the organs of vision, adult patients are prescribed more effective means for resolving the clouded area, including polymer active compounds that selectively affect the affected area.
Laser treatment of cataracts is performed for adults of adult age who have clouding of the lens body from birth. The laser method can dissolve partially non-polar cases of lateral and anterior cataracts and lighten partially complete turbidity.
Forecast
Surgical treatments currently in most cases provide a favorable prognosis. I must say that congenital monocular cataract is treated much worse and still gives a lot of different complications provoked by this pathology. In addition, cataracts are very rarely observed in isolation, in connection with which the prognosis is also diagnosed with concomitant diseases: chromosomal pathologies, metabolic disorders, infections, etc. (photo of cataracts in a child are presented in the article).
Prevention
From congenital cataract, prevention is carried out during pregnancy. It is necessary to exclude the woman’s contact with patients with infection, to minimize the influence of teratogenic factors (radiation diagnostic and therapeutic methods, smoking, alcohol, etc.). Women who suffer from diabetes are given the supervision of an endocrinologist throughout their pregnancy. The pathology of chromosomes in most situations is diagnosed even before childbirth, and then a woman can decide whether to terminate the pregnancy or bear the baby consciously. There is no specific prophylaxis for congenital cataracts.
We must not forget about the observance of a competent diet. You need to eat vegetables and fruits, herbs, seafood, nuts, dairy products. What berries from cataracts will help a child? Bilberry is especially effective for vision. It is recommended to exclude all fried and fatty foods, spicy dishes, smoked meats and pickles.
Disability with Congenital Cataract in Children
If the child’s second eye is healthy, disability is not given.
The disease requires timely treatment, since with its progression, significant loss of vision is possible, up to its complete loss. This means disability, a strong deterioration in the future quality of life, disability.
Reviews
Users note that the removal of complete congenital cataract in the eyes of children is an operation that is not among the complex ones. Such interventions are successfully carried out in large clinics. First, one eye is operated on, and after three months the second. In this case, vision does not return immediately, because the eye needs to learn to see, but after two months the child begins to distinguish objects and navigate in space. Eyes will certainly begin to see, the most important thing is to develop the baby’s eyesight, that is, wear glasses with convex lenses that compensate for the absence of the lens, and engage in special exercises.
Parents note that the most important thing is to undergo a timely examination by specialists and engage in treatment on time. In addition, they note the importance of choosing a competent doctor. Doing an operation is better in a proven clinic.