Developmental cataract Present at birth or after birth 25% have a hereditary predisposition Causes : intrauterine infections [TORCHES] : prematurity, : inborn errors of metabolism : trauma e.g forceps delivery

Developmental cataract Types of cataract Punctate Anterior polar Posterior polar Central nuclear Zonular Sutural

Clinical presentation Nystagmus Squint Leucokoria [cat’s eye reflex ] Squeezing their eyes to get a pinhole effect. Mother notices child is not focusing

Management INVESTIGATIONS Ocular examination- Assess density of cataract- ophthalmoscopy Morphology of cataract Associated ocular pathology- corneal clouding, microphthalmos Special tests- prefrential looking

Lab investigations Serological tests- TORCH Urinalysis for reducing substance Urine chromatography of amino acids Blood sugar levels Serum calcium and phosphorus Galactokinase levels Chromosome analysis

Treatment Small cataract and not impairing vision – just observe Significant cataract and impairing vision surgical treatment Timing of the surgery is crucial – early the surgery better the prognosis because of amblyopia

Surgery Lens aspiration[ lensectomy] with posterior capsulotomy with posterior chamber intra ocular lens under G.A. Child more than 3 yrs-- IOL Child is less than 3 yrs – lensectomy with contact lens or spectacles Unilateral aphakia, spectacles should not be given,because of diplopia

Post operative complications  The same as in adults except the postoperative inflammation is more severe  In all cases a posterior capsulotomy and an anterior vitrectomy is performed to prevent posterior capsule opacification  amblyopia

Questions SIGNS AND SYMPTOMS OF CONGENITAL/DEVELOPMENTAL CATARACT MANAGEMENT OF DEVELOPMENTAL CATARACT