1. Cataracts in Paediatric patients
(With acknowledgements to the Online Journal of Ophthalmology:

2. Introduction Opacity in lens Can be: Visually significant or not
Stable or Progressive
Congenital or Acquired
Unilateral or Bilateral
Partial or Complete
Congenital: incidence 6/10 000
10% of childhood blindness

3. Classification : Acquired cataracts
Systemic diseases : Diabetes mellitus
: Myotonic dystrophy
: Atopic dermatitis
: Neurofibromatosis 2
Ocular diseases : Chronic anterior uveitis
: High myopia
: Fundus dystrophies eg Retinitis
pigmentosa
Drugs : Corticosteroids
: Chlorpromazine
Trauma : Blunt
: Sharp

4. Congenital cataracts: Bilateral
Genetic Mutation : Autosomal Dominant
Metabolic : Galactosaemia
: Lowe
: Hypoparathyroidism
: Fabry
Infective : TORCH organisms
Chromosomal : Trisomy 21 (Down)
: Trisomy 18 (Edward)
: Trisomy 13 (Patau)
Skeletal : Hallerman-Streiff
: Nance-Horan
Ocular anomalies : Aniridia
: Anterior segment dysgenesis syndrome
Idiopathic : in 50%

5. Congenital cataracts: Unilateral
Sporadic, no family history
Ocular anomalies : Persistent foetal vasculature
Cause identified in only 10%

6. Morphology : Examples

7. Evaluation Screen newborns with red reflex test History : Family
Maternal infections
Examination: systemic diseases or syndromes
Workup: Bilateral cases without known hereditary basis
TORCH screen
s-glucose
s-calcium, phosphate
Urine: reducing substances (galactosaemia)
amino acids ( Lowe syndrome)
haematuria (Alport syndrome)

8. Ocular examination Formal estimate of vision not possible in neonate
Special tests: Preferential looking test, visually evoked potentials
Density and position of cataract
Morphology
Associated ocular pathology
Indicators of severe visual impairment : No fixation
Nystagmus
Strabismus

9. The visually significant cataract
In central visual axis, bigger than 3mm
Posterior cataract
No clear zones in between
Retinal details not visible with direct ophthalmoscope
Nystagmus or strabismus present
Poor central fixation after 8 weeks

10. Treatment Surgery: Cataract extraction and intraocular lens
implantation for visually significant cataract
By 6 weeks of age
Bilateral cases: 1 week apart
Non visually significant cases : careful observation, possible pupillary dilation

11. Considerations regarding surgery
Intraocular lens : Power of lens – Myopic shift of the
growing eye
Surgical technique
Postoperative intraocular inflammation (uveitis)
Glaucoma and retinal detachment may develop

12. Pseudophakic eye

13. Postoperative considerations
Clear vision for distance and near
Intraocular lens: regular refraction
Spectacles
Contact lenses
Treatment of amblyopia : Occlusion therapy

14. Conclusion: Congenital cataracts
Correct management essential to prevent permanent visual loss
Team effort ophthalmologist, paediatrician, geneticist,family
Early detection within the first month of life is very important
Knowledge of systemic conditions associated with cataract