Cataract in children: causes, symptoms, diagnosis, treatment

Cataract - any opacity of the lens. The relationship between deprivation amblyopia and cataracts that occurred in early childhood emphasizes the importance of eliminating this cause of disability in children. Early diagnosis and treatment are the main actions that must be taken to prevent persistent loss of vision.

[1], [2], [3], [4], [5], [6], [7], [8]

Causes of Cataracts

The etiology of cataract can not be determined in all cases. However, a thorough morphological study, a survey of parents and an appropriate laboratory examination help to establish a diagnosis in many patients.

Common causes of cataract in children include:

• heredity;
• autosomal recessive heredity (rare, except for metabolic disorders);
• autosomal dominant heredity - anterior polar, layered cataracts (can be combined with microphthalmos);
• X-linked by recessive trait (Lowe syndromes, Nance-Horan, Lenz.

Intrauterine infections

The introduction of mandatory vaccination significantly reduced the prevalence of rubella-associated em-briopathy. Nevertheless, a child with a diffuse cataract, both one-sided and bilateral, should undergo a test to exclude rubella virus; for this purpose, the child and mother are examined for the presence of antibodies to immunoglobulin G (IgG) and IgM.

Disruption of exchange

The development of cataracts is associated with a variety of metabolic disorders, including the following.

• Galactosemia - the cause is a mutation of the gene encoding galactose-1-phosphate uridyltransferase and localized on the short arm of the 9 chromosome. Symptoms include diarrhea, vomiting, jaundice, hepatomegaly and gram-positive septicemia. Usually, cataracts are detected no sooner than the child has general complaints. Heterozygosity for galactosemia creates the risk of cataract formation during puberty.

The appointment at the very beginning of the disease dairy-free diet prevents the formation of cataracts.

• Wilson's disease is a violation of iron metabolism, accompanied by a subcapsular cataract resembling a sunflower flower.
• Hypocalcemia is a combination of epileptic seizures, developmental disorders and delicate whitish pinpoint opacities in the lens.
• Diabetes mellitus - in adolescence, juvenile diabetes often causes turbidity in the cortical layers of the lens.
• Hypoglycemia - beginning in early childhood, causes opacities of the lens, which are reversible in nature.
• Autosomal recessive syndrome, including lactic acidosis, mitochondrial pathology, hypertrophic cardiomyopathy and congenital cataract.

Chromosomal pathology and other syndromes

• Trisomy 21 - mature cataracts, often occurring in early childhood.
• Cri du chat syndrome is due to the partial deletion of the short arm of the 5th chromosome and is combined with low-lying ears and heart disease.
• Syndrome Hallermann-Streiffe-Francois (Hallermann-Streiff-Francois). A combination of dyscephaly, dwarfish growth, hypothyroidism of the eyelashes, anomalies of the teeth, blue sclera and congenital cataracts.
• Martsolf's syndrome (Martsolf) - mental retardation, micrognathia, brachycephaly, flattening of the upper jaw, wide sternum and persistent deformation of the foot.
• The Marinesco-Sjogren syndrome is mental retardation, cerebral ataxia, myopathy.
• Spot chondrodysplasia - occurs in 3 forms: autosomio-recessive, X-linked dominant and autosomal dominant. X-linked cataract, muscle spasticity and mental retardation. Autosomal recessive encephalo-eye-skeletal-facial syndrome - mental retardation, microcephaly, ankylosis of joints, micrognathia.
• Chazel-JIaypu syndrome (Czeizel-Lowry) - microcephaly, Perthes hip joint disease and cataract.
• Killian-Pallister-Mosaic syndrome - rough features, sagging cheeks, hypertelorism, thinned hair and cataracts. Tetrasome of the short arm of the 12th chromosome.
• Progressive spin-cerebral ataxia, hearing loss, peripheral neuropathy and cataract.
• Proximal myopathy with weakness of facial and ocular musculature, hypogonadism, ataxia and cataract.
• The Schwars-Jam-pel syndrome is congenital myotonic myopathy, ptosis, skeletal disorders, microphthalmia and cataract.
• Cataract, mental retardation, micro-donation, and hypertrichosis.
• Velo-cardio-facial syndrome - protruding nose, depression of the wings of the nose, micrognathia, cleft palate.
• Others.

Steroid and radiation cataracts

Long-term corticosteroid therapy creates a risk of developing a posterior subcapsular cataract that regresses in the event of a rapid withdrawal of steroid treatment. Similar cataracts occur in children receiving radiotherapy.

Uveitis

Often, subcapsular cataracts are formed in combination with pars planitis and juvenile rheumatoid arthritis.

Prematurity

There are reports of transient opacities along the posterior lens suture in preterm infants.

[9], [10], [11]

Treatment of cataracts

Preoperative examination

In cases of congenital binocular and progressive cataracts, if opacity closes the optic axis, early surgical intervention is clearly shown. With partial cataracts, it is difficult to determine whether clouding the lens can cause amblyopia. In such cases, the morphology of cataracts helps: nuclear cataracts often provoke the development of amblyopia, rather than lamellar. Nevertheless, in order to clarify the expediency of surgical intervention in a patient with lamellar cataract, a survey is necessary in dynamics.

To clarify the possibility of a negative effect of the combined pathology on the functional effect of surgery, it is important to evaluate the state and other structures of the eyeball.

Monocular congenital cataracts

The issue of mandatory surgical removal of congenital monocular cataracts remains relevant. Despite the fact that some children, operated in the first months of life, can achieve excellent visual acuity, in most patients with monocular congenital cataracts visual acuity remains low. Parents should be warned about the difficulty of achieving a high and stable functional effect.

General examination

A general examination of a patient with congenital or developing cataract should be agreed with the pediatrician. In some cases, the morphology of lens opacity (for example, in the case of PGPS) indicates that there is no need for a general examination. In other cases, a detailed examination is performed to exclude metabolic or infectious causes of the disease.

Operation of cataract in children

For newborn children, the most appropriate method of removing monocular or binocular congenital cataracts is the technique of lenvitretomy performed on the closed eye. This procedure provides a free optical center and the availability of retinoscopy in the postoperative period. The technique is not associated with a significant risk of detachment of the retina, although there remains the need for prolonged follow-up of the patient in the postoperative period.

In children older than 2 years old, with the possibility of intraocular lens implantation, the standard technique of lens aspiration is preferable.

In the early postoperative period, in a large number of these patients, due to clouding of the posterior capsule, it becomes necessary to carry out the YAG laser capsulotomy.

The technique of phacoemulsification is rarely used in patients of child age.