Congenital cataract: treatment

Methods of treating congenital cataracts are determined by the following features:

• the absence of a dense nucleus in the lens of the child;
• strength of ligaments (zinn and hyaloid-capsular).

Treatment of patients with congenital cataracts is surgical and is indicated only with a significant reduction in visual acuity and inability to read.

At opacity on the periphery of the lens, when the visual acuity does not exceed 0.1 and does not improve after the pupil dilatation, removal (extraction) of the turbid lens is indicated. To operate it is necessary as soon as possible, at the age not later than 2-2,5 years. The earlier the operation is performed, the better the results regarding the function of vision.

Features of the technique - a small incision, cataract is always removed extracapsular; there is the possibility of aspiration of lens masses. Methods of removal:

• the oldest method is lens mass dyssic. Currently this method is not applied;
• optical iridectomy. Indications for this operation: the preservation of a wide transparent zone at the periphery of the lens, if in this case the visual acuity rises sufficiently after dilating the pupil. Excision of a piece of the iris opens access to the light rays to the retina through the transparent peripheral parts of the lens. Although iridectomy gives a small increase in vision (in comparison with the operation of lens removal), the preservation of the lens and accommodation is of great importance, especially for the child;
• Aspiration (aspiration) of lens masses. Children's cataracts are usually mild. They are easily removed by extracapsular method of aspiration and washing out with a special tool through a small incision (up to 3 mm);
• extracapsular extraction (linear extraction) - make a small incision, dissect the anterior capsule of the lens, remove the catarrhal spoon. After extraction of cataract, correction of aphakia, pleoptical treatment, measures aimed at elimination of strabismus, treatment of nystagmus;
• The ideal combination of surgical treatment is aspiration and extraction;
• with a film cataract cut in the optical zone and remove it with tweezers;
• laser capsulofacopuncture;
• emulsification - crushing of the lens by ultrasound with simultaneous suction.

The question of the timing of the removal of congenital cataracts is solved individually for reasons of the clinical form of cataract, residual visual acuity, the etiology of cataract, the general condition of the child. In connection with the danger of the emergence of obstructive amblyopia, or more precisely - the underdevelopment of the visual analyzer as a result of the retinal lesion with the prolonged existence of congenital cataracts, as well as the need to improve visual acuity, in order for the child to fully develop, it is expedient to carry out the operation in the early periods. Early operations are operations at the age of six months to one year with complete, semi-rasped and pleated, bilateral cataracts. If there are signs of inflammation and signs of a deferred uveitis, the period is extended to 1.5 years, and the operation is performed after the preliminary treatment. With central cataracts operate at 3-5 years, if vision is 0.2 and lower. The lower the vision with central cataract, the earlier the operation is performed. If the child's vision is 0.3, he is not subject to surgical treatment; if the vision is 0.2, then the question of the operation is delayed, it is produced at the age of 9-11 years. In order to prevent damage to the visual analyzer, permanent pupil dilatation is performed with the help of mydriatics, followed by eye irritation with light stimuli. These manipulations should be carried out in the first months of life, if by this time no operation has been done - extraction of cataract. The question of surgical intervention with zonal cataract is solved individually depending on the initial visual acuity of the patient. With total or diffuse cataracts, the pupil area is gray. Turbidity is homogeneous, there is no objective vision, In such cases, early surgical treatment is required. The operation should be carried out in the first year of the child's life, until deep amblyopia develops (blindness from inaction).

Now the cloudy lens can be replaced with an artificial lens, which is injected into the eye.

Contraindications to surgical cataract treatment:

• contraindications for anesthesia;
• sight = 0;
• changes of the vitreous body;
• anticipated retinal detachment.

Depending on visual acuity, children can study in different schools:

• general education - vision 0.3 or more;
• for the visually impaired, vision is more than 0.05;
• for the blind, vision is less than 0.05. Postoperative vision does not always satisfy the surgeon, since congenital cataracts are accompanied by other congenital pathologies with severe obstructive amblyopia.

[1], [2], [3], [4], [5]