Congenital Cataracts - Treatment

Treatment methods for congenital cataracts are determined by the following features:

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

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

In case of clouding on the periphery of the lens, when visual acuity does not exceed 0.1 and does not improve after dilating the pupil, removal (extraction) of the cloudy lens is indicated. It is necessary to operate as early as possible, at the age of no later than 2-2.5 years. The earlier the operation is performed, the better the results in terms of visual function.

Features of the technique - small incision, cataract is always removed extracapsularly; there is a possibility of aspiration of lens masses. Removal methods:

• the most ancient method is lens mass discission. This method is not used today;
• optical iridectomy. Indications for this operation: preservation of a wide transparent zone on the periphery of the lens, if after dilation of the pupil visual acuity increases sufficiently. Excision of a piece of the iris opens access of light rays to the retina through transparent peripheral parts of the lens. Although iridectomy gives a small increase in vision (in comparison with the operation of lens removal), preservation of the lens and accommodation is of great importance, especially for a child;
• aspiration (suction) of the lens masses. Children's cataracts are usually soft. They are easily removed extracapsularly by aspiration and washing out with a special instrument through a small incision (up to 3 mm);
• extracapsular extraction (linear extraction) - a small incision is made, the anterior capsule of the lens is dissected, and the catarrhal masses are removed with a spoon. After cataract extraction, aphakia correction, pleoptic treatment, measures aimed at eliminating strabismus, and nystagmus treatment are performed;
• The ideal combination of surgical treatment is aspiration and extraction;
• in case of membranous cataract, an incision is made in the optical zone and it is removed with tweezers;
• laser capsulopuncture;
• emulsification - crushing of the lens using ultrasound with simultaneous suction.

The question of the timing of congenital cataract removal is decided individually based on the clinical form of cataract, residual visual acuity, cataract etiology, and the general condition of the child. Due to the risk of obstructive amblyopia, or more precisely, underdevelopment of the visual analyzer as a result of retinal damage during long-term existence of congenital cataracts, as well as the need to improve visual acuity so that the child can fully develop, it is advisable to perform the operation at an early stage. Early operations are operations at the age of six months to one year for complete, semi-resolved and membranous, bilateral cataracts. If there are symptoms of inflammation and signs of a history of uveitis, the period is extended to 1.5 years, and the operation is performed after preliminary treatment. In case of central cataracts, surgery is performed at 3-5 years of age if vision is 0.2 and below. The lower the vision with central cataracts, the earlier the operation is performed. If a child's vision is 0.3, he or she cannot be surgically treated; If vision is 0.2, then the question of surgery is postponed, it is performed at the age of 9-11 years. In order to prevent damage to the visual analyzer, permanent dilation of the pupils is carried out using mydriatics with subsequent irritation of the eyes with light stimuli. These manipulations should be carried out in the first months of life, if by this time surgery has not been performed - cataract extraction. The question of surgical intervention in case of zonular cataract is decided individually depending on the initial visual acuity of the patient. In case of total or diffuse cataract, the pupil area is gray. The opacity is homogeneous, there is no object vision. In such cases, early surgical treatment is required. The operation must be carried out in the first year of the child's life, until deep amblyopia (blindness from inactivity) develops.

Nowadays, a cloudy lens can be replaced with an artificial lens that is inserted into the eye.

Contraindications to surgical treatment of cataracts:

• contraindications for anesthesia;
• vision = 0;
• changes in the vitreous body;
• impending retinal detachment.

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

• general education - vision 0.3 or more;
• for the visually impaired - vision more than 0.05;
• for the blind - vision 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.

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