Cataracts in children, congenital and ways for kids to make money acquired – eyewiki

A cataract is any light scattering opacity of the lens. It is estimated that congenital cataracts are responsible for 5% to 20% of blindness in children worldwide. Incidence varies from country to country. One retrospective study of the prevalence of infantile cataracts in ways for kids to make money the U.S. Showed a rate of 3-4 visually significant cataracts per 10,000 live births. [1] this is a similar rate to a U.K. Study which showed 3.18 per 10,000. [2]these numbers underestimate the total number since they do not ways for kids to make money take into consideration visually insignificant cataracts.

The majority of bilateral congenital or infantile cataracts not associated ways for kids to make money with a syndrome have no identifiable cause. Genetic mutation is likely the most common cause. Over fifteen genes involved in cataract formation have been identified, and the inheritance is most often autosomal dominant although it ways for kids to make money can be X-linked or autosomal recessive. [3] within the same pedigree, there can be considerable morphologic variation.

In contrast, most unilateral cataracts are not inherited or associated with a ways for kids to make money systemic disease and are of unknown etiology although they do ways for kids to make money not rule out the possibility of an associated systemic disease. They are usually the result of local dysgenesis and may ways for kids to make money be associated with other ocular dysgenesis such as persistent fetal ways for kids to make money vasculature (PFV), posterior lenticonus or lentiglobus.

Cataracts present as an opacity in the lens which run ways for kids to make money a spectrum from easily visible in the undilated state and ways for kids to make money apparent to the parents or pediatrician, to much more subtle changes requiring dilation and careful examination ways for kids to make money with a slit lamp. The red reflex is an extremely useful part of the ways for kids to make money exam giving an estimate of size and location within the ways for kids to make money visual axis, even in an uncooperative child.

Often an infant with mild cataracts appears asymptomatic, delaying the diagnosis for years. At other times, lack of reaction to light, strabismus, a failure to notice toys and faces or an apparent ways for kids to make money delay in development become the cause of concern. Mild cataracts may cause photophobia only in bright lights. Dense cataracts also may be discovered if they lead to ways for kids to make money the development of sensory nystagmus.

For unilateral cataracts in an otherwise healthy child, an extensive workup is not necessary. The most critical part of the workup is a thorough ways for kids to make money ophthalmologic exam including slit lamp examination of both eyes, checking intraocular pressure, and an ultrasound of the posterior pole if not visible. If the exam reveals the classic appearance of a specific ways for kids to make money diagnosis such as PFV or posterior lenticonus, no further evaluation is necessary.

The first step in the workup of bilateral cataracts should ways for kids to make money be a family history including examination of family members. If there is a clear autosomal dominant pattern and the ways for kids to make money child is healthy, further evaluation is not necessary. In cases without clear family history, a thorough pediatric and developmental exam should be performed. Recommended lab workup includes TORCH titers, VDRL, serum calcium and phosphorus levels and urine for reducing substance. Additional systemic workup should be done in coordination with the ways for kids to make money pediatrician. Dysmorphic features may suggest the need for involvement of a ways for kids to make money geneticist.

Not all pediatric cataracts require surgery. A small, partial or paracentral cataract can be managed by observation. Pharmacologic pupillary dilation with phenylephrine or tropicamide can be helpful. Dilation with atropine should be avoided as it is amblyogenic. Part-time occlusion may be necessary in unilateral or asymmetric cases ways for kids to make money that develop or are at risk for amblyopia. These techniques may at least delay the need for surgery ways for kids to make money until a point when eye growth has stabilized and an ways for kids to make money IOL can be implanted with less refractive uncertainty. Because of the unpredictability in the progression of partial cataracts, these patients should be carefully monitored and if significant amblyopia ways for kids to make money develops and is unresponsive to treatment, surgical intervention should be performed.

If the cataract(s) are felt to be visually significant, surgical intervention is the only option. The timing of surgery is critical for visual development. Most investigators recommend surgery within the first two months of ways for kids to make money life. [4] there has been evidence to suggest that before one month ways for kids to make money of age, the risk of aphakic glaucoma is increased. [5] in cases of bilateral cataracts, it may be advantageous to perform surgery on both eyes ways for kids to make money in the same intervention to allow for simultaneous initiation of ways for kids to make money visual rehabilitation as well as reducing exposure to general anesthesia. In this setting, treating each eye as a separate sterile procedure may reduce ways for kids to make money infection risk.

Several options exist to open the anterior capsule in pediatric ways for kids to make money cataracts. The ideal anterior capsulectomy technique is one that results in ways for kids to make money low incidence of radial tears and is easily performed. In cases of dense cataract, dye can be used to stain the anterior capsule, making this step easier and safer. A manual continuous curvilinear capsulorhexis (CCC), which is the preferred method in adult eyes, can be difficult in pediatric cases due to the elasticity ways for kids to make money of the pediatric capsule. However, when it can be controlled and completed, it creates an edge, which has a low incidence of radial tears. [4]

A mechanized circular anterior capsulectomy, known as vitrectorhexis has been proven to be a very ways for kids to make money good, safe alternative if the CCC is not possible. The vitrector tip is placed through a stab incision at ways for kids to make money the limbus and irrigation is provided though a sleeve around ways for kids to make money the vitrector or though a separate limbal incision. The vitrector port is oriented posteriorly, and held in the center of the capsule to create ways for kids to make money an initial opening. The opening is enlarged in a circular fashion, holding the cutter just anterior to the capsule to aspirate ways for kids to make money the capsule up into the cutter. A smooth, round capsulectomy that is also resistant to radial tears can ways for kids to make money be produced.

To reduce the risk of posterior capsule opacification most surgeons ways for kids to make money perform a posterior capsulorhexis at the time of surgery. The lens capsule can be filled with viscoelastic and a ways for kids to make money posterior continuous capsulorhexis made slightly smaller than the anterior one. If an IOL is to be implanted, it can be placed in the capsular bag at this ways for kids to make money time and some advocate the technique of optic capture where ways for kids to make money the optic is pressed through the posterior capsulorhexis and the ways for kids to make money haptics remain in the bag. [6]

It is controversial whether an anterior vitrectomy should be performed ways for kids to make money at the primary surgery. It can be performed either though the limbal incisions, after making the posterior capsulotomy with the vitrector hand piece, or through the pars plana. The anterior vitreous is removed and the lens epithelial cells ways for kids to make money therefore cannot grow in the vitreous face.

Care should be taken to remove the viscoelastic entirely to ways for kids to make money prevent elevated intraocular pressure following surgery and the anterior chamber ways for kids to make money should be checked carefully for vitreous. The sclera in children is soft and elastic and it ways for kids to make money is difficult to achieve a self-sealing incision, thus the incision should be closed using 10-0 nylon or vicryl suture.

Opacification of the visual axis is the most common complication ways for kids to make money of cataract surgery in children. This is a serious complication because it can lead to ways for kids to make money amblyopia. A posterior capsulorhexis and anterior vitrectomy as previously discussed is ways for kids to make money one way to avoid this. An IOL can prevent the formation of a sommering’s ring, but it is also easier for the lens epithelial cells ways for kids to make money to migrate to the center of the pupil. Others have suggested captruring the optic by placing the haptics ways for kids to make money in the bag and pushing the optic through the posterior ways for kids to make money capsularhexis may prevent opacification. If opacification occurs, a nd:YAG laser capsulotomy can be attempted. In this age group, general anesthesia is necessary and a surgical membranectomy may be ways for kids to make money indicated if the nd:YAG laser is not effective or available.

Secondary glaucoma is the most sight threatening complication of pediatric ways for kids to make money cataract surgery. Open-angle glaucoma can develop months to years after the surgery. The highest incidence is found when surgery is performed younger ways for kids to make money than 2 months and especially within the first month of ways for kids to make money life. An IOL may inhibit the development of secondary glaucoma. Glaucoma may also result from inflammation. Angle-closure glaucoma can result from anterior synechiae leading to pupillary ways for kids to make money block, which can be treated with a peripheral iridectomy. Some eyes with secondary glaucoma can be controlled with topical ways for kids to make money medication, but many cases will require additional surgical intervention.

Fibrinous or exudative postoperative uveitis is common due to increased ways for kids to make money tissue reactivity of these eyes. Inflammation can be treated with topical steroids. The visual axis may require clearing with the nd:YAG laser or vitrectomy/membranectomy. Tissue plasminogen activator has been recommended in cases of severe ways for kids to make money fibrin deposition on the IOL surface, threatening visual rehabilitation.

Careful surgical technique can reduce early postoperative complications such as ways for kids to make money wound leak, iris to the wound and vitreous to the wound. Retinal hemorrhages can occur, probably as a result of leaving the intraocular pressure low ways for kids to make money at the end of surgery. Iris capture of the IOL optic can cause discomfort and ways for kids to make money disfigure the pupil. This is caused by iris scarring to the posterior capsule ways for kids to make money and risk can be reduced by careful placement of the ways for kids to make money lens at the time of surgery. Cystoid macular edema in children is not common as with ways for kids to make money adults, but can be seen on rare occasions.

In the postoperative period, it is important to prevent and keep under check any ways for kids to make money significant inflammatory reaction. The prolonged use of local steroids, nonsteroidal anti-inflammatory agents, and atropine are recommended for this purpose. Systemic steroids are used by some to prevent or treat ways for kids to make money secondary membranes, but often are not successful resulting in the need for ways for kids to make money nd:YAG laser or surgery. The eye must be monitored regularly for the development of ways for kids to make money a secondary cataract or any other early or delayed problem.

Unlike adult cataract, the management of a pediatric patient is not complete when ways for kids to make money the post-operative period is over. In some ways, the more difficult and important part of management is still ways for kids to make money ahead. Neglecting the treatment and prevention of amblyopia or not giving ways for kids to make money proper refractive correction is leaving the work half done. Lifelong careful follow-up is essential for all pediatric cataract cases.

Although not the first choice, aphakic spectacles are an option in children who are contact ways for kids to make money lens intolerant or as a backup to contact lenses in ways for kids to make money bilateral aphakes. Spectacles should not be used for unilateral aphakes because they ways for kids to make money disrupt binocular fusion. However, for a child without binocular potential or strabismus, unilateral aphakic spectacles in combination with patching can be used. A high refractive index lens can diminish the weight and ways for kids to make money size of aphakic spectacles making them better tolerated.

Amblyopia treatment must be initiated as soon as possible. For amblyopia treatment to be effective, the amblyopic eye must have not only a clear visual ways for kids to make money axis, but also the proper corrective lenses to provide the retina ways for kids to make money with a clear image. In unilateral cases, the amount of patching required depends on the age at ways for kids to make money which the visual axis was cleared patient and family education ways for kids to make money about amblyopia and treatment strategies is essential.

The most serious complication of congenital cataracts is permanent visual ways for kids to make money impairment. When the visual axis is blocked by a lens opacity ways for kids to make money during the sensitive period of visual development, irreversible amblyopia and permanent nystagmus may result. The first two months of life are the most critical ways for kids to make money for visual development; amblyopia resulting from visual deprivation after the age of 2 ways for kids to make money to 3 months can often be reversible to some degree. Visual development continues until at least 7 years of age.

• ↑ infant aphakia treatment study group, lambert SR, buckley EG, drews-botsch C, dubois L, hartmann EE, lynn MJ, plager DA, wilson ME. A randomized clinical trial clinical trial comparing contact lens with ways for kids to make money intraocular lens correction of monocular aphakia during infancy: grating acuity and adverse events at age 1 year. Arch ophthalmol. 2010. Jul:128:810-8.

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