Pediatric Cataract

Question 1

What is a pediatric cataract?

Answer 1

• It is an opacification of the crystalline lens of the eye in children
• This lead to blurred vision or worsen to blindness
• This necessitates early intervention to prevent amblyopia.

Question 2

Types of pediatric cataracts?

Answer 2

1. Congenital or acquired
2. Inherited or sporadic
3. Unilateral or bilateral
4. Partial or complete
5. Stable or progressive
6. Isolated or associated with systemic conditions

Question 3

What is the lens?

Answer 3

The lens is a transparent, biconvex, flexible structure behind the iris.

Question 4

What factors influence the lens transparency?

Answer 4

1. Uniform arrangement of lens fibres
2. Thin epithelium
3. Little cellular organelles
4. Little extracellular space
5. Orderly arrangement of lens proteins
6. Relative dehydration
7. Semipermeable character of lens capsule
8. Avascularity
9. Antioxidants

Question 5

Epidemiology of pediatric cataract?

Answer 5

• It is one of the leading causes of treatable childhood blindness worldwide.
• Contributes 5% to 20% of the causes of blindness and severe visual impairment globally.
• Developing countries are more affected than developed countries
• No preference in gender

Question 6

Congenital causes of pediatric cataract?

Answer 6

1. Inherited genetic mutations (most common)
2. Metabolic disorders i.e DM, galactosemia, Fabry disease
3. Intrauterine infections (TORCHES)
4. Chromosomal disorders i.e Downs syndrome, Patau syndrome and Edward syndrome

Question 7

Acquired causes of pediatric cataract?

Answer 7

1. Eye trauma
2. UV light exposure
3. Drugs i.e. steroids
4. Nutritional deficiency

Question 8

Pathophysiology of pediatric catarct?

Answer 8

• Depends on the etiology
• In general there is
  > An alteration of the lens protein
  > Distortion of the lens microarchitecture
• Leading to opacification of the lens

Question 9

Morphological classification of pediatric cataracts?

Answer 9

Nuclearcataract
Corticalcataract
Posteriorsubcapsularcataract
Lamellar (zonular)cataract
Anteriorpolarcataract

Question 10

Clinical features of pediatric cataract?

Answer 10

1. Leukocoria
2. Strabismus
3. Nystagmus
4. Photophobia
5. Delayed visual milestone
6. Absent or reduced red reflex

Question 11

Evaluation of pediatric cataract?

Answer 11

1. Thorough history taking
2. Pupillary red reflex examination with direct ophthalmoscopy
3. Slit lamp examination
4. Dilated fundus examination
5. B scan

Question 12

Evaluation of bilaterl pediatric cataract?

Answer 12

1. CBC
2. TORCH titers
3. CMP with calcium and phosphorus
4. Urinalysis
5. Genetic testing

Question 13

Management of pediatric cataract?

Answer 13

Medical – prevention and treatment of amblyopia
Surgical – extracapsular cataract extraction with primary posterior capsulotomy and anterior vitrectomy
Galactosemia – dietary restriction of galactose

Question 14

Ddx for pediatric cataract?

Answer 14

Retinoblastoma
Corneal opacity
Persistent fetal vasclature
Congenital glaucoma
Retinal detachment
Uveitis
Coats’ disease

Question 15

Complications of pediatric cataract?

Answer 15

Cataract itself
1. amblyopia
2. strabismus
Cataract surgery
3. VAO - vascular artery occlusion
4. Glaucoma
5. Postoperative anterior uveitis
6. Inflammation and infection