Congenital cataract is a complete or partial clouding of the lens that develops in the fetus inside the womb. It manifests itself in varying degrees from the time the baby is born: from a barely noticeable whitish spot to a completely affected lens. Congenital cataract in a child is characterized by a deterioration in vision or its complete loss, and nystagmus and strabismus are also observed in children.
Causes of pathology
Congenital cataract in a child most often accompanies a combination of TORCH infections, which includes toxoplasmosis, rubella, cytomegalovirus infection and herpes virus. It is not the only sign, however. Each disease has its own specific symptoms. The second most common source of congenital cataracts is metabolic disorders in a child: diabetes mellitus, hypocalcemia, Wilson's disease, galactosemia, etc. In some cases, pathology occursdue to hereditary mutations in autosomal recessive and autosomal dominant patterns.
Congenital cataract in a child with chromosomal disorders also does not become the only sign. She, as a rule, is accompanied by defects in mental and physical development and other symptoms specific to a particular nosology. The causes of the disease of exogenous exposure can be treatment with steroid hormones, antibiotic therapy, radiation therapy and other teratogenic factors. Congenital cataracts in premature babies are also noted separately.
Mechanisms of clouding of the lens
The clouding of the lens is carried out by one of two mechanisms. First of all - initially incorrect bookmark of the eye. It is typical for infections of the intrauterine type in the early stages of pregnancy, teratogenic effects and chromosomal disorders that occur in the first trimester of pregnancy, during the formation of the organ system. Another mechanism is the defeat of the already formed lens. Often characteristic of metabolic disorders (diabetes mellitus, galactosemia, etc.), the influence of external factors during pregnancy (in the second and third trimesters).
Symptoms of congenital cataracts
The main symptom of congenital cataract in a child is clouding of the lens of a certain degree. It can manifest itself in the clinical picture as a noticeable white spot against the background of the iris, but more often there are cases of congenital cataracts in which this symptom is absent. If the lesion is unilateral, strabismus is observed, most often converging. In some cases, instead of it, they findrhythmic pathological trembling of the apple of the eye. Almost all children with congenital bilateral cataracts have nystagmus. At about two months, a he althy baby is able to follow an object with his eyes, but this does not happen when he is sick, or the baby always turns in one direction only with his he althy eye.
Are children eligible for disability with congenital cataracts? More on that below.
Diagnosis of disease
Primary diagnosis is carried out during routine ultrasound screening of women during pregnancy. The lens is normal already in the second trimester is visualized as a dark spot on ultrasound. It happens that on the second ultrasound it is not possible to reliably confirm or exclude the diagnosis, and then this can be done in the third trimester. It is very important to understand that the diagnosis at this stage cannot be confirmed with absolute certainty, however, the disease can be suspected, and according to statistics, this method is highly reliable.
A pediatrician after the birth of a baby will be able to see only an intense clouding of the lens of the eye of the central localization. Cataracts are often not diagnosed by physical examination. For all newborns, an examination by a pediatric ophthalmologist is mandatory. A doctor can suspect and diagnose congenital cataract by seeing even a slight defect in the passage of light through the lens. The specialist will also detect nystagmus and strabismus. Since congenital cataract accompanies various intrauterine infections, chromosomal and metabolic disorders, when diagnosing thesepathologies, the child will be examined to exclude defects in the organs of vision.
Instrumental methods of diagnostics
The following instrumental methods are used to diagnose cataracts in a 1-year-old child: slit biomicroscopy, ophthalmoscopy, ultrasound of the eyeball. All of them make it possible to verify changes in the transparency of the lens, to exclude diseases that are similar in the clinic.
For example, in children, retinopathy is also characterized by strabismus and visual impairment, but the cause in this case is damage to the retina, and examination with an ophthalmoscope makes it possible to diagnose it. Tumors of the outer eye can significantly reduce vision, as can congenital cataracts. Visual inspection, methods of X-ray diagnostics and ultrasound, ophthalmoscopy allow to differentiate them.
What are the remedies for lightening cataracts in a child?
Congenital cataract therapy
For each child, after a thorough examination of his visual system, it is necessary to draw up an individual treatment plan. If the size of the opacity and the localization of the lens do not interfere with the normal development of visual functions, the cataract does not need surgical therapy, but the disease should be monitored by a specialist.
If clouding in the lens reduces central visual acuity and interferes with its proper development, the cataract should be removed as soon as possible.
What is cataract surgery in children?
About the operation
The operation is based on the removal of the lens.
On the other hand, surgical therapy is accompanied by a certain likelihood of complications, such as increased pressure inside the eye, which can cause secondary glaucoma. The general anesthesia used during the operation also becomes a significant risk factor.
For the normal development of the child's visual system after surgery, a complete correction of the eyes with contact lenses or glasses becomes an indispensable condition. If an ophthalmologist recommends a contact correction, it will usually be long-wear lenses for ease of use and handling.
The question of the timing of artificial lens implantation after cataract elimination in a one-year-old child is rather complicated. This is due to concerns that the intraocular lens will interfere with the normal growth of the apple of the eye. The calculation of the optical power of the lens cannot be accurate, since the refractive power and size of the eye change. However, a correctly calculated intraocular lens, i.e. IOL, is the most physiological method for correcting aphakia after surgery.
What to do with a cataract in a child is interesting to many.
In a situation where the baby does not see at all, experts prescribe him a surgical intervention. At the same time, it is carried out already in the second year of a baby's life, since by this time the eye has completed its intensive development, but in size it is almost identical to the organ of vision of an adult. Among other things, by the year of lifethe child begins to walk, and it is very difficult to do this without vision. Parents of children with complete cataract quite often ask for surgery at the age of 3-4 months, but the experience of several eye pathology institutes suggests that such operations are not recommended for children under one year of age. However, it is also not necessary to postpone the intervention until 4-5 years, since the eye simply cannot develop correctly after spending a long period without visual stimuli. We must not forget also about the development of the baby, which will slow down to a large extent if he cannot see the world around him.
Currently, cataracts are removed using the methods described below.
Extracapsular removal
This method involves the complete elimination of the lens, which is replaced by an artificial one. During the operation, the patient's eye membrane is cut, which is then sewn together. The presence of a seam may affect the child's vision (which is a disadvantage of the method). Another disadvantage is the lengthy recovery process.
There are also contraindications: the presence of inflammation processes, infections, oncological diseases and infancy.
Phacoemulsification
A small incision is made in the eye shell, through which an ultrasonic probe is passed, which destroys and removes the lens. In this case, an artificial lens is inserted into the patient. This operation is not performed on children with diabetes, as well as with conjunctivitis and corneal dystrophy.
Intracapsular extraction
In this case, the lens is removed simultaneously withcapsule. The lens is removed by freezing it. The intervention is not carried out for young children (such a contraindication is due to the anatomical structure of the child's eyes).
Femtosecond laser
The lens is removed with a laser beam without damaging the cornea. For carrying out the only indications are: overripe cataract, clouding of the cornea of the eye, a special anatomical structure of the eye.
If the therapy of congenital cataract did not lead to the final restoration of the organs of vision, adult patients are prescribed more effective means for resorption of the clouded area, which include active polymer compounds that selectively affect the affected area.
Laser cataract treatment is performed for adults of legal age who have clouding of the lens body from birth. The laser method can dissolve partially non-polar cases of lateral and anterior cataracts and lighten partially complete opacity.
Forecast
Surgical methods of treatment currently provide a favorable prognosis in most cases. It must be said that congenital monocular cataract is treated much worse and still gives a lot of various complications provoked by this pathology. In addition, cataracts are very rarely observed in isolation, and therefore the prognosis is also diagnosed with concomitant diseases: chromosomal pathologies, metabolic disorders, infections, etc. (photos of a cataract in a child are presented inarticle).
Prevention
From congenital cataract prophylaxis is carried out during pregnancy. It is necessary to exclude the contact of a woman with patients with an infection, to minimize the influence of teratogenic factors (radiological diagnostic and therapeutic methods, smoking, alcohol, etc.). Women who suffer from diabetes are assigned to the supervision of an endocrinologist throughout their pregnancy. Chromosomal pathologies in most situations are diagnosed even before childbirth, and then a woman can decide whether to terminate the pregnancy or carry the baby consciously. There is no specific prophylaxis for congenital cataracts.
We must not forget also about observing a competent diet. You need to eat vegetables and fruits, greens, seafood, nuts, dairy products. What berries for cataracts will help a child? Blueberries are especially effective for vision. It is recommended to exclude all fried and fatty foods, spicy dishes, smoked meats and pickles.
Disability due to congenital cataract in children
If the child's second eye is he althy, he is not given a disability.
The disease requires timely therapy, because with its progression, significant loss of vision is possible, up to its complete loss. This means disability, a strong deterioration in the quality of life in the future, loss of ability to work.
Reviews
Users note that the removal of a complete congenital cataract of the eye in children is an operation that is not among the complex ones. Successful interventions like thiscarried out in large clinics. First, one eye is operated on, and three months later, the second. In this case, vision does not return immediately, because the eye needs to learn to see, but after two months the child begins to distinguish objects and navigate in space. The eyes will definitely begin to see, the most important thing is to develop the baby's vision, that is, wear glasses with convex lenses that compensate for the absence of the lens, and engage in special exercises.
Parents note that the most important thing is to get examined by specialists in a timely manner and be treated on time. In addition, they note the importance of choosing a competent doctor. It is better to do the operation in a trusted clinic.
