A cataract is a clouding of the lens. Unfortunately, it happens that a similar pathology is diagnosed in newborn children. The consequence of cataracts is a sharp decrease in vision, which can be returned to normal values only by surgery. Without appropriate therapy, this condition can lead to disability. What are the main symptoms of congenital cataracts, as well as which treatment method is most appropriate for children, will be discussed in this article.
Etiology of the disease
Statistics show that annually congenital cataracts are diagnosed in 0.5% of all newborns. Moreover, most often the degree of lens opacity is such that other methods of treatment, except for surgery, will not be effective. It happens that the opacity affects only the peripheral region of the lens and does not affect the quality of central vision. In such cases, drug therapy can be dispensed with.
Causes of congenital cataracts:
- genetic predisposition (violation of the normal formation of the protein structure during embryonic development);
- metabolic disorders (including diabetes mellitus);
- the use by the expectant mother of certain types of drugs (for example, antibiotics);
- intrauterine infection (rubella, measles, cytomegalovirus, chickenpox, herpes simplex and herpes zoster, poliomyelitis, influenza, Epstein-Barr virus, syphilis, toxoplasmosis and others).
Sometimes congenital cataracts are diagnosed in older children, but the causes remain the same.
Varieties
There are several types of congenital cataracts, depending on the localization of the pathological process in the structure of the lens:
- Anterior polar cataract. Point clouding is localized in the front of the lens. This type of disease is associated with a genetic predisposition. It is considered a mild form of cataract, since it has practically no effect on the child's visual acuity and does not need surgical treatment;
- Posterior polar cataract. In this case, the pathological process is localized in the back of the lens;
- Nuclear cataract. This is the most common type of cataract. Here the opacity is localized in the central part of the lens;
- Layered cataract. This is also a common form of this disease. Lens opacity is localized in its central part around a transparent or cloudy nucleus. With this pathology, vision may decrease to the minimum;
- Complete cataract. The opacity spreads to all layers of the lens.
Clinical picture
The first thing you need to pay attention to is the appearance of a small area of discoloration in the pupil area. During a routine examination, the ophthalmologist may notice the development of strabismus in one or both eyes, as well as nystagmus (uncontrolled periodic movement of the eyeballs).
A newborn child from about two months begins to fix his gaze on objects and people around him. If this does not happen, then most likely the baby's vision is significantly reduced. At an older age, you may notice that each time, trying to examine an object, the child tries to turn towards it with one and the same eye.
Without timely treatment, cataracts can provoke education amblyopia ("lazy eye"). Such a violation of the visual function in a child inevitably leads to certain problems in the development process.
Therefore, it is important to undergo all ophthalmological examinations required for a newborn child (especially routine preventive examinations for children under 1 year old), so that, in the event of a similar pathology, at an early stage of the development of the disease, take effective measures to solve this problem.
Operative treatment
If the degree of opacity in the lens does not have a negative effect on the formation of central vision, then such a pathology does not require a radical solution and the child is placed on a dispensary. If the area of opacity in the thickness of the lens is large enough and negatively affects the central visual acuity, then an ophthalmologist raises the question of surgical removal of cataracts.
Of course, any surgical intervention is a certain risk of complications associated primarily with the effect of general anesthesia on the child's body. Also, such manipulation can provoke the development of secondary glaucoma, which is characterized by a persistent increase in intraocular pressure.
It is believed that the most optimal age for surgical removal of congenital cataracts is from 6 weeks after birth to 3 months.
One of the main conditions for the full development of the visual apparatus in a child who has undergone cataract surgery is correct spectacle or contact vision correction... If parents and an ophthalmologist come to the conclusion that wearing contact lenses for a particular child is the most acceptable way of correction, in most such cases, lenses are prescribed for long-term wear. The increased demand for them is associated with simplified operating rules.
The timing of implantation of an artificial lens, after removal of the clouded one, is set for each child individually, since there is a possibility that an intraocular lens will create additional difficulties in the process of growth of the eyeball.
It is rather difficult to calculate the exact optical power of the lens due to the enlarging eyeball, and, accordingly, its changing refractive power. But, if, nevertheless, it was possible to correctly determine this parameter, then it is possible to avoid the development of postoperative complications, for example, such as aphakia (complete absence of the lens in the eye)
Also, among the probable complications after surgical removal of cataracts include:
- change in the normal shape of the pupil;
- strabismus;
- increased intraocular pressure;
- secondary cataract;
- damage to the retina;
- the development of a severe inflammatory process in any part of the eye.
Such phenomena occur quite rarely, however, in the event of the appearance of one of the above signs, another operation is performed, with the help of which the appeared defect is eliminated.
To remove a clouded lens in a child, a microsurgical operation is used, which is performed under general anesthesia. Laser correction is not used to treat pediatric cataracts.
Recovery postoperative period
For some time after the operation, the child will need vision correction, which consists in the correct focusing of light rays on the surface of the retina. This can be achieved in several ways:
- constant wearing of glasses;
- constant wearing of contact lenses;
- implantation of an artificial intraocular lens.
Spectacle correction is the easiest and most affordable way to improve visual acuity in a child with a removed lens. After the operation, you will have to wear glasses all the time, since without them the baby will not be able to clearly see objects and freely navigate in space. Wearing glasses is an ideal postoperative correction method for children who have had a clouded lens removed in both eyes.
The ophthalmologist can prescribe multifocal (allowing to clearly distinguish objects at a far, middle and close distance) or bifocal (allowing to see objects far and near) glasses.
If the baby was operated on only on one eye, then the ophthalmologist will most likely prescribe an artificial intraocular lens implantation or contact correction. The so-called "breathing" contact lenses are quite popular. They have powerful optical power and remain invisible when worn.
For the correct selection of lenses, you must consult with an ophthalmologist, which will determine the exact parameters of the lenses and help with the choice of the model that is optimal for your child. In addition, he must explain in detail and show how to properly put on and take off lenses, as well as talk about other nuances of operating these optical products, since the child will have to wear them all the time.
As the baby gets older, he will need to change his contact lenses.
An artificial intraocular lens can be implanted during the operation itself to remove the clouded natural lens or some time after it. It must fully compensate for the refractive function of the natural lens.
The artificial intraocular lens has a sufficiently powerful refractive power, due to which it does not require replacement as the eyeball grows.
For information on what cataracts are in children, see the next video.
