Pathology of cataracts in children

2021-02-02 12:00 AM

For congenital cataracts, surgery should be done as soon as possible to avoid amblyopia. The method of surgery for cataracts in children is different from that in adults.

Cataracts in children are a fairly common eye disease. The disease can be in one or two eyes, present at birth or appear later. Cataracts can be isolated or accompanied by other damage to the eyes and body. In the past, cataracts in children were often handled late, so the ability to restore vision was very limited due to amblyopia. Now, thanks to the advancements in machines as well as technical innovations, cataract surgery in children can be done very early, so the prognosis of vision becomes much better.

Diagnose

The diagnosis of cataracts is very easy, mostly visible to the naked eye, with the main sign of white pupils and loss of pink light of the pupils. For detailed examination and evaluation, a pupil dilator is required. If the lens is cloudy, the fundus may not be visible. Cataracts can be accompanied by other damage to the eye such as eyeball jerky, small eyeballs, iris defect, retinal defect, nerve atrophy, squint, etc.

Differential diagnosis

It is necessary to distinguish cataract from some other diseases of the retina in children that may have white pupil signs such as: retinal cancer, premature retinopathy, Coats disease, vitiligo persistence primitive, toxocara worm, retinal detachment, etc.

Patterns

Microscopic examination with pupil dilatation allows detailed assessment as well as locating turbidity and helps to classify cataract according to different morphologies: cataract, shell, and layer (multi-layer opaque lateral outside the Y-shaped joint line, the inner core), chisels (the core and crust shrinks, the anterior and posterior sheaths close together, the lesions are calcified), the anterior opaque, the anterior sheath opaque, the posterior polar chisel, pine tree cloudiness, etc. This classification of cataracts can indicate the time of the cataract and prognosis. Chisels and anterior pinhole are usually congenital, and periostomic and subcapsular are usually acquired. The anterior axillary is usually small (less than 1-2 mm), with little progression with little visual effect, so usually no surgery is required.

 

Aetiology

Cataracts of unknown cause account for 50-60% of cases, about 30% of genetics, the rest is due to systemic diseases (Hallerman-Streff, Lowe, Down, Alport, Marfan, hypercalcemia, hypocalcemia, hypothyroidism, etc.) or infection from the fetus (rubella, tuberculosis, toxoplasma, herpes, etc.).

Treatment

For congenital cataracts, surgery should be done as soon as possible to avoid amblyopia. The method of surgery for cataracts in children is different from that in adults. For children under 2 years old, usually, there is no indication for intraocular placement. The most common method is a surgical aspiration or vitrectomy (with a vitreous tip). For children over 2 years old, intraocular lenses can be surgically inserted. Postcostal perforations usually appear early after cataract surgery in children, so during surgery, it is possible to simultaneously perform posterior circumcision and anterior vitrectomy to avoid the risk of secondary posterior cataracts. After surgery, it is necessary to soon treat amblyopia (i.e., the loss of vision due to the inability of the eye) with refractive correction (contact lenses, frames) combined with a better blindfold (in case of cataract one eye).