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CONGENITAL CATARACT |
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I can see some white opacity in my child's eye....
White opacity seen in a child's eye can have several reasons. The commonest of all is cataract. If such opacity is seen right since birth, it is called a congenital cataract. |
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Why do infants get cataract at such an early age?
Most common reason for a new born baby to have cataract is maternal infections acquired during pregnancy called TORCH group of infections. Out of these, rubella, also called German measles is an important cause for congenital cataracts in our country.
Other cause is heredity. Approximately 1/8 of bilateral cataracts are inherited, 1/3rd are associated with other disorders and 1/9 are due unidentified causes. Cataracts are also seen in children with other associated abnormalities of other systems of the body and eye. Metabolic disorders and syndromes are yet another cause of cataract.
Injury to the eye is an important cause in children Burn as well as penetrating injury to the eye can cause cataract.
Steroids used for a long time, either systematically or through eye drops can cause cataract in one or both eyes in young children. Children often are steroid responders and are more prone to various side effects of steroids taken for a long time. |
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Does heredity play a major role for cataracts at birth?
Yes, some hereditary cataracts are sometimes present at birth, others develop over time, genetic as well as chromosomal disorders are associated with cataracts. Families with history of congenital cataracts should receive genetic counseling. |
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What are the implications of having cataract in such a young age?
Cataracts in infants or children are not uncommon and are an important cause of moderate to severe visual impairment in children. Infants with complete cataracts in both eyes often show very little 'visual interest' and have delayed development Lazy eye can develop in these babies called - deprivational amblyopic due to presence of cataract, the brain receives no visual information and thus the eyes turn 'lazy'. Such lazy eyes are difficult to treat due to the severity of amblyopic unsteady gaze or nystagmus also develops which indicates poor vision. Appearance of squint in the eye also is a sign that the vision is poor. |
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What can be done to save any child's vision?
Surgery is the treatment of choice in most cases. Visually significant cataracts whether present in one eye or both eyes, should be removed urgently, if the baby is too young. In slightly older children, timing of surgery depends upon duration of visually significant opacity. When age of baby is less than 2 years, I usually do not implant an intraocular lens in the eye for cataracts seen in both eyes. Such babies are given glasses or more preferably contact lenses till they attain 2 years of age, after which intraocular lens can be implanted in the eye. Regarding use of contact lenses, parents are first taught how to insert and remove the contact lenses and how to maintain hygiene which is of utmost importance. Once parents matter the insertion and removal of contact lenses, are the contact lenses handed to the parents which clear instructions to report back if they find that they are unable to handle the lens or the baby does not seem comfortable with lenses on. Finally, once the child crosses 2 years of age, lens implantation is performed as a second stage procedure. If the cataract is seen in a younger child but only in one eye, usually intraocular lens is inserted inside the eye irrespective of age of child. When after implantation of intraocular lens the child will require glasses. As exact power of the lens is calculated in an adult, it is not possible in a child as the eye is still growing. Management of lazy eye in form of patching and Synaptophore exercises need to be given in every case. They must be followed continuously as treatment of lazy eye in the later years life is often tedious and unrewarding. |
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What care should I follow the surgery?
Your baby will be given a short course of steroid eye drops. Please use only as advised for the time as advised. Children tend to have steroid-inflammatory reaction hence these eye drops are very important.
Keep the eyes clean and do not miss out on the timings of eye drops. Use of glasses or contact lenses is mandatory and should be followed meticulously.
Patching of the good eye as prescribed should be followed.
Children are often uncooperative for all these post-operative necessities. parents must cajole them, coax them into following all the above instructions.
If you ever notice that your child is rubbing the operated eye all the time, the is having discharge or looking reddish, please report to your pediatric ophthalmologist immediately. |
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What is the prognosis of children operated for cataracts?
Thanks to newer techniques cataract removal and excellent contact lenses and intraocular lenses, visual recovery of children with cataracts has improved markedly over past 15 years.
However, remember that management of such cataracts does not end with operation only. Proper postoperative care, use of glasses, therapy for lazy eye, all is virtually important. Actual rehabilitation of these children is incomplete without these things. They must be followed years after surgery. |
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