Pediatric Cataracts And Clinical Characteristics

Pediatric cataract is one of the most common reason of childhood blindness. The main causes of pediatric cataracts are hereditary causes, systemic syndromes, intrauterine infections, radiotherapy, drugs ( corticosteroids), ocular anomalies (aniridia, persistan fetal vasculature, peters' anomaly, anterior segment dysgenesis) and ocular trauma.

In this study, systemic features and  clinical characteristics of pediatric cataracts were analyzed.

Also choice of surgical techniques  and postoperative complication profile were evaluated  in the pediatric patients with cataract.

In this retrospective study, patient charts of pediatric patients, under the age of 15, who were operated for congenital or acquired cataracts between January 2013 and June 2018 in a tertiary care center were reviewed after the approval of hospital ethics committee.

Demographic data, morphology of cataract, etiology, type and timing of the surgery, early and long term complications and follow up time were recorded and analyzed. 

The patients were divided into two groups as traumatic cataract group (Group 1) and nontraumatic cataract (congenital/infantile)  group (Group 2).Trauma was classified as penetrating or blunt trauma. Nontraumatic cataracts  were classified due to the morphologic type.

Two surgical techniques were used based on the age of the patient and morphologic type of cataract. Limbal lensectomy was performed in the patients older than 3 months old and pars plicata lensectomy in the patients younger than 3 months old. Posterior vitrectorhexis and anterior vitrectomy were performed all patients. In case of retinal injury vitrectomy was performed. Hydrophobic acrylic intraocuar lens (IOL) was implanted for eligible patients. 

The study recruited 166 eyes of 119 patients. There were 31.1% of patients in Group 1 and 68.9% of patients  in Group 2. 

There were 8.1% of patients with retinal detachment and 5.4% of  patients intraocular foreign body in Group 1.

There were ROP (7.3%) , Peters' Anomaly (4.9%), PFV(4.9%), Microcornea(3.6%), Posterior Lenticonus(2.4%), Megalokornea(1.2%), Microsperophakia(1.2%), Oculodigital Syndrome,(1.2%)Morning glory syndrom(1.2%) in Group 2. Prematurity, Galacosemia and Down Syndrome were the most common systemic anomalies in Group2.

In the early postoperative period, the most commonly seen complication  was  fibrinoid reaction in anterior chamber in Group1  and  superficial hemorrhagic retinopathy in Group2.

All traumatic cases were unilateral, mostly caused by penetrating trauma and  more commonly occurred in males. In contrast,  72.9% of patients in Group2  were bilateral. Analysis of morphological features  total and nuclear cataracts were the two most common types of cataracts in Group2. In this study the most common systemic association was prematurity and  most common ocular anomaly was ROP in Group2. Clear anterior segment is necessery for ROP screening. Therefore, coincidence of ROP and cataract is a difficult issue  there are some questions like timing of surgery, type of surgery, follow-up procedures waiting to be answered.

In conclusion, pediatric cataracts remain a major challenge in ophthalmology.