Congenital Unilateral Cataract With High Degree Myopia And Posterior Lenticonus: A Clinical Case

Pediatric cataract, characterized by the opacification of the crystalline lens in children, represents a significant and relevant pathology in modern ophthalmology. Thus, the precise diagnosis and appropriate treatment approaches play a crucial role in addressing this condition effectively. Associated ocular anomalies create additional treatment challenges. High-degree myopia and posterior lenticonus, as in our case, complicate eye surgery, increasing the risks of amblyopia and anisometropic amblyopia. Precise intraocular lens (IOL) type selection is vital, especially for implantation into the capsular bag. This abstract underscores the significance of managing congenital cataracts along with the associated ocular complications.

This clinical case was observed at the Malayan Eye Center in Yerevan, Armenia. At the center, early treatment for congenital cataracts is prioritized to reduce the risk of amblyopia development. Primary interventions include timely cataract surgery and optical corrections like aphakic glasses, contact lenses, and IOL implantation. The main methods used to calculate IOL power are Sanders-Retzlaff-Kraff theoretic (SRK/T) and Barrett 4th generation formula.

A 6-year-old presented to the S.V. Malayan Eye Center with decreased visual acuity and left eye strabismus. Visual acuity was 20/20 in the right eye (OD) and 20/600 in the left eye (OS). Clinical examination detected OS strabismus with outward deviation. Autorefractometer findings showed OD sph +0.75D cyl +0.25D ax 74 and OS sph -12.75D cyl -5.25D ax 175. Primary slit lamp examination revealed left eye crystalline lens opacification. Ocular ultrasound indicated an axial length of 21.64mm in the right eye and 25.18mm in the left eye, revealing vitreous opacities and distortion of the posterior ocular wall in the left eye. Biomicroscopy revealed a deformation of the central part of the posterior lens capsule into the vitreous. Subsequent ophthalmoscopic examination showed optic disc pallor, myopic staphyloma, and retinal thinning. The diagnosis was as follows: OD- mild hyperopia, OS- high myopia, myopic astigmatism, divergent strabismus (30 prism diopters), congenital diffuse complicated cataract, myopic staphyloma, and posterior lenticonus. The treatment plan included cataract surgery and primary IOL implantation in the left eye, with VERION Image Guided System for IOL power calculation. The surgery included posterior capsulotomy and implantation of a primary three-piece IOL (13.0D) into the capsular bag. One-month post-op the visual acuity was 20/100 and the autorefractometer results were OS: sph -0.00D cyl -3.25D ax 175° with no significant improvement with correction.

Pediatric cataract is a significant pathology requiring prompt surgical intervention to prevent potential amblyopia. The optimal timing and choice of IOL depends on the individual diagnosis and potential complications. Minimizing anisometropia is one of the treatment priorities. Associated ocular anomalies, that change eye structure, may elevate the risk of retinal detachment in cases of post-operative macular edema. Addressing these factors optimizes pediatric cataract management.