Causes of cataract in children. Congenital cataracts in children
Children's visual impairments always have serious consequences for the entire future life of the child. Unfortunately, despite the current level of development of medicine, this problem has not lost its relevance, since quite often we are faced with congenital diseases and pathologies that are almost impossible to prevent.
One of these serious problems that young parents may encounter is a cataract in their newborn child. Nevertheless, even with such a diagnosis, one should not panic.
What it is?
Usually, under the cataract, doctors mean the process of clouding of the lens in the human eye. In order to fully understand this problem and its consequences, it is necessary to make a small digression into the physiology of our visual apparatus.
Inside the eye of a newborn baby, like any other person, there is a lens. It represents a special vitreous body shaped like a biconvex lens. Such an unusual, but very significant organ is necessary for the correct refraction of light waves and focusing the image on the retina of the eye. It is thanks to this mechanism that we are able to perceive the world around us visually.
congenital cataract manifests itself in violation normal structure protein inside the lens. As a result, this part of the child's eye becomes cloudy and, accordingly, its ability to transmit light is lost. Depending on the severity of this process, it can be observed as minor violation vision, and almost complete blindness, which manifests itself in the reflex perception of a source of bright light.
The main problem that frightens congenital cataracts in children is This is the impact of this disease on the future life of the baby. Many of the kids are not able to perceive the objects around them normally, it is difficult for them to navigate and adapt to the space, others appear with age. social problems For example, the communicative competence of a growing child is reduced.
Depending on the degree of visual impairment, several groups of children are distinguished: with borderline vision between the norm and reduced, with reduced vision, visually impaired, blind.
It is also worth noting that congenital cataracts can progress over time. However, this disease never spreads beyond the boundaries of the lens, that is, it does not affect other parts of the eye.
Reasons for the appearance
As a rule, if we are talking about congenital disorders, doctors find it difficult to give an exact answer to the question of what exactly caused them. Nevertheless, modern medicine highlights a number of factors that can trigger the development of congenital cataracts in your baby long before he is born. The most significant among them:
- Violation metabolic processes both in the child and in the mother during pregnancy. Most often, we are talking about diseases such as diabetes, varying degrees beriberi, hypocalcemia, dystrophy.
- Sometimes a cataract develops as a result of another specific inflammatory process that began in a child in the womb. For example, the cause may be intrauterine iritis - inflammation of the iris.
- Intrauterine diseases provoked by infectious agents. Quite often, newborns are diagnosed with cataracts if their mother has been ill with the herpes virus, chicken pox, rubella, and syphilis during pregnancy.
- Pathology may also be due to genetic disorders. Usually in this case, congenital cataract accompanies another chromosomal syndrome, such as Marfan, Down or Lowe syndrome.
- Also, congenital cataract can be inherited by a child from one of the parents.
Classification
To date, medicine knows several different types of cataracts. The main categories of this pathology have been studied and included in the official list of classifications of diseases of the ICD-10. According to this list, There are the following variants of congenital children's cataract:
- Capsular cataract. It differs by an isolated lesion of only the anterior or posterior surface of the lens. The clouding process can visually spread both to part of the pupil and to its entire surface, so the quality of the child's vision directly depends on the degree of development of the pathology. As a rule, capsular cataract is a consequence of an inflammatory disease transferred in the womb.
- Polar. In this case, the process extends not only to the surface of the lens capsule, but also to its internal substance. Visually, the anterior or posterior pole of the pupil can be affected, hence the name of this type of congenital cataract, which usually affects both eyes.
- Layered cataract. It occurs most often and manifests itself in the defeat of the central part of the transparent nucleus of both eyes, which manifests itself in a rather serious visual impairment of the newborn.
- Nuclear cataract develops as a result of various genetic and hereditary factors. It affects the nucleus of the lenses of both eyes as a whole, therefore, as a rule, leads to complete blindness. In some cases, only the isolated embryonic nucleus is affected, so visual impairment may be minimal.
- The full form of cataract affects the entire body of the lens. Newborns with this type of cataract have no vision and only light perception is preserved.
How can you identify?
It is almost impossible to independently diagnose a cataract in a newborn. Only a professional ophthalmologist can clarify such diseases after a series of additional examinations of the baby's eyes. However, parents should pay attention to general state their child in order to contact a specialist in a timely manner. In particular, one should not forget about some symptoms indicating the likelihood of congenital progressive cataracts in children:
- During eye contact, the child's gaze is not fixed on the faces of the people around him or on various bright objects.
- On closer examination of the pupil of the child, cloudy spots are visible on it.
- The baby has a strabismus. This state quite often accompanied by congenital clouding of the lens.
- Heterochromia is also a provoking factor for cataracts - different colour and pupil size.
- Excited and restless state in bright light.
- The baby always turns the same side to people or objects around him. This may indicate the presence of a cataract of the eye on the opposite side, which is why it is perceived by the child as a "blind zone".
If you have ever observed nystagmus in your baby, that is, a quick twitching of the eyeball in a vertical or horizontal direction, this is a serious reason for a visit to an ophthalmologist.
Treatment
Unfortunately, today there are no medicines that would allow treating congenital cataracts at home. On the other hand, it is far from always the case goes to surgical intervention. Much depends on the severity of visual impairment. If the presence of clouding of the lens practically does not affect the child's ability to see the world around him, and the decrease in vision is easily corrected with glasses or lenses, then this type of cataract only needs under regular supervision.
To treat the disease today, a surgical method is used. The clouded lens is removed and an artificial intraocular lens (IOL) is placed in its place. Indications for surgery, the time of its implementation and the optimal time for implantation of a piece lens are determined on an individual basis. As a rule, children are operated on at the age of 1-3 months, and the IOL is placed later.
Causes
A common cause of congenital cataracts are gene and chromosomal mutations. Typically, children receive the defective gene from one of the affected parents. Also, congenital cataract can be one of the symptoms of Down syndrome, Marfan, Ehlers-Danlos, Low, etc. Gene defects lead to impaired synthesis of structural proteins and clouding of the lens.
The cause of cataracts in newborns may be a violation of intrauterine development of the fetus. This may be caused by the action of teratogenic (harmful) factors on the mother's body during pregnancy.
The development of cataracts in a newborn can be provoked by:
- Toxic Substances (nicotine, alcohol, tetracycline antibiotics and some other drugs). Toxins from the woman's blood enter the growing body of the baby and disrupt its normal development.
- Endocrine diseases and metabolic disorders in the mother's body (diabetes mellitus, galactosemia, Wilson-Konovalov disease, pathology thyroid gland). Metabolic disorders have a negative impact on the fetus and ultimately lead to defects in its development.
- Bacterial and viral infections (rubella, toxoplasmosis, chickenpox, syphilis, influenza). If a woman has had one of these diseases during pregnancy, the child has a high risk of being born with cataracts and more severe defects. Rubella transferred in the 1-2 trimester is an indication for artificial termination of pregnancy.
Kinds
With a massive cataract interfering normal development eyes, the child is referred to an ophthalmic surgeon, who determines the indications for surgery and performs surgical treatment.
Diagnostics
Pathology can be detected even in the third trimester of pregnancy with the help of ultrasound screening. Statistics show that this method is reliable and, with sufficient attention of the uzist, allows diagnosing cataracts in advance. In newborns, the disease can be detected by examination and additional research methods.
Methods for diagnosing congenital cataract:
| Method | Description | Result |
|---|---|---|
| visual inspection | The ophthalmologist carefully examines the child in good light | During the examination, the doctor can identify white spots that are localized in the pupil area. |
| Biomicroscopy | The method involves examining the baby's eyes in the light of a slit lamp. | Biomicroscopy allows you to see lens opacities, as well as clearly determine their size and localization. |
| Ophthalmoscopy | The doctor examines the baby's fundus using a direct or indirect ophthalmoscope | The examination reveals neonatal retinopathy, which has similar symptoms |
| Ultrasound of the eyeball | The baby is examined using a special apparatus | Ultrasound makes it possible to visualize the structures of the eyeball and detect lens opacities |
Treatment
In the presence of small opacities, the treatment of congenital cataracts is carried out conservatively. In this case, a sick child is prescribed cytoprotectors and vitamins. Unfortunately, with a massive cataract, drug therapy does not have the desired effect.
Surgery indicated for children with central opacity of the lens, which greatly reduces visual acuity. Experts recommend removing such a cataract at the age of 6 weeks-3 months. The operation is most often performed by the method of irrigation-aspiration. The question of the timing of intraocular lens implantation is still controversial in medical circles.
Some doctors believe that IOL placement interferes with the normal growth and development of the eyeball. Therefore, it is better to implant an artificial lens in a child later, at the age of three or more years.
On the other hand, the intraocular lens provides the highest quality and physiological vision correction. Its setting helps to avoid the development of amblyopia and other undesirable consequences of the absence of the lens.
Rehabilitation
The recovery period after the removal of the lens lasts several weeks. During this time, the child's eye is completely healed. If the operation was performed at an early age, after a few years the baby will need another surgical intervention (intraocular lens implantation).
In the first week after surgery, the child needs to drip the medication prescribed by the doctor into the eye. They are necessary for the prevention of infectious and inflammatory complications. If the baby has not received an IOL, parents will need to ensure that the baby wears the products in the future. optical correction(glasses or contact lenses). This step is necessary for the normal development of the eye and the prevention of amblyopia.
Prevention
Prevention of the disease must be carried out during pregnancy. The expectant mother needs to carefully monitor her health and avoid the effects of harmful environmental factors. She will need to completely stop smoking and drinking alcohol. Women with diabetes during pregnancy should be under the constant supervision of an endocrinologist.
If during screening ultrasound examinations the unborn baby has serious defects, a woman may be recommended an artificial termination of pregnancy. Abortion is necessary when the child has severe developmental defects incompatible with life.
Useful video about congenital cataract
A cataract is a clouding of the lens. Unfortunately, it happens that a similar pathology is diagnosed in newborns. The result of a cataract is a sharp decline 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.
Statistics show that annually congenital cataract is diagnosed in 0.5% of all newborns. In this case, most often the degree of clouding of the lens is such that other methods of treatment, except for surgery, will not be effective. It happens that clouding affects only the peripheral region of the lens and does not affect the quality central vision. In such cases, drug therapy can be dispensed with.
Causes of congenital cataract:
- genetic predisposition (violations of the normal formation of the protein structure during embryonic development);
- metabolic disorders (including diabetes mellitus);
- use by the expectant mother of certain types of drugs (for example, antibiotics);
- intrauterine infection (rubella, measles, cytomegalovirus, chickenpox, herpes simplex and herpes zoster, polio, influenza, Epstein-Barr virus, syphilis, toxoplasmosis and others).
Sometimes congenital cataract is diagnosed in older children, but the causes of its occurrence remain the same.
There are several types of congenital cataract, depending on the localization of the pathological process in the structure of the lens:
- Anterior polar cataract. Point clouding is localized in the anterior part of the lens. This type disease is associated with genetic predisposition. Counts mild form cataracts, as it practically does not affect the visual acuity of the child and does not need surgical treatment;
- Posterior polar cataract. In this case pathological process localized in the back of the lens;
- Nuclear cataract. This is the most common type of cataract. Here the opacification is localized in the central part of the lens;
- Layered cataract. This is also the most common form of this disease. Opacification of the lens is localized in its central part around a transparent or cloudy nucleus. With this pathology, vision may decrease to minimal levels;
- Complete cataract. Opacification extends to all layers of the lens.
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).
From about two months old, a newborn baby 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 can notice that every time, trying to examine an object, the child tries to turn to him with the same eye.
Without timely treatment, cataracts can provoke the formation of amblyopia ("lazy eye"). Similar violation 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 scheduled 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 on solving this problem.
If the degree of clouding in the lens does not negative impact on the formation of central vision, then such a pathology does not require a radical solution and the child is put on a dispensary record. If the area of opacification in the thickness of the lens is quite extensive and negatively affects the central visual acuity, then an ophthalmologist raises the question of surgical removal of a cataract.
Of course, any surgical intervention is a certain risk of complications associated primarily with the effect of general anesthesia on children's body. Also, such a manipulation can provoke the development of secondary glaucoma, which is characterized by a persistent increase in intraocular pressure.
It is believed that the 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 decide that wearing contact lenses for a particular child is the most appropriate method of correction, in most such cases, lenses are prescribed for prolonged wear. The increased demand for them is associated with simplified operating rules.
The terms of implantation of an artificial lens, after removing the cloudy one, are set for each child individually, since it is likely that the 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 growing eyeball, and, accordingly, its changing refractive power. But, if you still managed to correctly determine this parameter, then you can avoid the development postoperative complications such as aphakia (complete absence of the lens in the eye)
Other possible complications after cataract surgery 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.
Strabismus
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 defect that has appeared is eliminated.
To remove the clouded lens in a child, a microsurgical operation is used, which is performed under general anesthesia. Laser correction is not used to treat children's cataracts.
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 simplest and affordable way improve visual acuity in a child with a removed lens. You will have to wear glasses after the operation all the time, because without them the baby will not be able to clearly see objects and freely navigate in space. Wearing glasses - perfect way postoperative correction for children whose cloudy lens was removed in both eyes.
An ophthalmologist may prescribe multifocal (allowing you to clearly distinguish objects that are at a far, medium and close distance) or bifocal (allowing you to see objects far and near) glasses.
If the baby was operated on only one eye, then the ophthalmologist will most likely prescribe the implantation of an artificial intraocular lens 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 need to consult an ophthalmologist, which will determine the exact parameters of the lenses and help you choose the model that is best suited 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 grows older, he will need to change contact lenses.
An artificial intraocular lens can be implanted during the actual operation 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 cataracts in children, see next video.
Source: http://www.o-krohe.ru/zrenie/vrozhdennaya-katarakta/
congenital cataract
congenital cataract- partial or complete clouding of the lens of the eye, developing in utero. AT varying degrees manifests itself from the moment the child is born: from a barely noticeable whitish spot to a completely affected lens.
Congenital cataract is characterized by a decrease in vision or its complete loss, and strabismus and nystagmus are also noted in children. Primary diagnosis carried out prenatally, after birth, the diagnosis is confirmed by ophthalmoscopy and slit biomicroscopy.
Surgical treatment is shown; lensvitrectomy is performed in the first months of life in uncomplicated cases.
Congenital cataract is a pathology of the organ of vision, often found in the clinic of many childhood diseases. In 36% of cases, it occurs as a result of intrauterine infections. The general frequency of congenital cataract in the population is 1-9 cases per 10,000 newborns. The share of this disease among all defects of the organ of vision is 60%.
No gender differences in incidence were found, with the exception of genetic mutations, which are more common in boys, while girls often remain asymptomatic carriers of the altered gene. Currently, the problem of congenital cataract in pediatrics is given Special attention. The disease is caused by many reasons, so the efforts of doctors are aimed at the prevention and early diagnosis of cataracts.
Improving methods of surgical treatment. All measures are aimed at preserving the child's vision for better social adaptation.
Causes of congenital cataract
Most often, congenital cataract accompanies a group of TORCH infections, which includes rubella, toxoplasmosis, herpes virus and cytomegalovirus infection. However, it is not the only symptom. Each disease has its own specific symptoms.
The second most common cause of congenital cataracts is metabolic disorders in a child: galactosemia, Wilson's disease, hypocalcemia, diabetes mellitus, and others. Occasionally, the disease occurs in connection with genetic mutations in the autosomal dominant and autosomal recessive types.
Mutations linked to the X chromosome are even rarer.
In the case of chromosomal pathologies (Down's syndrome, cat's cry syndrome, punctate chondrodysplasia, Hallermann-Streiff-Francois syndrome, etc.), congenital cataract is also not the only symptom.
As a rule, it is accompanied by disorders of physical and mental development and other manifestations specific to a particular nosology.
Exogenously acting causes of the disease can be antibiotic therapy of a pregnant woman, steroid hormone therapy, radiation therapy and influence of other teratogenic factors. Separately allocate congenital cataract of prematurity.
Opacification of the lens occurs by one of two mechanisms. Firstly, initially incorrect laying of the organ of vision. It is characteristic of intrauterine infections in the early stages of pregnancy, chromosomal pathologies, and in general any teratogenic effect if it occurs in the first weeks of pregnancy, when the organ system of vision is formed in the fetus.
The second mechanism is the defeat of the already formed lens. It often occurs with metabolic disorders (galactosemia, diabetes mellitus, etc.), exposure to external damaging factors during pregnancy (second or third trimester).
In any case, the structure of the lens protein changes, due to which it gradually becomes hydrated and then loses its transparency, as a result of which a congenital cataract develops.
The disease is divided into types depending on the location of the turbidity zone and its vastness. There are the following types of cataracts: capsular, polar (anterior and posterior), layered (membraneous), nuclear, complete.
Capsular congenital cataract is a decrease in the transparency of the anterior or posterior lens capsule. The lens itself is not affected. Visual impairment is often minor, but blindness also occurs if the damage to the capsule is extensive, or both the anterior and posterior capsule simultaneously.
With a polar cataract, changes affect the anterior or posterior surface of the lens. The capsule is most often also involved in the process. This species is characterized by bilateral lesions. The degree of visual impairment varies greatly.
A stratified cataract is a clouding of one or more of the central layers of the lens. The most common type of congenital cataract is usually bilateral. Vision is usually significantly reduced.
Nuclear cataract is called clouding of the central part of the lens - its nucleus. This type occurs in all hereditary causes diseases. The lesion is bilateral, vision is reduced up to complete blindness.
Complete congenital cataract is characterized by clouding of the entire lens. The degree of clouding varies, but more often this form of the disease completely deprives the child of vision. The defeat is bilateral.
By origin, congenital cataract is divided into hereditary and intrauterine. The first of them is transmitted to the child from one of the parents, the second develops in the fetus directly during pregnancy. Atypical (polymorphic) is considered a cataract of complex shape.
There are unilateral and bilateral cataracts, and the disease is also classified according to the degree of visual impairment (I-III degrees are distinguished).
Some classifications separately designate a complicated form of cataract, but this can be called any clouding of the lens, accompanied by diseases of other organs.
The main symptom is clouding of the lens of one degree or another. In the clinical picture, it may appear as a noticeable white spot against the background of the iris, but more often there are cases of congenital cataracts when this symptom is absent. With a unilateral lesion, strabismus is noted, as a rule, converging.
Sometimes, instead of it, pathological rhythmic trembling of the eyeball is found. Almost all children with bilateral congenital cataracts have nystagmus.
At about two months of age, healthy children can already follow the object with their eyes, but this does not happen when they become ill, or the baby always turns towards the object only with his healthy eye.
Diagnosis of congenital cataract
Primary diagnosis is carried out during the planned ultrasound screening of pregnant women. Already in the second trimester, the lens is visualized on ultrasound as a dark spot (normal). There are cases when the second ultrasound still cannot reliably exclude or confirm the diagnosis, and then this can be done in the third trimester. It is important to understand that at this stage the diagnosis cannot be confirmed 100%, but the disease can be suspected, and statistics show that the method in high degree reliable.
After the birth of a child, the pediatrician will be able to notice only an intense clouding of the lens of the central localization. Most often, a cataract cannot be diagnosed by physical examination. An examination by a pediatric ophthalmologist is mandatory for all newborns.
The specialist will be able to suspect and confirm the diagnosis of congenital cataract, noticing even a slight violation of the passage of light through the lens. Also, the doctor will detect strabismus and nystagmus.
Because congenital cataracts are associated with many intrauterine infections, metabolic disorders, chromosomal pathologies, then when diagnosing these diseases, the child will be examined to exclude eye defects.
The following methods are used to diagnose congenital cataract: instrumental methods: ophthalmoscopy, slit biomicroscopy, ultrasound of the eyeball. All of them make it possible to verify the change in the transparency of the lens and to exclude similar diseases in the clinic.
In particular, retinopathy in children is also characterized by visual impairment and strabismus, however, in this case, the cause is damage to the retina, and examination with an ophthalmoscope will allow this to be established. Tumors of the outer part of the eye can significantly reduce vision, as can congenital cataracts.
Visual inspection, ophthalmoscopy, ultrasound methods and X-ray diagnostics help to differentiate them.
Treatment of congenital cataract
conservative methods treatment is justified only with a slight clouding of the lens. In therapy, cytoprotectors and vitamins are used. However, most often, congenital cataracts are treated surgically.
Surgical removal should be done as early as possible to allow for proper eye development. Cataract surgery - lensvitrectomy - is considered the least traumatic in childhood, so it is done most frequently.
The condition after removal of the lens is called aphakia and requires long-term dynamic observation and vision correction.
Aphakia is corrected with glasses or contact or intraocular lenses. Observation by an ophthalmologist is necessary in order to exclude possible postoperative complications, in particular, glaucoma. A few decades ago, the list of complications was more extensive, but with the introduction of lensvitrectomy, most of them were reduced to a minimum. So, cases of retinal detachment, corneal edema, endophthalmitis and amblyopia are extremely rare.
Prediction and prevention of congenital cataract
Modern methods of surgical treatment provide a favorable prognosis in most cases. Removal of the affected lens at the age of up to six months (better in the first weeks and months) and further vision correction contribute to a good social adaptation of children in adulthood.
It should be noted that monocular congenital cataract responds to treatment much worse and currently gives the largest number all complications associated with this disease.
In addition, cataract is extremely rare in isolation, so the prognosis is also determined by comorbidities: infections, metabolic disorders, chromosomal pathologies, etc.
Prevention of congenital cataracts is carried out during pregnancy. It is necessary to exclude the contact of a woman with infectious patients, to minimize the impact of teratogenic factors (alcohol, smoking, radiation methods of diagnosis and therapy, etc.).
Women with diabetes should be monitored by an endocrinologist throughout pregnancy. Chromosomal pathologies in most cases are diagnosed before childbirth, and then a woman can already decide to terminate a pregnancy or deliberately carry a child.
There is no specific prophylaxis for congenital cataracts.
Source: http://www.krasotaimedicina.ru/diseases/children/congenital-cataract
Causes of development and methods of treatment of congenital cataract in children
A congenital cataract is a clouding of the lens that occurs in a newborn baby. However, quite often this pathology is not detected immediately, but after a while after a detailed examination.
If any signs appear that indicate a cataract in a child, you should seek help from an ophthalmologist.
The lens in a healthy child is a transparent biconvex lens, which is a refracting medium. There is no innervation or blood supply in it, and food is produced due to the watery structure of the organ of vision.
There are factors that lead to a violation of the composition of the proteins of the lens fibers, as a result of which it loses its transparency.
According to statistics, this disease is diagnosed in one newborn child out of two thousand. Moreover, the defeat is usually unilateral.
Classification
This pathology has quite a few varieties, each of which has some features:
Capsular cataract is an isolated lesion of the posterior or anterior lens capsule. In such a situation, vision may be slightly blurred or completely absent - it all depends on the area of \u200b\u200bthe lesion. Metabolic disorders in the mother's body or inflammation during fetal development lead to the development of this pathology.
polar cataract- damage not only to the capsule, but also to the surface of the lens. As a rule, this form of pathology is characterized by a bilateral lesion. The quality of vision is affected by the intensity and area of the lesion.
Layered cataract- damage to the central region of the lens. This form of the disease is most common, its danger is that the child almost completely loses his sight. The main reason for the development of pathology lies in hereditary predisposition.
Complete cataract- this pathology develops in two eyes at once, and it is characterized by such a strong degree of clouding that, as a rule, children are born blind. In addition, a complete cataract is accompanied by other eye diseases - strabismus, hypoplasia. yellow spot.
Complicated cataract- this disease is a consequence of infection with viral or bacterial infections on the early stages pregnancy. In this case, two eyes are affected at once, and other diseases are almost always present. Moreover, comorbidities do not necessarily affect the eyes at all - violations can affect the hearing organs, speech apparatus, heart or nervous system.
Reasons for the development of the disease
There is a whole group of risk factors that increase the risk of developing congenital cataracts:
genetic predisposition This disease can be inherited in an autosomal dominant manner.
Metabolic disorders- hypocalcemia, myotonic dystrophy, diabetes mellitus.
Genetically determined pathologies in a child - this may be Down's, Lowe's or Marfan's syndrome.
intrauterine infectious diseases- the development of congenital cataracts is often provoked by syphilis, rubella, toxoplasmosis, herpes, chicken pox.
Intrauterine inflammatory processes of the organs of vision - for example, iritis.
Diagnosis at an early stage
Diagnosis of this disease begins with a visit to an ophthalmologist. In order to timely identify pathology, you need to know what symptoms it is accompanied by:
- clouding of the pupil;
- lack of gaze fixation at the age of two months;
- strabismus;
- viewing objects with one eye;
- nystagmus;
- severe amblyopia - blindness associated with lack of treatment.
In addition, a pediatric ophthalmologist should conduct the following types of studies that will help detect the disease:
- Ophthalmoscopy.
- Optical coherence tomography.
- Slit biomicroscopy.
- Echoophthalmoscopy - ultrasound of the eyeball.
Features of surgical treatment
Exist different approaches for the treatment of congenital cataracts.
- If it negatively affects central visual acuity, the cataract should be removed as soon as possible.
- If the location of the clouding does not affect the clarity of central vision, such a cataract does not need surgical treatment, but requires dynamic monitoring.
At the same time, the operation is also associated with the threat of complications - in particular, an increase in intraocular pressure. General anesthesia used for surgery is also a risk factor.
Many doctors claim that appropriate age for a child surgical correction– from 6 weeks to 3 months. Today there are several types of interventions:
- extracapsular cataract extraction;
- cryoextraction;
- intracapsular cataract extraction;
- phacoemulsification.
Rehabilitation and development of vision in children
After the operation, it is very important to special treatment providing visual perception at the baby. Thanks to this, it will be possible maximize visual acuity.
After removal of the cataract, the condition in which the lens is missing in the eye is called aphakia. It is determined by the trembling of the iris and the deep anterior chamber. This condition needs correction, which is carried out by means of positive lenses.
For this can be used:
- Contact lenses - shown up to the age of two years.
- Glasses - used for bilateral pathology at an older age.
- Epikeratoplasty is indicated for the correction of aphakia.
- Intraocular lens implantation is the least suitable method for young children. But for older children it is used quite often.
Congenital cataract is an extremely serious disorder that can cause deterioration or even loss of vision. To prevent this from happening, it is important to identify the disease in a timely manner and take measures to eliminate it.
Sometimes you can't do without surgical intervention. If such a need arises, priority should be given to postoperative rehabilitation.
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Source: http://www.help-eyes.ru/zabolevanie/katarakta/ktr-vrozhdennaja-u-detej.html
Cataract in children under one year old and older (congenital, etc.): causes, symptoms, treatment, etc.
Vision plays very important role in the processes of learning and adaptation in the world around, for a child this is an extremely valuable mechanism for development.
Unfortunately, many eye diseases have become much younger, experts attribute this to the deterioration of environmental conditions, the wrong lifestyle that many people lead, and high stress due to constant contact with phones and computers.
During a visit to the doctor, the diagnosis of "cataract" leads many parents into a state of shock and all because of the fear that the child may forever lose the joy of seeing the world around him in all its colors.
Such fears often turn out to be groundless - modern technologies make it possible to slow down the destructive processes occurring in the body, but this is subject to timely seeking help. In infants, this disease is extremely rare - only a few cases per 10 thousand newborns, but under the influence of certain factors, the disease can develop at any age already as an acquired pathology.
Congenital cataract: causes and symptoms
Many mistakenly believe that a cataract is the formation of a film on the lens, which interferes with the normal perception of surrounding objects through vision.
In fact, the disease is not outside, but inside the eye, that is, a cataract is a clouding of the substance in the lens, which prevents the normal passage of light.
A healthy lens is absolutely transparent, and clouding causes a decrease in visual acuity and, without appropriate treatment, can lead to its complete loss.
Cataract is a pathology of the lens of the eye, which leads to partial or complete loss of vision. The lens of a healthy eyeball is transparent, but the disease makes it cloudy, due to which the rays of light are refracted incorrectly. So an eye affected by a cataract projects a fuzzy, blurry image.
Children's cataract- a disease that most often occurs in newborns. However, there are cases of acquired cataracts in children under the age of one year. If you do not treat the affected eye, the child may go blind, because this disease is progressive. With the timely treatment of parents to the clinic, it is possible to get rid of the pathology and restore full vision. 
Clouding of the lens in cataracts can be either complete or partial. The degree of the disease is determined by an ophthalmologist through examination and special tests. Even if the pathology is visually visible only on one eyeball, the specialist diagnoses both eyes.
Cataract in children can develop and provoke the appearance of accompanying diseases:
- eye inflammation;
- retinal detachment;
- swelling of the eye;
- dislocation of the lens;
- amblyopia;
- secondary cataract.
Types and degrees of the disease
Based on the time of occurrence of childhood cataracts, the disease can be divided into 2 types:
- congenital - detected after examination in the first days of the baby's life;
- acquired - diagnosed after 2-3 months after birth, sometimes after the first year of life.
Depending on the location, the pathology has the following types:
- capsular - clouding extends only to the lens capsule;
- polar - touches the capsule and the substance of the lens;
- layered - spreads along the center of the lens;
- nuclear - at best, it affects only the embryonic nucleus, then visual acuity decreases slightly. However, most often the disease is hereditary and vision gradually deteriorates to complete blindness;
- full - congenital pathology when a baby is born with a completely clouded lens and reacts only to bright light;
- complicated - occurs due to the development of another disease. For example, diabetes, deafness, heart disease, etc.
The degree of the disease is determined by the doctor after the diagnosis. The greater the damage to the lens, the worse the patient's vision. There is one- and two-sided cataract. Unilateral affects one eye and is more dangerous due to the risk of amblyopia. With lazy eye syndrome (amblyopia), the work of one organ of vision is suppressed and the entire load goes to the second, healthy eye. Thus, the disease progresses faster, which leads to irreversible loss of vision. 
Congenital cataract in children develops in utero and may occur due to such factors:
- viral disease during the first trimester of pregnancy;
- abuse of alcohol, drugs or contraceptives during pregnancy;
- chronic diseases parents;
- different Rh factor in mother and child;
- lack of vitamins;
- metabolic disorders.
Cause the occurrence of congenital cataracts can become premature birth. In premature babies, the visual system is not fully formed, which can lead to the development of cataracts and other eye diseases.
Acquired children's cataract arises due to the negative impact on the fragile body of external factors:
- head and eye injuries;
- bad ecology;
- baby diseases (diabetes mellitus, infection, toxocariasis and others);
- taking medicines that are not suitable for children;
- disturbed metabolism;
- radiation radiation.
Depending on the causes of cataracts in children and the nature of the course of the disease, appropriate treatment is prescribed. If you turn to the clinic for help at the initial stages of the development of pathology, it is possible to restore the ability of the lens to focus light rays. 
Symptoms
It is quite difficult for parents to identify the symptoms of cataracts in young children. The behavior of the child should be carefully observed. Signs of cataract in newborns:
- gray/white pupils;
- the child's eyes run fast, do not focus on one point;
- the child does not observe what is happening around or examines objects with one eye;
- strabismus.
In one-year-olds and older children, cataracts appear gradually. Visual acuity decreases depending on the degree of damage to the lens.
Symptoms of children's cataract:
- blurred look;
- when viewing a picture or photo, the child cannot clearly answer what exactly is shown there due to the blurring of the lines;
- in ordinary situations from life, the child behaves differently, becomes irritable, withdraws into himself;
- complaints of flashing before the eyes of points, stripes;
- the color of objects is distorted, the shades are confused.
Cataract can cause poor development of the baby. Due to insufficient visual acuity, the child loses interest in activities that require prolonged concentration. It is very difficult to learn how to read, write, because even lines seem blurry, letters blur and become like spots. To exclude vision problems in such cases, it is necessary to undergo an examination. Doctors recommend checking your child's vision at least once a year.
Congenital cataracts are often diagnosed at the first examination of the baby after birth. However, the pediatrician does not always state vision problems in a child. Most often, the disease is detected when you return to the clinic for a routine examination. Also, parents, when symptoms are detected, independently record their children for an appointment with an ophthalmologist.
The ophthalmologist is primarily engaged in collecting an anamnesis - information that will help in making a diagnosis (information about the medical history, previous diseases etc.). After that, visual acuity is checked, the retina is examined, visual fields are revealed, pressure inside the eyeball is measured.
Possible examinations that a child must undergo for an accurate diagnosis:
- ophthalmoscopy - assessment of the condition of the fundus using a mirror or electric ophthalmoscope;
- optical coherence tomography (OCT) - using a special device, the layers of the retina are scanned, after which the image is transmitted to the monitor;
- biomicroscopy - examination of the cornea, lens, anterior segment eyes. Diagnostics takes place in complete darkness, the ophthalmologist directs a beam of light at the patient's lens and, through a microscope mounted on a special device, determines the transparency of the lens, the refractive power, etc.
Older children are prescribed a visual acuity test according to the Sivtsev or Orlova table. Letters are located in the lines of the first table, so this diagnosis is carried out for school-age children. Orlova's table contains pictures instead of letters, which is why the table is used to test visual acuity for patients who do not yet know the alphabet. 
Cataract treatment medications is not efficient. Eye drops can only slow down the development of the disease, but not restore full vision. the only way out for small patients is surgery.
Surgery is carried out taking into account the following factors:
- patient's age;
- degree of cataract development;
- type of disease;
- the presence of accompanying diseases.
Carry out under general anesthesia. The essence of the treatment is that the affected lens is removed, and a new one is put in its place, which will play the role of a natural lens. artificial lens has a large optical power, which allows the child to restore full vision. The implant is replaced as the child grows.
Cataract removal surgical method takes from 15 minutes to half an hour, depending on the complexity of the case. Infants after surgery are placed in a hospital, and older children can undergo recovery period at home.
The success of the operation also depends on the rehabilitation process. The eye heals for about two weeks. To avoid the occurrence of complications, it is necessary to follow the doctor's prescriptions: use special eye drops for the prevention of infectious diseases, regularly come for examinations, avoid getting water in the eyes for one month.
An ophthalmologist may also prescribe the wearing of glasses to correct vision. This is possible with a bilateral form of the disease. Spectacles can be with multifocal and bifocal lenses. The former help to focus vision on objects that are near, far and at an average distance from the child. Bifocals allow you to see well what is far or close. 
If one of the parents (or both parents) has a cataract, then you need to inform the gynecologist about this even before conceiving a child. It is necessary to undergo examinations to identify the factor of heredity of the disease. To exclude the development of cataracts in utero, the mother of the child is prescribed special treatment, taking vitamins. Also future mom should:
- stop drinking alcohol and strong drugs;
- timely treat infectious diseases if they occur during pregnancy;
- protect yourself from injury, radiation;
- spend more time outdoors
- Healthy food;
- worry and worry less to eliminate the risk of preterm birth.
For the prevention of acquired cataracts in children, it is necessary to adhere to the following recommendations:
- provide optimal lighting in the nursery so that the child is comfortable playing and studying;
- watch the baby's food. Vegetables, fish, fruits, dairy products should always be present in his diet so that the body is saturated with vitamins and minerals;
- walk outdoors more. Limit the time you watch cartoons, games on a computer or tablet;
- don't forget to pass scheduled checkups at the ophthalmologist every year;
- take care of your child's hygiene. Infectious diseases associated with unwashed hands are one of the causes of eye diseases;
- Buy sunglasses for your child. This should be done only in optics under the guidance of a specialist. Otherwise, there is a risk of buying glasses with poor quality lenses that will not protect the eyeball from ultraviolet radiation and bright light.
Cost of cataract surgery
| Last edit: | 06.05.2019 | Surgical treatment of cataract | № | Service name | Price, UAH | 1 | 8000,00 | 2 | 8950,00 | 3 | Cataract phacoemulsification with IOL implantation "SL 907" (US Optics) | 9950,00 | Cataract phacoemulsification with IOL implantation "611HPS" "/ 640AB Q-Flex | 13250,00 | 4 | 13250,00 | Cataract phacoemulsification with IOL implantation "SA60AT" (Alcon) for the disabled, combatants, participants in the liquidation of the accident on Chernobyl nuclear power plant upon presentation of the relevant certificate | 13250,00 | 5 | Phacoemulsification of cataract with implantation of aspheric IOL "Clare" (Cristalens) | 15950,00 | 6 | Cataract phacoemulsification with implantation of IOL "SA60AT" (Alcon) / IOL "MA60MA" (Alcon) / IOL "MA1AC" (Alcon) with a 5% discount | 18700,00 17750,00 | 7 | Cataract phacoemulsification with IOL implantation "Hydro-Sense Aspheric" (Rumex) | 18400,00 | Phacoemulsification with implantation of an aspherical IOL Basis Q B2AW00 / Basis Z B1AW00 (1stQ) (Germany) | 14700,00 | 8 | Cataract phacoemulsification with implantation of aspheric IOL "SN60WF" IQ (Alcon) with a 5% discount | 22000,00 20900,00 | Phacoemulsification of cataract with implantation of aspheric IOL "TECNIS Q" (Johnson & Johnson) with a 5% discount | 19250,00 16750,00 | 9 | Cataract phacoemulsification with aspheric IOL implantation "Adapt AO / MI 60" (Bausch & Lomb) with a 5% discount | 23050,00 21900,00 | Phacoemulsification of cataract with implantation monofocal toric IOL "SN60T3 -T5" (Alcon) | 24300,00 | 10 | Phacoemulsification of cataract with implantation monofocal toric IOL "SN60T6-T9" (Alcon) | 33500,00 | 11 | Cataract phacoemulsification with implantation of multifocal IOL "Lentis 313" (Oculentis) / Medicontur Liberty | 35500,00 | 12 | Cataract phacoemulsification with implantation of multifocal IOL "AcrySof IQ PanOptix" (Alcon) with a 5% discount | 47300,00 44900,00 | 13 | Cataract phacoemulsification with toric IOL implantation Acrysof Panoptix TFNT 20 (Alcon) USA with 5% discount | 52650,00 49990,00 | Cataract phacoemulsification with toric IOL implantation Acrysof Panoptix TFNT 30 Alcon USA with 5% discount | 56750,00 53900,00 | 14 | Phacoemulsification of cataracts with implantation of toric IOLs Acrysof Panoptix TFNT 40, 50, 60. Alcon with a 5% discount | 60950,00 57900,00 | 15 | Surcharge for complications of cataract phacoemulsification | 2900,00 | 16 | Removal of secondary cataract (surgical method) | 6900,00 | 17 | YAG laser discission of secondary cataract | 3800,00 | 18 | Surcharge for surgery on the lens, complicated by other diseases (infectious and post-traumatic diseases of the cornea, diabetes mellitus, glaucoma, cicatricial changes in the eyeball, subluxation of the lens, uveitis, complications of myopia, refractive surgery) | 6900,00 | 19 | Suture fixation of the IOL | 8900,00 | 20 | Phacoemulsification of cataract with IOL implantation "HemaFold" (Global Ophthalmics) | 8000,00 | 21 | Cataract phacoemulsification with IOL implantation (US Optics) | 8950,00 |
Cataract is an eye disease accompanied by clouding of the lens. As a rule, cataracts in children are congenital. According to medical research 5,000 out of 100,000 newborns have cataracts; in older adults, three to four children out of ten thousand.
Cataracts in children can be unilateral or bilateral. It is amenable to treatment, prescribed only by a doctor, based on the severity of the disease and the age of the child.
There are two types of cataracts in children:
- Congenital. It is either already present in the baby at birth, or appears within a few days after.
- Acquired. It can appear at least two months after birth.
Causes
Unfortunately, there are many reasons that cause clouding of the lens of the eye.
Causes of congenital cataract:
- Genetics. Usually, congenital cataracts in children appear due to a "breakdown" in the genes received from both parents. Further, the lens of the eye begins to develop abnormally.
- Chromosomal disorders related to various pathologies. For example, Down syndrome.
- Infections carried by the mother during gestation - toxoplasmosis (a helminth infection that can be contracted through water, soil, and also from pets); rubella (virus, the body is covered with a red blistering rash); chickenpox (a milder form of chickenpox); cytomegalovirus (a common viral disease that is often asymptomatic and has unpleasant consequences); herpes virus.
Causes of acquired cataract in a child:
- Eye damage. For example, during an injury or after surgery.
- Galactosemia. With this pathology, the child's body cannot break down galactose.
- Toxocariasis. A rare disease that affects the eyes. More often infected with toxocariasis from animals.
Symptoms
The manifestation of the disease in a child is affected by the degree of clouding of the lens, damage to one or both eyes, and localization of the focus of clouding.
Even in the hospital, doctors will be able to determine the presence of a disease in a newborn.
At the age of one month, ophthalmologists check the child's vision at a preventive examination.
Children's cataract can be visually recognized if:
- one or both pupils of the child became white or gray;
- the child is not able to focus, for example, on a toy, he inactively watches moving objects, people;
- child's eye movements become uncontrollable.
The manifestation of a cataract in a child in the eye. To enlarge, click on the picture.
The first "bell" of the development of a cataract in a baby can be a changed behavior. For example, a child looks at rattles with just one eye. Schoolchildren begin to study worse, it becomes more difficult for them to focus their eyes and concentrate. Parents who notice such changes should take them seriously and immediately bring the child to an ophthalmologist for examination.
Note that such symptoms may indicate the presence of other eye diseases in the child. In any case, only a specialist will be able to correctly diagnose the disease and prescribe the necessary treatment.
Diagnostics
As mentioned above, cataracts in newborns can be determined even in the hospital. If the child was born healthy, mom and dad should be observant and not neglect visits to doctors.
If the ophthalmologist suspects a cataract, he will drip the baby special drops causing the effect of short-term mydriasis (pupil dilation). After that, the child's eyes will be examined with the help of special equipment.
If, during examination, the doctor reveals the absence of a red reflex and clouding of the lens in a child, then most likely he will be diagnosed with a cataract.
Non-surgical treatment
If a cataract is diagnosed in a baby, the doctor will prescribe treatment based on the degree of the disease.
When illness does not interfere visual system child to develop normally, conservative therapy will be prescribed.
For example, a doctor may prescribe eye drops (Quinax, Oftan Katahrom, Taufon). It is forbidden for a child to drip drugs at his own discretion; a preliminary consultation with an ophthalmologist is necessary.
Folk ways
Sometimes for the treatment of cataracts resort to the achievements of alternative medicine:
- Dill seeds. Take 3 teaspoons of dill seeds, place them in 2 cloth bags (it should hold water well) measuring five by five centimeters. Pour water into bags with seeds and boil. Then cool them and apply to the eyes. Keep the compress for 15 minutes.
- Calendula. Take 2 teaspoons of calendula officinalis flowers and pour 2 cups of boiling water. The resulting infusion can be used orally, as well as rinse their eyes.
- Parsley and carrot juices. You need to combine them in a ratio of one to ten, mix well. Drink 3 times a day.
- Spinach and carrot juices. Connect in a ratio of one to five. Drink 3 times a day.
Operational treatment
If the cataract becomes a factor that interferes with the normal development of the baby's vision, then it must be removed surgically.
The operation for babies with cataracts is carried out not earlier than two or three months of age. Operations are not performed on children up to six weeks of age, as the risk of harm from general anesthesia is too great.
Three-month-old babies are operated on by an aspiration-irrigation method through a very tiny incision.
There are also other types of operations to remove cataracts in newborns:
- Operation according to the method of cryoextraction. The lens is removed by "sucking" it to the cold tip of the cryoextractor.
- Operation according to the method of intracapsular extraction. With the help of an ice metal rod, the lens is removed along with the capsule. With extracapsular extraction, the capsule is not removed, but remains in the eye. The core and matter are removed.
- Phacoemulsification. During the operation for this method several two-three-millimeter incisions are made. Through them, the lens is exposed to ultrasonic radiation. It is converted to an emulsion, then removed. Where the lens used to be, a special elastic lens is placed. It fits well inside the eye.
The duration of the operation is on average two hours. Anesthesia is general. If the cataract has affected both eyes, then the manipulations are carried out on each eye separately, and a time interval of a week is made between them.
After surgical intervention the affected eye is covered with a bandage. The child remains in the hospital for a short time, then he is discharged.
Note: Lens implant surgery can be performed on children over four years of age. Small children are operated on by the method of irrigation-aspiration.
Postoperative period
After the patient's eyes have been operated on and the lens removed, the doctor will prescribe contact lenses or glasses if both eyes were sick, since the eyes cannot focus on their own.
Also, glasses or lenses are prescribed to children when they have been given artificial lenses during surgery. After all, they work, as with farsightedness - they focus well on distant objects, and close ones will not be clearly visible.
Usually, the ophthalmologist prescribes lenses or glasses not immediately, but after a while after the operation. The doctor is obliged to explain the rules for caring for lenses, the frequency of their change.
If the child has had surgery on one eye, the doctor may prescribe a bandage on the healthy eye. You need to wear it for a short time until the operated eye will work. If earlier the diseased eye could not transmit the signals seen to the brain, then after wearing such a blindfold, the eyes will work as expected. The baby needs the support of parents, the process is not very pleasant.
Note that after the operation, the child must periodically come to the ophthalmologist for examination.
- Women planning a pregnancy need to cure chronic diseases or put them into stable remission.
- During pregnancy, exposure to radiation, toxic waste, viral diseases should be avoided.
- It is necessary to give children vitamins for the eyes (B1, B2, B12 and others prescribed by a doctor). Nutrition must be balanced.
- After the operation, you need to support the child and follow the advice of ophthalmologists.
Summary
cataract is serious eye disease requiring immediate therapy and strict control.
Due to environmental degradation, women's lack of control over their own health during pregnancy, babies with congenital cataracts are becoming more and more common.
This disease can also manifest itself after birth. To exclude the development of pathology, it is necessary to be attentive to the health of your own and your children.