Cataract in children types of treatment causes. The whole truth about cataracts in children: possible dangers and surgery as the only way to treat

The lens is a transparent body that serves to refract light rays and focus them on the retina. It is located behind the iris. Clouding of the lens directly affects vision, since this structure, together with the iris, makes up the optical system of the eye. Cataracts in children can interfere with the normal development of the visual analyzer and cause a lifelong visual defect. Therefore, clouding of the lens requires immediate treatment.

Varieties and features of cataracts in children

Cataract is an eye disease in which the lens becomes cloudy. Most often, cataracts are diagnosed in the elderly, although clouding can also occur in children. At an early age, the disease is most often due to congenital factors.

Statistics show that 5 out of 100,000 children have cataracts. Older children suffer from the disease more often: three cases per 10 thousand. Cataracts in children are constantly progressing and can end in complete blindness. Only timely diagnosis and proper treatment can save visual function.

Types of cataract according to the degree of manifestation are divided into unilateral and bilateral. According to the degree of maturity, the initial, immature, mature and overripe turbidity are divided.

Types of pediatric cataract:

• congenital (manifested immediately after birth or in a short time after childbirth);
• acquired (manifested a few months or years after the birth of the baby).

Children are more often diagnosed than acquired. Congenital turbidity is difficult to prevent. A woman should monitor her health at the planning stage and during pregnancy, as well as protect herself from infections.

It must be remembered that no drops will cure cataracts. Only a few of the modern drugs can resolve the opacities, but only with long-term treatment, and the results will be negligible.

It is often misunderstood that cataract surgery is a lengthy process that requires hospitalization. Typically, patients are sent home immediately after surgery, which is quick, safe, and minimally invasive. No stitches are required after cataract removal.

Signs of cataract in children

The clinical picture of cataracts will depend on certain factors. It is necessary to take into account the degree of clouding and its localization, as well as whether one or both eyes are affected. In cataracts, the lens masses become cloudy and prevent light from reaching the retina.

Parents rarely can independently identify cataracts in a newborn, so this is done by a doctor in the maternity hospital. A month after birth, a thorough preventive examination is carried out.

Late signs of cataract in infants:

• pupils become gray or white;
• rapid eye movements, sometimes uncontrolled;
• decreased visual acuity (the child is not able to focus his eyes, the activity of observing moving objects decreases).

You can recognize the first signs of cataract by the behavior of the baby. It becomes difficult for the child to focus on toys, he examines them with one eye. Older children experience difficulties in the learning process, attention and concentration suffer.

Parents should monitor the child and, if symptoms are detected, contact a specialist. The above symptoms may indicate not only cataracts, but also other diseases that require urgent treatment.

Causes of clouding of the lens in children

Very often, the cause of a cataract cannot be determined. In this case, doctors suggest factors that most often cause clouding of the lens.

Usually, the cause of congenital cataracts is infections carried by the mother in the first trimester. Acquired clouding develops due to trauma, glaucoma, systemic pathologies (Down, Lowe, Marfan, Hallermann-Streif-Francois or Alport syndromes).

Cataract diagnostics

Cataracts in children are detected during a routine ophthalmological examination, so you can not ignore the doctor's advice. Only an experienced ophthalmologist can correctly diagnose a cataract. It is almost impossible to detect turbidity at home. Therefore, it is important to observe the regimen of visiting a pediatric ophthalmologist.

Congenital cataracts can be detected even in the parental home. However, if the pathology has not been identified by doctors, this does not mean that turbidity will not occur in the future.

To conduct an accurate diagnosis, infants are introduced into drug sleep. The inability of the child to be at rest during the examination often leads to errors in the examination. For this reason, ophthalmologists often overlook other ocular pathologies in children who are examined while awake.

Examination of children in drug-induced sleep allows you to carefully conduct those examinations that are necessary for the individual selection of intraocular lenses. They are implanted into the eye in place of the removed lens in the treatment of cataracts.

In children from two years old, it is easier to identify congenital and acquired cataracts. Changes can be analyzed using a slit lamp. If suspected, the doctor prescribes drops to dilate the pupil. For visual inspection, tools equipped with a magnifying glass and lighting are used. With their help, the doctor sees the state of the eyeball and its structures, and also reveals the first signs of cataracts (clouding of the lens masses and the absence of a red reflex).

Surgical treatment of pediatric cataract

Treatment of cataracts in children takes a long time because clouding is often combined with other ophthalmic pathologies. The process begins with the diagnosis and ends with the full development of the visual system, which occurs during adolescence.

To determine the time and intensity of therapy, the doctor must take into account the age of the patient, the spread of the pathological process, the presence of complications. It is important to analyze all the positive and negative aspects of the operation. The main disadvantage of cataract removal in children is a violation of the natural mechanism of accommodation (focusing the gaze at different distances). Cataract is treated only through surgery. When the opacification is located peripherally and does not affect visual acuity, surgical removal is not required.

Before the operation, it is necessary to conduct a complete examination of the eyes, even if the disease has affected only one. In addition to turbidity, infants may have other pathologies that are not diagnosed visually. Therefore, it is important to assess all risks and identify all contraindications.

Cataract surgery involves general anesthesia, since it is impossible to achieve immobility from infants. Modern techniques and microsurgical instruments make it possible to completely remove the pathology and almost 100% prevent its recurrence.

Hospitalization is required for newborns under three months of age. Older children can go home a few hours after surgery. For the rehabilitation period, special drops are prescribed to protect the eyes and speedy recovery. Sometimes small patients are prescribed glasses or lenses that provide normal perception of objects.

Children are not allowed to touch and rub their eyes, as well as visit the pool. At the stage of rehabilitation, it is necessary to regularly see a doctor, assess the degree of recovery and, if necessary, eliminate complications in a timely manner.

After cataract surgery, redness of the eyes and the development of strabismus are possible. With these deviations, you need to urgently contact an ophthalmologist to exclude weakening of the eye muscles and infection.

Postoperative complications:

• strabismus;
• loss of the rounded shape of the pupil;
• retinal damage;
• glaucoma (increased intraocular pressure);
• rarely endophthalmitis (severe infection).

Cataract in children is a serious disease that requires constant monitoring and timely treatment. Although the disease often affects the eyes of older people, children can also suffer from its manifestations. Even after recovery, it is necessary to monitor the behavior of the child in order to exclude the development of related pathologies.

Implantation of an artificial lens

It is very important to choose the right intraocular lenses for your child. The lens is implanted instead of the removed lens, and it performs all its functions, biologically combined with the structures of the eye. Children are selected with special lenses that effectively and quickly improve visual acuity after surgery.

Artificial intraocular lenses replace the natural structure affected by cataracts and removed during surgery. A special lens can be implanted immediately or after some time.

Artificial lenses have a constant optical power, so they are not replaced during the development of the visual system. For this reason, it is very important to carefully calculate the parameters of the lenses in advance, as well as take into account the changes that will occur during the growth of the child.

After cataract surgery, the child is prescribed glasses with low or medium diopter lenses. Since the artificial lens does not provide full vision at any distance, the patient needs bifocal or multifocal optical systems.

It should be remembered that it is not always possible for infants to have a lens implanted. Although surgery is more common for cataracts in one eye, implantation of an artificial lens is also applicable for bilateral lesions.

Recovery after cataract in children

After cataract removal, the baby needs optical correction, which will ensure the correct focusing of light rays on the retina. For these purposes, glasses or contact lenses are prescribed, or an artificial lens is implanted into the eye.

Glasses are a safe way to correct vision in children who have had cataract treatment. This method is recommended for patients whose clouding has affected both eyes. Glasses tend to have strong but thick lenses and are prescribed on an ongoing basis.

The natural lens has a transparent and flexible structure, providing a sharp and clear vision of objects at different distances. Since cataract therapy involves the removal of the lens, after treatment, the child loses the ability to focus. Restore vision allow multifocal and bifocal glasses. Multifocal lenses provide near, far and intermediate vision. Bifocal lenses allow you to see clearly near and far.

Children with cataracts in only one eye cannot use glasses. They are prescribed the implantation of an artificial lens or wearing contact lenses. Usually, rigid breathable lenses of high optical power are prescribed that do not cause discomfort.

For the correct selection of the lens parameter, several visits to the doctor are required. The ophthalmologist should inform parents about the rules for wearing lenses and caring for them. Because lenses need to be worn every day, parents should teach their child how to remove and put them on. Proper care of contact lenses and compliance with the wearing regimen is a guarantee of comfortable vision.

As your child grows, contact lenses will need to be replaced. It is noteworthy that at an early age, optical systems need to be changed frequently. If turbidity is detected at an early stage and adequately treated, it is possible to rid the child of cataracts and prevent complications in the vast majority of cases.

Cataract in children and its consequences

Cataracts in newborns are often combined with strabismus, and in older children - with amblyopia or lazy eye syndrome. Through a cloudy lens, the eye does not receive information about the world around it, therefore, in the process of growth, the child cannot learn to see. There is a significant deterioration in vision, which manifests itself in the behavior of the child.

Amblyopia is the main cause of visual impairment in children with cataracts. It is very important that in the process of growth the visual system of the child works correctly, and clouding of the lens reduces visual acuity. The brain does not receive clear pictures and “turns off” the eye, which sees worse, to eliminate visual discomfort. The part of the brain responsible for the perception of the image ceases to function, muscles and nerves atrophy, and amblyopia develops.

Surgical treatment of cataracts and optical correction is the first stage of restoring vision in children with ophthalmic disorders. Therapy of the lazy eye syndrome should be given maximum attention. It may take several years to get rid of the disease and restore the functionality of the eye.

Amblyopia after unilateral and bilateral cataracts is treated differently, so you need to contact a good specialist. Often, even after prolonged therapy, defects in the visual system remain. Often, with an incorrect diagnosis of congenital cataract, they begin to treat amblyopia, only aggravating the child's condition.

The main dangers of cataracts in children are amblyopia and subsequent irreversible blindness. Congenital opacification, which is not treated in the first weeks after the birth of a child, in most cases ends in loss of vision. Only early detection of pathology and competent treatment guarantee comfortable vision in the future. It is very important to ensure the proper development of the baby's visual system.

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 such serious problem that young parents may face is cataracts 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 is 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 the form of a violation of the normal structure of the 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, both a slight visual impairment and almost complete blindness can be observed, which manifests itself in the reflex perception of a bright light source.

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 space, other social problems appear with age, for example, the communicative competence of a growing child decreases.

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, when it comes to 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 of metabolic processes in both the child and the mother during pregnancy. Most often we are talking about such diseases as diabetes mellitus, varying degrees of 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 can 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. Nevertheless, parents should pay attention to the general condition of 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 condition is often accompanied by congenital clouding of the lens.
• Also, a provoking factor in cataracts is heterochromia - a different color and size of the pupils.
• 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.

Content

Partial or complete clouding of the lens is a common congenital pathology. It accounts for more than 50% of cases of hereditary and intrauterine visual impairment. Cataracts can change the shape of the pupil and size. It is often accompanied by other eye anomalies. This problem is treated by an ophthalmologist.

Features of the treatment of congenital cataract

The earlier the pathology is detected, the higher the chances of its elimination. When a cataract is removed in a child under the age of six months, the probability of ensuring the correct development of the eyes is maximum. The bilateral form is more treatable than the one-sided form. Thanks to modern medicine, the prognosis is favorable, but depends on:

• the severity of the pathology;
• areas of damage;
• concomitant diseases.

Children often have surgery. The best methods are lensvitrectomy or aspiration. Congenital cataracts in adults, which do not greatly threaten vision, may respond to medications. They are also required after surgical treatment. During recovery, you need to wear glasses. The treatment regimen is always tailored to the patient. Methods depend on the diagnosis:

Conservative treatments

You can do without surgery at an early stage of the disease. When the affected area is small, the cataract does not greatly affect the development of other organs of vision. Some medications can prevent pathology from developing and improve the quality of vision. In children under 3 months of age, treatment begins with conservative methods. Operation at this age is prohibited. Medical therapy for congenital cataract requires the use of:

• cytoprotectors - with concomitant retinal detachment;
• metabolics (Quinax, Oftan Katahrom) - to regulate metabolic processes, resorption of opaque proteins of the eye;
• preparations for dilating the pupil (Midriacil, Cyclomed) - to improve vision;
• vitamins (Taufon, Vicein, Taurine) - designed to improve cell nutrition.

Drugs to combat congenital cataracts need to be used for months and years. The doctor may prescribe them to maintain vision after surgery. The frequency of application of drops - 2-5 times a day. Additionally, it is recommended to take vitamins C and group B.

Surgery for congenital cataract

If, due to the large amount of turbidity, vision falls sharply, surgical treatment is indicated. The same recommendation is for patients who have not benefited from conservative therapy. Congenital cataract in a child requires removal at the age of 2–2.5 years. This affects the results of treatment. The choice of method depends on the density of the lens masses, the strength of the ligaments, and the maturity of the pathology. Modern medicine uses:

• optical iridectomy;
• cryoextraction;
• emulsification;
• aspiration;
• extracapsular extraction.

The method is used for limited opacities in the center of the lens. Pathological masses are pulled out with tweezers. Additionally, a part of the iris is excised, which improves vision. The procedure is performed under general anesthesia. The drug is administered intravenously. The operation after that looks like this:

1. The surgeon makes an incision along the edge of the cornea to access the anterior chamber.
2. Working through a microscope, he removes part of the lateral portion of the iris.

The cost of such treatment in Moscow ranges from 10,000 to 15,000 rubles. The danger of the operation is the risk of violating the integrity of the anterior part of the capsule. Thanks to the microsurgical technique, it has become less dangerous for the patient, but after it the following may occur:

• inflammation of the iris;
• 
  the formation of adhesions of adhesions;
• retinal disinsertion;
• visual interference (probability - 17%).

Aspiration

Congenital cataracts in children older than 3–6 months are often corrected by aspiration. The method is used on a loose, soft lens, so it is not suitable for the treatment of adults. The average cost of the operation is 25,000–30,000 rubles. It is carried out under general anesthesia. The surgeon removes pathological masses with a vacuum. The course of the procedure looks like this:

1. The patient is placed under general anesthesia.
2. A drug is instilled into the eye to dilate the pupil.
3. The surgeon makes an incision to expose the lens. Makes an opening of the anterior capsule with a scalpel.
4. The aspiration-irrigation system draws out soft masses.
5. An intraocular lens is placed between the anterior and posterior capsules.

About a week the child is in the hospital under the supervision of doctors. Topical medicines are used to suppress inflammation and infections. Vision to the patient is fully restored in 1-2 months. Complications after such treatment occur with a frequency of up to 20%:

• secondary cataract;
• glaucoma;
• displacement of the intraocular lens;
• development of an intraocular infection.

Cataract removal is carried out through the partial removal of the anterior chamber. First, the surgeon removes the nucleus of the lens, then the cortical masses. If the posterior capsule is clear, it can be left in place. The procedure can be performed with a very hard lens - this is its main advantage. After using anesthetic drops and an injection under the skin around the eyes, the surgeon:

1. Makes an incision in the eye.
2. Removes the lens.
3. Inserts an intraocular lens.
4. Puts stitches. They are removed after 3-4 months.

The technique has drawbacks. They are associated with the risk of leaving part of the lens masses in the chambers of the eye. The result is a secondary cataract. The problem is also the seams, because of which the patient's quality of vision suffers, astigmatism may appear. There may be a divergence of the scar during physical exertion, injuries. The cost of such treatment is 15,000-40,000 rubles.

Laser capsulophacopuncture

With this method of treatment, the front of the capsule is destroyed by a laser beam. Turbid masses swell and dissolve. According to statistics, in 5 out of 15 people they disappear completely. The therapy is carried out in several stages in a hospital, with local anesthesia:

1. The doctor stains the capsule with the drug.
2. Opens it with a laser beam.
3. After the procedure, mydriatics are used, which keep the pupil dilated.

Turbid masses resolve up to 8 years. The cost of stage 1 is 7,000–10,000 rubles. The method is used to treat mild cataracts. Due to its average efficiency, it is often combined with iridectomy, aspiration. The risk of complications with laser treatment is reduced to zero. Reversible consequences:

• point destruction of the horny epithelium;
• corneal edema.

Phacoemulsification

The most modern and safe method of dealing with congenital cataracts. The surgeon removes the clouded lens with a laser or ultrasound and replaces it with a lens made under the patient. The operation is performed like this:

1. The surgeon injects anesthesia locally - with drops or an injection.
2. Makes a micro incision of 2-3 mm.
3. Injects a drug that protects the vitreous body.
4. Ultrasound or laser beam liquefies the lens.
5. The resulting emulsion is removed and a soft lens is introduced in its place.
6. At the last stage, the lens preparation is washed out and the operation is completed. No stitches are needed. The patient is then sent home.

This removal of congenital cataract is carried out quickly, it is easily tolerated. The only downside is the high cost: 65,000–70,000 rubles. in Moscow clinics. The ultrasound method is cheaper - 30,000–50,000 rubles. The complication rate with this treatment is 1%, these include:

• retinal disinsertion;
• inflammation of the vascular and iris of the eye;
• hemorrhage in the anterior eye chamber;
• displacement of the artificial lens.

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One of the most common eye diseases is cataract. It is mainly diagnosed in adults and the elderly, but it can also be found in children.

The prevalence in newborns is 5 people per 100 thousand, in older children - 3-4 cases per 10 thousand people.

Disease Definition

Cataract is an eye disease in which there is a clouding of the lens substance with partial or complete loss of sharpness and clarity of vision. Turbidity can be both total and incomplete.

According to the International Classification of Diseases 10th revision, nosology is coded as H25-H28. But a congenital disease in children according to ICD-10 has the code Q12.0.

The lens is a biconvex lens, it refracts the sun's rays passing through it and focuses them on the retina.

Irritation from the retina is transmitted along the optic nerve to the information processing areas in the brain.

With cataracts, due to turbidity, the refraction of sunlight is disturbed, the image becomes blurry.

Etiology

It is not possible to find the exact cause of cataracts, but there are factors that may predispose to its development:

The leading factor in the appearance of a congenital form of cataract is heredity. Often, among close relatives of a sick child (mother, father, brothers and sisters), there are cases of cataracts in history.

The disease is linked to some genes, there is a high probability of cataracts in offspring.

Causes of congenital pathology in children:

But congenital cataract is registered and in children without burdened heredity. How can this be explained?

The fetus is very susceptible to viral infections during the first trimester of pregnancy.

If at this time he is attacked by viruses, then the congenital form may develop and become the least of the evils that viruses can inflict on the fetus.

Causative agents of intrauterine infection:

In diabetes, there is an increase in the glucose content in the lens due to hyperglycemia. The lens fibers swell, lose their transparency - this is how this type of cataract begins.

With galactosemia, the accumulation of galactose in the lens similarly occurs. In transmitted light, it looks like oil droplets. These accumulations can be seen already during the first days of a child's life.

In traumatic lesions, regardless of age rosette cataracts develop, which progress and can completely occupy the entire lens.

Opacification of the lens can occur as a complication of other diseases. For example, in uveitis, inflammatory products can enter the lens, leading to the development of cataracts.

Various radiations have a negative effect on the lens: infrared, ultraviolet. There is a peeling of the anterior chamber of the lens, which leads to its clouding.

With a deficiency of calcium ions in the body, calcium cataracts occur. Its development is possible with the removal of the parathyroid glands responsible for calcium metabolism.

Turbidity appears as small, sometimes bright dots on the pupil, which can be seen with the naked eye. Treatment of children with punctate cataract is long.

The constant use of certain drugs can also lead to illness. The list includes hormonal drugs, cardiac glycosides.

The ingestion of various substances, such as alkalis, leads to toxic cataracts. Alkali reduces the acidity of the anterior chamber of the eye, glucose is washed out of the lens.

Causes, symptoms and treatment of the disease:

Classification

Depending on the age of occurrence of cataracts, 2 types of cataracts are distinguished - congenital and acquired.

More often, ophthalmologists encounter acquired cataracts, congenital cataracts are quite rare.

Depending on the stage, there are:

• initial;
• immature;
• mature;
• overripe.

Clinical manifestations

A newborn baby has a cataract usually at periodic medical examinations - you should not avoid them. You can suspect a cataract in a child on your own in the following cases:

• the child practically does not react to silent toys;
• does not accompany the gaze of parents - does not focus vision;
• rapid uncontrolled eye movements;
• gray or white pupil.



The organ of vision has just begun its development. Any violations at this stage can lead to serious consequences, up to blindness.

In older children, the symptoms are easier to identify, since they are accessible to verbal contact and can evaluate their vision subjectively. Clinical manifestations are as follows:

Strabismus occurs as a result of the fact that the eye due to clouding cannot focus the image on the retina with both eyes. One eye deviates either towards the nose or outwards.

The white pupillary reflex is determined using a slit lamp. This is an absolute sign of a cataract.

Nystagmus is also a consequence of a violation of the focus of the picture.

Symptoms of a cataract:

Diagnostics



Diagnosis is carried out by an ophthalmologist. Visual acuity is determined by Sivtsev tables.

An anamnesis of the disease is collected from the patient or from the parents.

A white or gray pupil is visually determined. A white pupillary reflex is recorded with a slit lamp. Measured intraocular pressure, visual fields.

Usually these measures are enough to make a diagnosis.

Cataract diagnostics - tests and examinations:

Treatment

Conservative treatment does not bring a positive effect. So the main method of treatment is surgical.

It consists of three stages:

• examination and assessment of the condition;
• operation;
• rehabilitation.

Assessment of the condition and examination is carried out by a pediatric oculist. The question of the expediency of the operation, indications, methods of its implementation is being decided.

For children under the age of 5-7 years, the operation is performed under general anesthesia. Hospitalization is not required, the operation is performed on the same day. Children under the age of 3 months may be hospitalized.



The operation is called phacoemulsification. Using a microsurgical instrument, an incision no larger than 2 mm is made.

Under the action of ultrasound, the substance turns into an emulsion and is removed from the eye through tube systems.

The operation is successful in most cases, but possible complications:

The main disadvantage of the operation is that as a result of the removal of the lens, the eye loses its ability to accommodate, it is not capable of focusing the image far and near.

If the operation was performed on both eyes, then multifocal glasses are used to achieve image focus on the retinal area.

They have thick lenses and promote distance, near and medium vision. Bifocal glasses are also used, but unlike the previous ones, they provide either distance or near vision.

If the cataract was removed in only one eye the use of contact lenses is advisable. Since the eye of children is constantly growing, then the lenses after a while need to be changed and selected others in size.

Parents should closely monitor the use of contact lenses by children, as the risk of infection is high.

After the operation, it is forbidden to rub your eyes for several days, you can not swim in the pools. Eye drops may be used to moisturize and prevent infection.

Intraocular lens implantation



The ideal way to restore vision is an operation to implant an artificial intraocular lens.

The eye begins to fully function, which manifests itself in the form of image focusing - both far and near.

The intraocular lens implantation operation is also carried out simultaneously and can be combined with cataract removal. Combination is possible in children older than 5-6 years and in adults.

The operation technique is a seamless method. An incision no larger than 2 mm is made, and an intraocular lens is inserted using a microsurgical instrument.

The peculiarity of this lens is its small size (otherwise it simply would not fit into the cut). When placed between the pupil and the vitreous body, the lens expands.

Usually implantation of such a lens is carried out for children not younger than 5 years.

Since the organ of vision in childhood is in a state of constant development, then full recovery of vision should be expected by adolescence

If the operation is late, then amblyopia may develop.. In the preoperative period, due to clouding of the lens, the eye develops incorrectly and "gets used" not to focus a clear image.

In the future after the operation, despite the absence of turbidity, the eye also does not focus the image. This phenomenon is called "lazy eye", or amblyopia.

This condition is difficult to deal with, so it is desirable to prevent it.

Amblyopia is treated with corrective glasses. The second method is eye activation. To do this, a healthy eye is covered with a bandage, and the patient begins to focus images on the retina.

The longer the patient wears the bandage, the better his vision becomes. There are cases when the sharpness was restored to 100%.

The effectiveness of treatment largely depends on the timing of detection. With early detection and further treatment, it is possible to restore vision. Cataract is successfully treated in our country.

The importance of preventing cataracts in children. Excessive strain on vision should be avoided, injury should be avoided and hygiene requirements should be observed.

In contact with

A cataract is a clouding of the lens, one of the most important parts of the eye. The lens is normally transparent, its function is refract light passing through the pupil into the eye.

In case of violation of this ability there is a severe decrease in vision, up to blindness.

The disease may occur in people of different ages, including in newborns. According to the time of manifestation of cataract symptoms, there are two main forms: congenital and acquired.

In the case of an infant's illness, it is usually a congenital cataract, and acquired cataract occurs at such a young age.

Causes of congenital and acquired cataracts

Causes congenital form diseases are numerous and, unfortunately, not always easy to establish.

The most common among them are the following:



• heredity;
• infectious diseases transferred by the mother during pregnancy;
• taking certain medicines by the mother during pregnancy;
• pathologies associated with metabolic disorders in the mother's body, which affected the formation of the child's organs of vision.

Heredity: in this case, it is understood that the appearance of the disease is associated with an already existing in the genes of the parents predisposition to it. The parents themselves may not have suffered from cataracts, but cases of the disease have already been noted in the family. A cataract can appear only in one of the children, since the predisposition to the disease is not always realized in the form of the disease itself.

Some viral infectious diseases can also have a negative impact on the developing body of the child if carried by the mother during pregnancy. The most common cause of cataracts is herpes group viruses- varicella-zoster virus, cytomegalovirus, herpes simplex virus.

The reason may be the transferred rubella, the causative agent of which has a significant teratogenic, that is, carrying the risk of developmental disorders in the fetus, effect. Usually pregnant women are offered to go through special analysis for the presence of infections of this group.

Attention! Some drugs are also teratogenic, such as anti-diabetic drugs such as Chlorpropamide and Tolbutamide. They can cause the development of congenital cataracts.

Eye pathology in a child can also be caused by a violation in the mother of the function of the endocrine system (for example, diseases of the pancreas and adrenal glands).

Symptoms of cataracts in newborns, photo

Diagnosis of visual impairment in newborns sometimes difficult due to the inability to clarify the presence of subjective symptoms and complaints, for example, decreased visual acuity. But there are a number of signs that will help parents and doctors determine the development of cataracts:



Photo 1. Cataract in a small child on the right eye, the iris becomes bluish.

• Unusual eye color in the pupil area- a cloudy film, a stain is visible on it.
• Child does not focus on a moving bright object. Normally, an infant is able to do this by the end of the first month of life.
• Baby follows a moving object with just one eye.



Photo 2. Cataract in a child. The pupil of the right eye is clouded, which greatly impairs the baby's vision.

According to the standards adopted in Russia, all children must be examined at the age of one month several specialists, including an ophthalmologist.



Photo 3. Signs of a cataract in the right eye of a child: the pupil is cloudy, greenish in color.

If parents suspect a cataract in a baby, they should draw the attention of a doctor to this. He has at his disposal effective methods of verification, for example, using a slit lamp for the study of all departments of the lens.

Treatment

Cataract treatment - necessary condition for the full development of the child. The doctor after the examination and determination of the type of cataract will offer the best treatment option.

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conservative

Conservative treatment includes the use of various drugs aimed at restoring the transparency of the lens. Drugs such as Quinax, Taufon, Oftan Katahrom contribute to the improvement of blood supply to the tissues of the eye, stimulate the processes of their recovery.

Usually conservative treatment can prevent the further development of the disease but not eliminate its effects. For a more complete restoration of vision, ophthalmologists recommend a surgical method.

Surgical, operation at 2 months

The surgical method of treatment involves lens replacement surgery. In infants, this operation is broken in two stages, significantly separated in time.

Initially, manipulations are carried out to remove the clouded lens, which should be done as quickly as possible, usually at the age of 2 months. This operation is performed under general anesthesia, with the use of drugs that cause pupil dilation. Recognized as the most effective method phacoemulsification- a combination of the use of ultrasound and the smallest incision to remove the affected tissues. She passes into three stages:



• removal of destroyed tissues in the form of an emulsion.

The incision itself does not require suturing, as natural sealing occurs. The whole operation takes about two hours. For some time, the baby will have to spend under the supervision of a doctor, since general anesthesia is a serious test for a small patient. But in a few days he will be at home.

The next operation, the purpose of which will be the installation of an artificial lens - an intraocular lens, is performed on children around 4-5 years of age. Her usually not done before 2 years, since during early childhood the growth of the eye occurs rapidly, and the artificial lens simply ceases to fulfill its function.

Sometimes doctors place an artificial lens on patients younger than two years old, then at the age of 5-7 years, surgery will be necessary to replace it. This option is chosen if the cataract is unilateral. First surgical intervention takes place in four stages:

• providing access to the lens through a micro-incision;
• destruction of the lens with ultrasound;
• removal of destroyed tissues in the form of an emulsion;
• introduction of an artificial lens through a micro-incision.