Filial de Ciencias Médicas de Baracoa

English Premium Exam

Title: Congenital Cataract

5th Year Medical Student

2013 - 2014
The human eye is an organ that reacts to light and has several purposes. As a
conscious sense organ

The eye is made up of three coats, enclosing three transparent structures. The
outermost layer, known as the fibrous tunic, is composed of the cornea and
sclera. The middle layer, known as the vascular tunic or uvea, consists of the
choroid, ciliary body, and iris. The innermost is the retina, which gets its
circulation from the vessels of the choroid as well as the retinal vessels
Within these coats are the aqueous humour, the vitreous body, and the flexible
lens. The aqueous humour is a clear fluid that is contained in two areas: the
anterior chamber between the cornea and the iris, and the posterior chamber
between the iris and the lens. The lens is suspended to the ciliary body by the
suspensory ligament made up of fine transparent fibers.
There are many diseases, disorders, and age-related changes that may
affect the eyes and surrounding structures.

• Ectropion
• Dermatochalasis
• Myopia
• Hypemetropia
• Astigmatism
• Presbyopia
• Daltonism
• Glaucoma
• Cataracts
 Cataracts
Cataract is a clouding of the lens inside the eye which leads to a decrease
in vision. It is the most common cause of blindness and is conventionally
treated with surgery. Visual loss occurs because opacification of the lens
obstructs light from passing and being focused on to the retina at the back
of the eye
 Classification:
Cataracts may be partial or complete, stationary or progressive, or hard or soft.
The main types of age-related cataracts are nuclear sclerosis, cortical, and
posterior subcapsular.

• Nuclear sclerosis is the most common type of cataract and involves the central or
'nuclear' part of the lens.

• Cortical cataracts are due to the lens cortex becoming opaque.They occur when
changes in the water content of the periphery of the lens causes fissuring.

• Posterior subcapsular cataracts are cloudy at back of the lens adjacent to the
capsulein which the lens sits. Because light becomes more focused toward the
back of the lens, they can cause disproportionate symptoms for their size.
Form of Presentation

•Parcial or complete.
•Congenital or adquiride.
•Estable or progressive.
•Unilateral or bilateral
•Hereditary or esporadic
•Aislada or sistemic.
 Signs and symptoms

Signs and symptoms vary depending on the type of cataract, though there is
considerable overlap. People with nuclear sclerotic or brunescent cataracts
often notice a reduction of vision. Those with posterior subcapsular cataracts
usually complain of glare as their major symptom
 Causes

•Age
Is the most common cause: Lens proteins denature and degrade over time and
this process is accelerated by diseases such as diabetes and hypertension.
•Trauma
Blunt trauma causes swelling, thickening and whitening of the lens fibers
•Radiation
Ultraviolet light,has been shown to cause cataracts and there is some
evidence that sunglasses worn at an early age can slow its development in later
life
•Skin diseases
The skin and the lens have the same embryological origin and can be
affected by similar diseases
•Drug use
Cigarette smoking has been shown to double the rate of nuclear sclerotic
cataracts and triple the rate of posterior subcapsular cataracts
•Medications
Some drugs, such as corticosteroids, can induce cataract development
Genetics

The genetic component is strong in the development of cataracts, most

commonly through mechanisms that protect and maintain the lens.
The presence of cataracts in childhood or early life can occasionally be
due to a particular syndrome and pregnancy infections that include:

• 1q21.1 deletion syndrome,

• Cri-du-chat syndrome,
• Down syndrome,
• Patau's syndrome,
• Trisomy 18
• Turner's syndrome.
• Congenital syphilis
• Cytomegalic inclusion disease
• Rubella
• Cockayne syndrome
 Congenital Cataract
Is the opacity of lent pesent in earyl age of the life or its present in the born
hour, that affect the nucleus or the corteza, whit tendency to progress.

Types of congenital Cataracts

• Cental pulverulent cataract

• Nuclear Cataract
• Laminar Cataract
• Suture of the lent Cataract
• Coronary Cataract
• Polar Cataract
• Focals Opacities
• Membranous Cataract
 Causes of Congenital Cataracts

Metabolics
• Galactosemia
• Deficiency of galactoquinasa
• Hipoglycaemia
• Neonatal Hipocalcemia

Intrauterine Infections
• Congenit Rubeola
• Toxoplasmosis
• Simple Herpes Virus
• Chikenpox

Sistemics Sindrome
• 1q21.1 deletion syndrome,
• Cri-du-chat syndrome,
• Down syndrome,
• Patau's syndrome,
• Trisomy 18
• Turner's syndrome.
 Epidemiology

The presence of congenital cataract is estimated betwen 1 to 15/ 10 000 children.

The incidence of bilateral congenital cataract in the countries of the first world is
aproximately 1-3 of 10 000 bors, probably more in the other countries.

It is considered that 200 000 children lost the vision by cataract in all the world.

The Congenital Cataract contitutes the first cause of low vision and the second of lost
vision in Cuba.
 Treatment
The treatment is based on the prevention, the surgical correption and the Visual
rehabilitation.

Prevention
Risk factors such as UV-B exposure and smoking can be addressed but are
unlikely to make large difference to visual function, regular intake of antioxidants
(such as vitamins A, C and E) would protect against the risk of cataracts

Surgery
Cataract removal can be performed at any stage and no longer requires ripening
of the lens. Surgery is usually 'outpatient' and performed using local anesthesia.

1. Phacoemulsification is the most widely used cataract surgery today.

Phacoemulsification typically comprises five steps:
• Anaesthetic
• Corneal Incision
• Capsulorhexis
• Phacoemulsification
• Irrigation and Aspiration
• Lens insertion
2.Extracapsular cataract extraction (ECCE), consists on removing the lens
manually, but leaving the majority of the capsule intact. The lens is expressed
through a 10–12 mm incision which is closed with sutures at the end of surgery.

This surgery is increasingly popular in the developing world where access to

phacoemulsification is still limited.

Treatment of congenital cataract

The congenital cataract constituted a problem for the oftalmologic specialist
because he presents two difficulties:
• Anatomical restauration of the ocular globe
• Avoid the ambliopya

Medical Treatment inmediate to the surgery:

•Topical and/or oral Corticoides.
•Small Midriatic (tropicamida y fenilefrina).
•Antibiótic Colirio
When don´t surgery?

In opacities less of 3 mm :

•Observation.
•Optical corretion if´s necesary.
•chronic pupilar dilatation (fenilefrina).
•Treatment of the ambliopia (oclusive therapy)

When surgery?
In opacities more of 3 mm and total opacities.

In bilateral
•In the first 2 months.

In unilateral:
•In the first 4 to 6 weeks.
 Surgical Techniques

•Phacoemulsification
•Extracapsular cataract extraction (ECCE)

Visual rehabilitation:
The post-operative recovery periods usually short. The patient is usually ambulatory
on the day of surgery but is advised to move cautiously and avoid straining or heavy
lifting for about a month.
The eye is usually patched on the day of surgery and at night using an eye
shield is often suggested for several days after surgery. In all types of surgery,
the cataractous lens is removed and replaced with an artificial lens, known
as intraocular lens, which stays in the eye permanently. Intraocular lenses are
usually monofocal, correcting for either distance or near vision
 Complications
Serious complications of cataract surgery are retinal detachment and
endophthalmitis. In both cases, patients will notice a sudden decrease in vision.
The risk of endophthalmitis occurring after surgery is less than 1 in 1000. Corneal
oedema and cystoid macular oedema are less serious but more common and occur
because of persistent swelling at the front of the eye in corneal oedema or back of
the eye in cystoid macular oedema. The risk of either occurring is around 1 in 100.
Posterior capsular opacification is common and occurs following up to 1 in 4
operations but these rates are decreasing following the introduction of modern
intraocular lenses together with a better understanding of the causes. Others
complications are Glaucoma, Strabism and Uveitis.
 Prognosis

The prognosis is depended of the type of cataract:

Bilateral Cataract: Is less ambliogenic than unilateral. Better results in

the first 2 months of the life.

•Unilateral Cataract: Has good prognosis if the Surgery and the optical
correction were doig in the first 2 months of the life. After the ambliopy
is more frecuently.

The nistagm is a sign of poor prognosis

 Bibliography

• Manual de diagnóstico y tratamiento en oftalmología

•English Throught Medicine II
•Oftalmología. Criterios y tendencias actuales. Tomo I
•Cataract - Wikipedia, the free encyclopedia
•Pediatría Oftalmológica, Rosaralis
Thanks