Kianersi F. M.D 1391/12/10 - PowerPoint Presentation

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Kianersi F. M.D1391/12/10

Types OF Cataract in Pediatric Patients

به نام خداوند جان وخردSlide2

Cataracts in Pediatric Patients can be classified by: Age, Etiology

, Morphology.ClassificationsSlide3

Classifications of Cataracts according to ageSlide4

Congenital Infantile

JuvenileCataracts in Pediatric PatientsSlide5

Lens opacity present at birth. Cataract Congenital

Slide6

Lens opacities develop during the first year of life.Infantile Cataract Slide7

Lens opacities develop before 10 years of age.Juvenile CataractSlide8

Because some lens opacities escape detection at birth and are noted only on later examination, these terms are used interchangeably by many physicians.Congenital - InfantileSlide9

Congenital and infantile cataracts cover a broad spectrum of severity. Whereas some lens opacities do not progress and are visually insignificant, others can produce profound visual impairment.Congenital and infantile cataracts may be unilateral or bilateral.

Congenital - InfantileSlide10

Etiologic ClassificationSlide11

1. Hereditary cataract2. Metabolic cataract3. Traumatic cataract4. Secondary cataract

5. Cataract secondary to maternal infection during pregnancy6. Iatrogenic cataract7. Syndromes and congenital cataractEtiologic ClassificationSlide12

AD: 75% (AR—XL)The affected individuals are usually perfectly well, and have no associated systemic illness.

Associated with microphthalmos.Examination of family members.1. Hereditary cataractSlide13

Galactosaemia Hypoglycaemia Hypocalcaemia

2. Metabolic cataractSlide14

Galactosemia is a metabolic disorder in which the child’s body cannot metabolize galactose, a major component of milk and milk products.

The baby develops typical ‘oil droplet’ cataracts which are easily seen by examining the red reflex. These are reversible, and the lens returns to normal on removing dairy products from the diet. 2. Metabolic cataract (Galactosaemia)Slide15

Hypoglycaemia of whatever cause may give rise to lens opacities in a child. The majority of babies with

hypoglycaemia will also have convulsions and may have permanent brain damage.2. Metabolic cataract(Hypoglycaemia)Slide16

Hypocalcemia may result in cataracts though these are usually functionally less significant than cataracts resulting from hypoglycaemia

.2. Metabolic cataract(Hypocalcaemia) Slide17

Trauma is the most common cause of unilateral cataract in children. Traumatic

cataract is usually the result of a penetrating injury, though blunt trauma can also lead to cataract formation.3. Traumatic cataractSlide18

The most common type of secondary cataract seen in the pediatric ophthalmology clinic is as a result of Uveitis seen in conjunction

with arthritis (juvenile chronic arthritis [JCA]). The cataract may be as a direct result of inflammation within the anterior segment, or can also result from the steroids used to treat the condition.4. Secondary cataract(Uveitis)Slide19

Cataracts caused by steroid ingestion are usually posterior sub-capsular. Progression of the cataract will be halted

following cessation of treatment although not reversible.4. Secondary cataract(steroid INDUCED)Slide20

Less frequently, cataract may be seen secondary to an intra - ocular tumor such as Retinoblastoma.

4. Secondary cataract(intraocular tumor) Slide21

TORCHS syndrom: Rubella Toxoplasmosis,

Toxocariasis, Cytomegalovirus (CMV), Herpes, Syphilis. Usually bilateral, dense, and central.5. Cataract secondary to maternal infection during pregnancy

(TORCHS SYN.) Slide22

The most common maternal infection to cause congenital cataract in the child is Rubella.The

cataracts caused by Rubella may be present at birth, or develop several months later. 5. Cataract secondary to maternal infection during pregnancy(Rubella) Slide23

These children may also have: Microphthalmia,

Glaucoma, Retinal pigmentary disease, Microcephaly, Deafness, Heart defects and Mental retardation.5. Cataract secondary to maternal infection during pregnancy

(Rubella) Slide24

Iatrogenic cataract is most commonly seen in children who have had: Total body irradiation for leukemia,

Organ transplants, On long-term systemic steroid therapy. These children are usually older children and do very well after cataract surgery.6. Iatrogenic cataractSlide25

There are large variety of chromosomal and dysmorphic syndromes, in which the child will have a high risk of having congenital cataract.

It is important to notice any abnormal features in children presenting with cataract, such as unusual facial features, extra digits, unusual skin, short stature, developmental delay, microcephaly or hydrocephaly.7. Syndromes and congenital cataractSlide26

7. Syndromes and congenital cataract(Dwan

syndrom)Slide27

Cataracts, Keratoconus, Glaucoma, Brushfield spots.

7. Syndromes and congenital cataract(Dwan syndrom)Slide28

Morphology Classification of Congenital Cataracts Slide29

Congenital cataracts occur in a variety of morphologic configurations, including: Polar,

Sutural, Coronary, Cerulean, Nuclear, Capsular, Lamellar, Complete, and Membranous. Each of these categories encompasses a range of severity.Morphology Classification of Congenital Cataracts Slide30

Lens opacities that involve the subcapsular cortex and lens capsule of the anterior or posterior pole of the lens.Polar CataractSlide31

Small, bilateral, symmetric, non progressive opacities that do not impair vision.Inheritance: AD pattern. Sometimes seen in association with other ocular abnormalities, including:

Microphthalmos, Persistent pupillary membrane, and Anterior lenticonus.Cataract Anterior PolarSlide32

Anterior Polar CataractSlide33

Produce more visual impairment than anterior polar cataracts because they tend to be larger and are positioned closer to the nodal point of the eye.Capsular fragility has been reported.

Posterior Polar Cataracts Slide34

Posterior polar cataracts are usually stable but occasionally progress. They may be sporadic or familial. Familial posterior polar cataracts are usually bilateral and inherited in an AD pattern.

Posterior Polar Cataracts Slide35

Opacification of the Y-sutures of the fetal nucleus that usually does not impair vision.Sutural

Cataract(Stellate Cataract)Slide36

These opacities often have branches or knobs projecting from them. Sutural Cataract

(Stellate Cataract)Slide37

Bilateral and symmetric, sutural cataracts are frequently inherited in an AD pattern.Sutural Cataract

(Stellate Cataract)Slide38

Consist of a group of club-shaped opacities in the cortex that are arranged around the equator of the lens like a crown, or corona.Coronary Cataract Slide39

They cannot be seen unless the pupil is dilated, and they usually do not affect V/A.Inheritance: AD pattern.Coronary Cataract Slide40

Small bluish opacities located in the lens cortex.Cerulean Catract

(Blue-dot Cataract) Slide41

They are non progressive and usually do not cause visual symptoms.Cerulean Catract

(Blue-dot Cataracts) Slide42

Opacities of either the embryonic nucleus alone or both the embryonic and fetal nuclei.They are usually bilateral, with a wide spectrum of severity. Nuclear CataractSlide43

Lens opacification may involve the complete nucleus or be limited to discrete layers within the nucleus. Nuclear CataractSlide44

Eyes with congenital nuclear cataracts tend to be small.Nuclear CataractSlide45

Small opacifications of the lens epithelium and anterior lens capsule that spare the cortex. They are differentiated from anterior polar cataracts by their protrusion into the anterior chamber. Capsular CataractSlide46

Capsular cataracts generally do not adversely affect vision.Capsular CataractSlide47

The cataract is visible as an horseshoe- shaped opacity that surrounds a clearer center and is itself surrounded by a layer of clear cortex. Lamellar Cataract

(Zonular Cataract) Slide48

The most common type of congenital/infantile cataract.They are characteristically bilateral and symmetric.Their effect on V/A varies with the size and density of the opacity. Lamellar Cataract

(Zonular Cataract) Slide49

Lamellar cataracts may be the result of a transient toxic influence during embryogenic lens development.The earlier this toxic influence occurs, the smaller and deeper is the resulting lamellar cataract. Lamellar cataracts may also be inherited as an AD trait.

Lamellar Cataract(Zonular Cataract) Slide50

All of the lens fibers are opacified.The red reflex is completely obscured, and the retina cannot be seen with either direct or indirect ophthalmoscopy.

Complete Cataract (Total Cataract) Slide51

Some cataracts may be subtotal at birth and progress rapidly to become complete cataracts. Complete Cataract (Total Cataract) Slide52

Membranous cataracts occur when lens proteins are resorbed from either an intact or traumatized lens, allowing the anterior and posterior lens capsules to fuse into a dense white membrane.Membranous CataractSlide53

EPIDEMIOLOGYSlide54

1 in every 250 newborn has lens opacity. All of them are not visually significant. Prevalence of visually significant cataract is 1.2 to 6 in 10000 live birth. 10-20% of blindness in children worldwide.

Bilateral cataract is more common than unilateral one.EPIDEMIOLOGYSlide55

1/3 of congenital or infantile cataracts are associated with other disease syndromes, 1/3 occur as an inherited trait, and

1/3 result from undetermined causes.EPIDEMIOLOGYSlide56

Unilateral Cataract in childhood: Evaluation of other Ocular abnormality.Bilateral Cataract in childhood: Familial & Systemic evaluation,

It is important that all children with congenital cataract are examined by a pediatrician to exclude any underlying systemic disorder.EPIDEMIOLOGYSlide57