Filial de Ciencias Médicas of Baracoa

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Exam
Title: Congenital Catar

5th Year Medical Student

2013 – 2014
Introduction
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
 Develop
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