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ORIGINAL ARTICLE

Dealing with paediatric cataract at Drashti Netralaya - our experience

There are few reports of prevalence and causes for blindness among children on a global or regional basis. A study from Andhra Pradesh¹ suggested that congenital cataracts account for up to 11% of blindness among children. Appropriate and timely treatment can help restore sight in cases of congenital cataract. Surgical techniques have evolved over the years with intraocular lens (IOL) implants now the treatment of choice for congenital and traumatic cataract in children over the age of 2.²However, there are conflicting opinions of whether intraocular lens implants are safe for children below two years. Determining the target postoperative refraction³ and the complexity of surgical procedures⁴ re additional concerns related to implanting intraocular lenses in small children. The impact of inflammation, amblyopia and posterior capsule opacification on postoperative results also has to be kept in mind. We present the results of a retrospective analysis evaluating the outcome and factors affecting outcome of cataract surgery done in the paediatric age group at our hospital during 2003.

We reviewed charts of all cases of surgery performed for cataract due to any cause among children below the age of 16 during the period January to December 2003. Evaluation included visual assessment, and anterior and posterior segment examinations. Younger children (aged below 4 years) were operated under general anaesthesia, and older children were operated under peri-bulbar block with sedation if the child cooperated.

Surgical technique

Wound construction was done using self- sealing suture less wound in most cases.⁵ Capsular management was obtained in most cases through a central capsulorhexis measuring around 4 mm. Lensectomy and Anterior vitrectomy were done in children under 2 years and in traumatic cases where posterior capsule was suspected to be ruptured, a limbal approach was taken for lensectomy and anterior vitrectomy.⁶ A primary posterior capsulotomy with or without vitrectomy was performed. A PMMA lens (12 mm) was implanted in the bag for children below 2 years.⁷ Intraocular lenses were not implanted for children aged less than 2 years. Children who did not receive IOL impants were rehabilitated postoperatively using spectacles or contact lenses. Patching was done if the cataract was unilateral and amblyopia was present.

Thirty-four children had vision less than or equal to 3/60 pre-operatively (vision could not be assessed for 7 children) in the affected eye. Postoperatively, vision improved to 6/18 or better in the operated eye for 21 children. Only 3 still had poor vision of 3/60 or less while 9 had moderate vision impairment and would benefit from further optical correction. Vision could not be assessed for 8 children postoperatively. Half were lost to follow-up after a month of surgery while another 30% were followed up for more than 2 months.

Results

A total of 41 (males 22, females 19) paediatric cataract cases were seen and managed in the year 2003. Twenty of the 41 cases were developmental or congenital cataract, 20 had cataracts due to trauma, and 1 case was diagnosed as complicated cataract. 30 cases underwent Extra Capsular Cataract Extraction (ECCE) with IOL implants and 11 cases had lensectomy and vitrectomy procedures performed. 21 children had bilateral cataracts. Major causes of trauma included wooden stick (n=9), firecrackers (n=3), and thorns (n=3). Six children were injured while engaged in subsistence labour, while 14 were injured during play.

Recommendations

• Concerted efforts must be made to educate people about the prevention of blindness due to cataract in all age groups in general and the importance of continued follow up in the paediatric age group in particular.

• Apart from school screening programmes, training programmes must be conducted to equip teachers to identify vision problems and to sensitise them about the significance of early reporting.

• The facilities at primary health care institutes need to be upgraded and the staff trained to provide postoperative follow up care to paediatric patients.