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    Congenital Cataract

    Uploaded by

    Raymonde Uy
    - The patient is a 4-month old Filipino female who presented with opacity in both eyes and was found to have congenital cataract in the left eye. She underwent lensectomy with partial anterior vitrectomy of the left eye. - Post-operatively, she was doing well with improved vision in the left eye and was prescribed antibiotic and steroid eye drops. She was advised on follow-up and watching for complications. - Congenital cataracts require early detection and treatment to prevent amblyopia. Surgery involves lens extraction and vitrectomy to prevent secondary issues. Prognosis depends on factors like laterality and progression, with unilateral cases having the worst prognosis.

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    Congenital Cataract

    Uploaded by

    Raymonde Uy
    206 views40 pages
    - The patient is a 4-month old Filipino female who presented with opacity in both eyes and was found to have congenital cataract in the left eye. She underwent lensectomy with partial anterior vitrectomy of the left eye. - Post-operatively, she was doing well with improved vision in the left eye and was prescribed antibiotic and steroid eye drops. She was advised on follow-up and watching for complications. - Congenital cataracts require early detection and treatment to prevent amblyopia. Surgery involves lens extraction and vitrectomy to prevent secondary issues. Prognosis depends on factors like laterality and progression, with unilateral cases having the worst prognosis.

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    - The patient is a 4-month old Filipino female who presented with opacity in both eyes and was found to have congenital cataract in the left eye. She underwent lensectomy with partial anterior vitrectomy of the left eye. - Post-operatively, she was doing well with improved vision in the left eye and was prescribed antibiotic and steroid eye drops. She was advised on follow-up and watching for complications. - Congenital cataracts require early detection and treatment to prevent amblyopia. Surgery involves lens extraction and vitrectomy to prevent secondary issues. Prognosis depends on factors like laterality and progression, with unilateral cases having the worst prognosis.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    206 views40 pages

    Congenital Cataract

    Uploaded by

    Raymonde Uy
    - The patient is a 4-month old Filipino female who presented with opacity in both eyes and was found to have congenital cataract in the left eye. She underwent lensectomy with partial anterior vitrectomy of the left eye. - Post-operatively, she was doing well with improved vision in the left eye and was prescribed antibiotic and steroid eye drops. She was advised on follow-up and watching for complications. - Congenital cataracts require early detection and treatment to prevent amblyopia. Surgery involves lens extraction and vitrectomy to prevent secondary issues. Prognosis depends on factors like laterality and progression, with unilateral cases having the worst prognosis.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 40

    TASHA TAN MDMBA 070011

    Patients Data
    y A. G. y 4 months old y Female y Filipino y Resides in Marikina y Roman Catholic y Mother:

    60% Reliable

    Chief Complaint:

    Opacity in the middle of both eyes

    Subjective Findings: HPI


    y 2 months y PTA y Leukocoria, OU y Child did not follow

    objects or respond to visual stimuli y Consult at the QMMC Ophtha OPD


    

    s/p Lensectomy of OD

    ADMISSION

    Birth History
    y Born Full Term to a G3P3 (3003) mother y Delivered via NSD in a lying in and assissted by a

    midwife and OB-Gyne y Birthweight = 7.2 lbs y Mother had a total of 12 prenatal check-ups in a private clinic y Mother had an asthma attack on her 8th month of pregnancy

    Past Medical History


    y s/p Lesectomy OD y No other previous surgeries or hospitalizations y Currently taking  Iron supplements  Vitamin C supplements  Multivitamins y No known food or drug allergies y Newborn Screening was normal

    Family History
    y Cataract  Maternal Grandfather Senile mature cataract  Paternal Uncle

    Personal and Social History


    y Both parents are college graduates and work as

    supervisors y Is usually left at home with aunt when parents are at work

    Immunization History

    y 1 BCG y 3 Hepatitis B y 2 DPT y 2 OPV

    Physical Examination
    AT THE OPD JULY 28, 2010

    Vital Signs
    y Heart Rate y Respiratory Rate y Temperature

    102 bpm 24 rpm 36.9

    Physical Examination: HEENT


    y HEENT  Intact tympanic membrane  Nose midline, symmetrical, with no discharge  No Tonsilopharyngeal congestion  No palpable cervical lymph nodes, flat neck veins

    Physical Examination: Eyes; VA


    y OD:  Able to follow bright colored objects and light beyond midline y OS:  No regard for bright colored objects or light

    Eye Examination
    y Gross Examination  Eye position symmetric.  Lids
    OU

    - No hyperpigmentaion, contusions, erythema, tenderness, palpable masses. - No matting.

    Lashes
    OU

    Eye Examination
    y Gross Examination
    

     

    Conjunctiva. OU - No swollen glands. Bulbar conjunctiva clear. Palpebral conjunctiva pink. Scleara OU Unicteric Cornea. OU - Cornea clear with no lesions, opacities, mass. Anterior chamber. OU - formed and clear. Pupils OU - Pupils are symmetric and round, measure 3 mm, equally brisk and reactive to light.

     

    Eye Examination
    y Extra Ocular Muscles

    Eye Examination
    y Tonometry
    

    Unremarkable

    y Ophthalmoscopy.
    

    OD
    dull red orange reflex. Clear media with peripheral opacity
    Slightly

    OS
    Very

    dull red orange reflex. Hazy media.


    

    Cup disk ratio and macula were not appreciated because of the dull red orange reflexes and cloudy media.

    Cranial Nerves: Optic Group


    y II
       

    (Ophthalmic)
    Difficulty to assess optic disc, retina on fundoscopy Sensitive to light source in a dark room With visual fixation Pupils equal, 2-3mm, EBRTL | partial ROR, OU

    y III
    

    (Oculomotor)

    No ptosis, outward, downward, adduction or elevation displacements of both eyes Intact EOMs

    Cranial Nerves: Brachiomotor Group and Tongue


    y IV (Trochlear)  No appreciated upward and outward eye deviation y VI (Abducens)  No medial deviation of the eyes  No nystagmus yV
    

    (Trigeminal)
    Corneal response in both eyes

    y VII (Facial)  Corneal / Blink reflex present

    Salient Features
    History Physical Exam

    y Age (4 months) y Leukocoria y Does not seem to

    y Lens Opacity y Visualization of fundus

    difficult

    notice or fixate on objects

    Differentials
    y Retinoblastoma y Congenital Cataract

    Admitting Diagnosis
    SENILE MATURE CATARACT, OS

    Course in the Wards

    Day 1

    y Assessment  Congenital Cataract, OS y Plan  Moxifloxacin eye drops

    1 drop Q4

     

    DAT, NPO past midnight Lensectomy with partial anterior vitrectomy, OS

    Day 2

    y Subjective  Irritable when wearing the eye patch y Objective  Unremarkable findings on general physical examination

    Day 2 July 29, 2010

    y Assessment  Congenital Cataract, OS  s/p Lensectomy with partial vitrectomy OU y Plan  Moxifloxacin eye drops

    1 drop Q4 1 drop Q1 1 drop Q8

    Prednisone eye drops

    Atropine eyed drops

    Day 3 July 29, 2010

    y Subjective  Better activity  Left eye now able to see light and follow objects y Objective  Otherwise unremarkable findings

    Operative technique
    y Patient Supine y Anesthesia inducted y Asepsis and antisepsis y Sterile drapes placed y Lid retractors placed y Stab incision at 2 o clock position y Intracaneral tryphan blue y Irrigation of tryphan blue

    Operative technique
    y Intracaneral OVD y Main port incision at 10 o clock position y Anterior capsulotomy y I and A of lens material y Part anterior chamber vitrectomy y Final I and A y Suturing with nylon 10-0 (corneal suture) y Eye patching

    Intra Operative Findings


    y OD  Distinct disc border  Slightly dull/hazy media  No detachment  (+) ROR  CDR 0.3, AVR 2:3  Refraction:05:21 5s +3.00s

    Intra Operative Findings


    y OS  White cortical material not seen anymore  No detachment  (+) ROR  CDR 0.3, AVR 2:3  Refraction:19.5s c 2.00 cyl x 150 +3.00 sph

    Intra Operative Findings


    y Cornea OD: y IOP OD:

    V 11 H 11 8.5 10.0

    OS:

    V: 11.5 H: 11.5 10.2 10.9

    OS:

    Day 3

    y Assessment  Congenital Cataract, OS  s/p Lensectomy with partial vitrectomy OU y Plan  Moxifloxacin eye drops

    1 drop Q4 1 drop Q1 1 drop Q8

    Prednisone eye drops

    Atropine eyed drops

    Advised
    y Follow-up y Wearing of protective eye patch y Compliance to medications y Watch out for postoperative complications, consult

    should be done

    Congenital Cataract
    y Congenital (infantile) cataracts  Present at birth or appear shortly thereafter  May be unilateral or bilateral y About one-third of cataracts are hereditary y Another third are secondary to metabolic or

    infectious diseases or associated with a variety of syndromes. y The final one-third result from undetermined causes.

    Congenital Cataract
    y Congenital lens opacities are common and often

    visually insignificant. y A partial opacification or one out of the visual axisor not dense enough to interfere significantly with light transmissionrequires no treatment. y Dense central congenital cataracts require surgery.

    Congenital Cataract
    y Congenital cataracts that cause significant visual loss y y

    y y

    must be detected early Large, dense white cataracts may present as leukocoria (white pupil), noticeable by the parents, Unilateral infantile cataracts that are dense, central, and larger than 2 mm,will cause permanent amblyopia if not treated within the first 2 months of life. Symmetric (equally dense) bilateral cataracts may require less urgent management. When surgery is undertaken, there must be as short an interval as is reasonably possible between surgery on the two eyes.

    Congenital Cataract
    y Lens extraction through a small limbal incision

    utilizing a mechanical irrigation aspiration handpiece. y Phacoemulsification is rarely required. y The posterior capsule and anterior vitreous are removed using a mechanical vitreous suction-cutting instrument.
     

    Prevents formation of secondary capsular opacification or after-cataract Avoids the necessity for secondary surgery and enhances early optical correction.

    Congenital Cataract
    y Complications are similar to those reported with

    adult cataract procedures. y Optical correction can consist of spectacles in older bilaterally aphakic children y Most childhood cataract operations are followed by contact lens correction y Use of intraocular lenses in early childhood is becoming increasingly frequent. I
     

    Lessens the difficulty of optical rehabilitation associated with contact lenses in children May need to be changed as the eye develops.

    Congenital Cataract
    y The visual prognosis for childhood cataract patients

    requiring surgery is not as good as age-related cataract. y Amblyopia and occasional anomalies of the optic nerve or retina limit the degree of useful vision that can be achieved. y The prognosis for improvement of visual acuity is worst following surgery for unilateral congenital cataracts and best for incomplete bilateral congenital cataracts that are slowly progressive.

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