Case presentationBy sivaraja rathinavel

Patient detail

Age 15/F

Class: XI

Come to our camp for screening

History & complaints

Chief complaints

H/o undergoing cataract surgery in OD about 2 years back. The cause of the cataract is unknown .

H/o wearing spectacle since 2 years (on and off). Had no specific complaints. No H/o Ocular or head injury.

Screening & refraction

Previous glass prescriptionSph Cyl Axis

OD +0.75 -1.00 5Os ± -0.75 10

Visual acuity

OD OS

Distance (aided)

6/9P 6/9

Near ( unaided)

6/24 6/6

Refraction

Objective refraction (autorefractometry)

Sph Cyl AxisOD +0.50 -1.00 175Os -0.25 -0.75 170

Subjective refraction (prescription)

Sph Cyl Axis Add BCVAOD +0.50 -1.25 175 +3.00 6/6POS ± -0.75 180 6/6P

Ocular Examinations

Torch light examinationParts OD OS

Cornea Clear Clear

Anterior chamber quiet quiet

Iris Normal Normal

Pupil R/R/R R/R/R

Lens Clear (PCIOL) Clear

External Examinations 

Slit lamp examination not done.

Hirsh Berg Test : Central

Extra Ocular Muscle Movement Test Full, Free in all the gazes 

Diagnosis

Pseudophakia(s/p – Operated for developmental cataract)

Pseudophakia

Pseudophakia is an aphakic eye with an artificial intraocular lens implant.

Management

Spectacles Prescribed.

Counseling for regular use of spectacles.

OD OS

Bifocal (kryptok) Single vision

Types of Cataract

Cataract

Etiological Morphological

Congenital & Acquired 1 CapsuleDevelopment 2

Subcapsule 1 Senile 3

Cortical 2 Traumatic 4

Supranuclear 3 Complicated 5

Nuclear 4 Metabolic 6 Polar 5 Electric 6 Radiational 7 Toxic 8 Other diseases

Acquired cataract

1.Senile 2.Traumatic 3.Complicated 4.Lamellar 5.Electric 6.Radiational 7.Toxic

Clinical types

1 Anterior capsular cataract

2 Posterior capsular cataract

3 Anterior polar cataract

4 Posterior polar cataract

5 Nuclear cataract

Clinical types

7 Sutural & axial cataract

8 Floriform cataract

9 Coralliform cataract

10 Spear shaped cataract

11Anterior embryonic

12 Coronary

Clinical types

13 Blue-dot

14 total-congenital

Cataract

The Opacification of any part of the crystalline lens is termed as cataract.

Congenital & developmental cataract

Disturbance in development of normal growth of lens

http://www.epainassist.com/eye-pain/congenital-or-acquired-cataracts-in-children

Continuation

CONGENITAL CATARACT1. When the disturbance

occurs before birth.2. The opacity is limited

to either embryonic or foetal nucleus.

3. Age of onset – 0 to 30 days of life.

DEVELOPMENTAL CATARACT

1. It occurs from infantile to adolescence.

2. The opacity may involve in infantile or adult nucleus, deeper part of cortex or capsule.

3. Age of onset – 1 month to 18 years of life.

Congenital and developmental cataract occurs due to some disturbance in the normal growth of the lens.

Etiology

Idiopathic

Heredity

Maternal factors

Foetal or infantile factors

Investigation

Slit lamp Examination

Dilated ocular examination

Biometry – A scan& B scan,Keratometry

Signs A noticeable cloudiness in the pupil

Dull retinoscopic reflex

Ref: https://www.southerncross.co.nz/group/medical-library/cataracts-causes-symptoms-treatment-surgery

Symptoms

Increased glare from lights.

Double vision (diplopia)

Poor vision in sunlight.

Cloudy, blurry, fuzzy, foggy or filmy vision

Differential diagnosis

Leukocoria

Retinopathy of prematurity.

Persistent hyper plastic primary vitreous.

Retinoblastoma.

Management

Surgery

Spectacles and contact lenses

Patching therapy in cases of amblyopia

Surgery

Power of IOL- below 2 years ( 20% under correction) b/w 2-8 years (10% Under correction) IOL calculation

Ref: IOL Power Calculation in Children Sandeep Gupta MS, DNB, Parth Patel MBBS, Gagandeep Kaur MBBS, V.S. Gurunadh MS, M.A. Khan MS, V.K. Mohindra MS Armed Forces Medical College, Pune, Maharashtra

Surgical options

Phacoaspiration with primary posterior capsulotomy with or without anterior vitrectomy and (with/without IOL implantation)

Anterior capsulorrhexis and irrigation aspiration of the lens matter or lensectomy.

Glasses

Ref;:http://www.jcor.in/article.asp?issn=2320-3897;year=2013;volume=1;issue=3;spage=169;epage=173;aulast=Sainani

Dispensing aspect

Tinted glasses / Photo chromatic lenses / Ultraviolet protection

Polycarbonate glasses

Frame: - Shell frame - Comfort cable temple

Ref: Special considerations for prescription of glasses in children Ashwin Sainani Department of Ophthalmology, PD Hinduja Hospital and Medical Research Center, Mahim, Mumbai, India

Aphakia

The absence of crystalline lens of the eye.

Optically, the lens is absent from pupillary area.

It produces high degree of hypermetropia.

Causes

Congenital absence

Surgical aphakia

Traumatic

Dislocation of the lens

Optics

Highly hyperopic

Total power of the eye is reduced to about +44D from + 60 D.

Total loss of accommodation.

Symptoms Defective vision

Erythropsia & cyanopsia

Signs

Limbal scar

Anterior chamber is deeper than normal

Iridodonesis

Pupil color – jet black

Signs Purkinje’s image test shows only 2 images

Fundus exam - hypermetropic small disc

High hypermetropia in retinoscopy

Treatment

Optically, convex lenses for appropriate power. Modalities for correcting aphakia: Spectacle Contact lenses Intra ocular lenses

Contact lenses

Ref: Special considerations for prescription of glasses in children ashwin sainani Department of Ophthalmology, PD Hinduja Hospital and Medical Research Center, Mahim, Mumbai, India

Thank you