Features of management of children with congenal cataracts and accompanying visual pathology

Аннотация

An analysis of the case histories of 72 children (117 eyes) diagnosed with congenital cataracts, who were hospitalized in the eye department of the TashPMI clinic for the period from 2016 to 2023 at the age of 3 months to 14 years, was carried out. The study revealed that, children with congenital cataracts and concomitant pathology of the visual organ require a differentiated approach to patient management: in the presence of microphthalmos, early surgical intervention is necessary before 1 year - stage 1, including cataract extraction, followed by stage 2 - IOL implantation. Constant dynamic monitoring is necessary, given the high percentage of postoperative complications. Keywords Congenital cataract, Concomitant pathology, Microphthalmia, IOL implantation 1. Introduction opacification and other serious complications [10,11,14,15]. Depending on the size of the eye, there are 3 degrees of One of the common causes of blindness and low vision in microphthalmos: 1 degree - a decrease in one or two of the children is congenital pathology of the lens, namely cataracts, above dimensions by 1.0-1.5 mm compared to the age norm; which account for up to 10-19.5% [5,7,9,16]. Congenital 2nd degree - decrease by 2.0-2.5 mm; 3rd degree - reduction cataracts (CC) are observed in 5 cases out of 100,000 by 3mm or more. Features of congenital cataracts with newborns and cause 10-38% of cases of childhood blindness microphthalmia are predominantly complete opacities of [5]. Cataract is a persistent clouding of the substance of the the lens - 66.7% (zonular are 2.7%), a high percentage of lens or its bag, accompanied by a decrease in visual acuity capsulo-lenticular opacities - 67.1%, a narrow rigid pupil and from a slight weakening to light perception. Congenital cataracts its various anomalies, even absence. The most common are often combined with other pathological changes in the change in the cornea in congenital cataracts is a change organ of vision, which are observed in 36.8-77.3% of children: in its size - microcornea. Colobomas of the iris are often strabismus, nystagmus, microphthalmos, microcornea and encountered, which vary widely in size and shape and are other anomalies of the cornea, as well as the vitreous body, often located in the lower segment [4]. Severe anomalies choroid, retina and optic nerve. Strabismus is observed in are various manifestations of mesodermal dysgenesis. 30.2-83.3% of children with congenital cataracts. More often Cataract is one of the elements of Rieger's syndrome it is converging, alternating, predominantly constant. Nystagmus (dysgenesis of the iris and cornea) and Peters syndrome is observed in 14.0-58.8% of children with congenital (mesodermal-ectodermal dysgenesis of the cornea and iris). cataracts; it can be congenital or acquired, associated with a CC is also part of the Persistent hyperplastic primary sharp decrease in vision. More often it is pendulum-shaped, vitreous (PHPV). PHPV is associated with a disruption of the horizontal, less often - jerky. Microphthalmos is a congenital process of regression of the primary embryonic vitreous anomaly that is often associated with congenital cataracts in body. Changes in the retina and optic nerve of varying 22.5% of cases due to its characteristic structures including a nature and severity, identified in 55% of cases, are one of the thickened sclera, a normal or slightly larger lens with a reasons for low visual acuity after extraction of congenital relatively small eye volume, a higher lens-to-eye volume cataracts. More often, combined lesions were observed ratio, and a shallow anterior chamber, narrow camera angle (40.5%), less often - isolated changes in the retina (5.0%) or and short ocular axis. Microphthalmos can cause glaucoma optic nerve (9.5%). Pathologies of the optic nerve included and other complications affecting the retina and choroid. partial atrophy and developmental abnormalities (reduction Congenital cataract with complex microphthalmos is often in size, change in disc shape, etc.). On the part of the retina, combined with ocular or systemic abnormalities, and patients macular hypoplasia, myelin fibers, central and peripheral after surgery are prone to secondary glaucoma, corneal dystrophy, “old” chorioretinal lesions (multiple, small, in the periphery, or large in the central region) were detected [2,3]. Received: Oct. 22, 2023; Accepted: Nov. 20, 2023; Published: Nov. 25, 2023 Treatment of congenital cataracts in children remains a serious Published online at http://journal.sapub.org/ajmms problem, which is associated not only with the anatomical 1796 Abdurakhmanova Charos et al.: Features of Management of Children with Congenal Cataracts and Accompanying Visual Pathology features of the structure of the child’s eye, but also with rupture of the posterior capsule), and the presence of the frequency of concomitant pathologies, as well as with pathology from the fundus of the eye (hypoplasia of the optic various c