Case presentation 2

Congenital
Cataracts
Supervisor
Dr Gede Suparta, Sp.M
 Outline
1. Introduction
2. Literatur Review
3. Case Report
4. Discussion
5. Conclution

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1

Introduction!
Let’s start with the first set of
slides
⦁ A person's eyes normally consist of clear
lenses that help focus the light so it falls right
on the retina. Lens opacity is called a cataract,
which can reduce vision by interfering with the
normal transmission of light to the retina.
⦁ Cataracts are generally a disease of old age,
but not infrequently found in newborns or
called congenital cataracts

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 Maps

The prevalence of congenital cataracts is reported to be 1 to 15 per 10,000 children in

the world, which ranges from 1 to 3 per 10,000 births in developing countries.

Blindness rates in children caused by congenital cataracts in the world and developing
countries are 200,000 and 133,000 cases.

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⦁ Congenital cataracts must get immediate
intervention. Without immediate intervention,
congenital cataracts can trigger "lazy eyes" or
amblyopia. This amblyopia situation then
triggers other problems such as nystagmus,
strabismus, and the inability to perfect the
image of the object. This will greatly affect the
ability to learn, personality, and appearance,
further affecting the entire life of the child

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2
Literature
Review!
Let’s start with the first set of
slides
Definition

Cataracts in children can occur from birth or are seen

immediately after birth which is called congenital cataracts,
cataracts that occur in the first year are called infantile
cataracts, while those that develop during the first 12 years are
called juvenile cataracts.

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 Maps

The prevalence of congenital cataracts has been reported from 1 to 15

per 10,000ourchildren
office
worldwide, while it ranges from 1 to 3 per 10,000
births in developing countries.

The incidence of cataracts in children in other developing countries such as

Singapore is estimated at around 1: 5000 to 1: 10,000 at each birth. this incident
is likely to increase to 1: 1000 births

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Etiologi
⦁ It is estimated that 50% causes of idiopathic
congenital cataracts, 30% hereditary (20% of
which are autosomal dominant), the rest due to
other reasons

⦁ Cataracts caused by infection include rubella (the most

common cause), rubeola, chicken pox, cytomegalovirus,
herpes simplex, herpes zoster, poliomyelitis, influenza,
Epstein-Barr virus, syphilis, and toxoplasmosis.
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 Risk Factors
⦁ There is a family history that needs to be traced because about one
third of congenital cataracts are hereditary.
⦁ Birth history related to prematurity,
⦁ maternal infection,
⦁ medication use and radiation during pregnancy needs to be asked.
⦁ Congenital cataracts often present together with other ocular or
systemic abnormalities.

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 Patofisiologi

The lens is formed during the invagination process of the surface

ectoderm which coats the optical vesicles. Embryonic nucleus
develops during the sixth week of pregnancy. embryonic nucleus
surrounded fetal nucleus. At birth, the embryonic nucleus and the fetal
nucleus form the largest part of the lens. After birth, lens cortical fibers
form from the conversion of the anterior epithelium of the lens into
lens cortical fibers.

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⦁ Sutura Y is an important sign to know the development of the fetal
nucleus. The lens material next to the peripheral Y suture is the lens
cortex, and the lens material located medially and including the Y
suture itself is the lens nucleus.

⦁ Various kinds of disorders (for example infections, trauma, metabolic)

of the nucleus or lenticular fibers can cause turbidity (cataracts) on
clear lenticular media. The location and pattern of turbidity can be
used to determine when these disorders occur as well as their
etiology
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Clinicals Manifestation
⦁ The most common and easily recognized symptom is leukocoria.
These symptoms are sometimes not apparent in newborns
⦁ Other symptoms that can be encountered include photophobia,
strabismus, nystagmus. There is a family history that needs to be
traced because about one third of congenital cataracts are
hereditary

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⦁ Ocular abnormalities that can be found include micropthalmus,
megalocornea, aniridia, coloboma, retinal pigmentation, retinal
atrophy, and others. While non-ocular abnormalities that can be
obtained include: mental retardation, kidney failure, dental
anomalies, congenital heart disease, mongoloid face and so on

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 Diagnosis
⦁ The diagnosis of cataracts is established by the history of the
presence of white in the eyes or like a cat's eye from birth and
⦁ ophthalmological examination on the slit lamp by means of the
patient being swaddled and positioned in front of the slit lamp.
⦁ Serum IgM toxopalasma and IgM rubella tests were performed on
all congenital cataract sufferers, but only one of the patients
returned and showed increased levels of IgM toxoplasma

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Therapy
⦁ Surgery
⦁ Surgical therapy is performed immediately on a visually
significant cataract which is more than 3 millimeters in
diameter. Removal of cataracts can be done without the
installation of intraocular lenses (IOL)

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⦁ ECCE
⦁ ECCE requires a relatively large limbus incision (8-10 mm) but
this is relatively simple and makes it easy to learn without the
need for expensive equipment. After can opener capsulotomy is
done with a fine needle or cystitome so that the lens nucleus is
pushed

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Complications
⦁ In children the complications after lens removal differ from
adults. Retinal detachment, macular edema, and corneal
abnormalities are rare in children. The incidence of infection
after surgery and bleeding, the same in adults and children.
Glaucoma associated with pediatric Afakia develops every
year after lens removal is reported to occur in up to 25% of
patients.

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3

Case Report!
“ PATIENT IDENTITY

⦁ Name : By AAP
⦁ Age : 18 months
⦁ Male :gender

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Main
Complain ?
White in the middle of the eyeball

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Current Disease History
The patient came to be taken by his mother to the
Polytechnic of NTB Hospital with white and white
complaints in both eyes which were obtained from birth.
No comorbid complaints like red eye

Past medical history

1) History of Eye Disease –
2) 2) Systemic Disease History -

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Family Disease History
-

Pregnancy History
The patient's mother had admitted to having body heat at
the age of 24 weeks Childbirth History

Childbirth History
-The patient is born quite months, according to the day of
estimated birth. The patient was born spontaneously with
2.9 kg

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 Allergy History
-

Treatment History
-

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“
GENERALIST
STATUS
⦁ General Conditions : well
⦁ Awareness : Compos
mentis
Vital Signs
⦁ Pulse : 110 times / minute
⦁ RR : 28 times / minute
⦁ Temperature: 36.5

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 Pemeriksaan OD OS
Visus cannot be evaluated cannot be evaluated
Visual Field cannot be evaluated cannot be evaluated
Eyeball position cannot be evaluated cannot be evaluated
1. Hirschberg
2. Cover-Uncover
 

Eyeball movement cannot be evaluated cannot be evaluated

Pain during Eyeball cannot be evaluated cannot be evaluated

Movement
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Palpebra Superior    
1. Edema (-) (-)
2. Hiperemi (-) (-)
3. Massa (-) (-)
4. Sikatriks (-) (-)
5. Entropion (-) (-)
6. Ektropion (-) (-)
7. Ptosis (-) (-)
8. Pseudoptosis (-) (-)
9. Lagophtalmos (-) (-)
Palpebra Inferior    
1. Edema (-) (-)
2. Hiperemi (-) (-)
3. Massa (-) (-)
4. Sikatriks (-) (-)
5. Entropion (-) (-)
6. Ektropion (-) (-)
 
 
 

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Konjungtiva    
Palpebra    
1. Superior (-) (-)
 Hiperemi (-) (-)
 Folikel (-) (-)
 Sikatriks    
1. Inferior (-) (-) Kornea    
 Hiperemi (-) (-) 1. Permukaan Cembung, kesan Cembung, kesan
 Folikel (-) (-) 2. Kejernihan rata rata
 Sikatriks 3. Leukoma Jernih Jernih
Konjungtiva     (-) (-)
Bulbi (-) (-)
1. Injeksi (-) (-)
Konjungtiva (-) (-)
COA    
2. Injeksi Siliar (-) (-)
1. Kedalaman Kesan normal Kesan normal
3. Injeksi (-) (-)
2. Hifema (-) (-)
perikorneal (-) (-)
3. Hipopion (-) (-)
4. Hiperemis
5. Edema
6. Massa
 

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 Iris    
1. Bentuk Normal Normal
2. Warna Cokelat Cokelat
3. Sinekia (-) (-)
4. Edema (-) (-)
Pupil    
1. Bentuk Bulat, reguler Bulat, reguler
2. Diameter + 2 mm + 2 mm
3. Refleks Tidak dapat dievaluasi Tidak dapat dievaluasi
Langsung/ Tak
Langsung

Lens
Clarity Cloudy  Cloudy
Iris shadow (-) (-)

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31
3

Discussion!
Identification of problems
⦁ Subjective
An 18-month-old baby is brought to the NTB
RSUP polyclinic by his mother with the main
complaint of whites in both eyes in both eyes
that his parents have realized since the patient
was born. A history of pregnancy at 24 weeks
of pregnancy, fever, spontaneously born
patients with BBL 2.9 kg

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⦁ Objective
From the ophthalmology examination
cloudy right and left
obtained
eye lenses

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Case Analysis! 35
 First!
⦁ Main complains  Leukoria
⦁ White complaints in both eyes or can be called leukoria. The causes
of leukoria are various.
⦁ Leukocoria is caused by retinoblastoma, congenital cataracts,
traumatic cataracts, intrauterine uveitis, retinopathy of prematurity
(ROP), anterior uveitis, endophthalmitis, optic nerve gliomas.
In children with leukoria most caused by cataracts, then followed by
retinoblastoma and ROP

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From previous history, from a history of pregnancy the mother has a
history of fever at 24 weeks gestation which is a sign of intrauterine
infection or maternal infection.
Infection is one of the most common causes of cataracts in
children, especially bilateral cataracts.

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Addition In addition to the history of pregnancy, the history of labor in this
case is normal, where the patient was born in normal condition and this
condition can be considered to exclude ROP as a cause of laukoria in this
case

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After physical examination, turbidity has been found on the lens. Where
turbidity of the lens is called cataracts. Because cataracts in these
children are recognized or present at birth, they are called congenital
cataracts

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Assessment?

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Congenital
cataracts ODS
Planning

Diagnostic Planning
TORCH, Rubella laboratory tests
Therapeutic Planning
ECCE ODS

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Education

⦁ Provide information to the patient regarding the diagnosis of the patient's

disease.
⦁ Provide information related to the causes and risks of the cause of patient
diagnosis
⦁ Give information related to examination that must be done on patients
⦁ Giving information related to the planning of management to patients
⦁ Provide information to patients about possible complications and prognosis
that can occur.

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⦁ 3.4 Prognosis
⦁ 1. Ad vitam (prognosis of life): Dubia ad
bonam
⦁ 2. Ad functionam (vision prognosis):
Bonam
⦁ 3. Ad Sanationam (healing): Bonam

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Thanks!
Any questions?

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