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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