Pediatric Cataracts Flashcards
What is the importance of distinguishing between unilateral and bilateral infantile cataracts?
It is useful when considering the etiology, as they have different causes and associations.
What is the most common cause of bilateral congenital or infantile cataracts not associated with a syndrome?
Genetic mutation, with over fifteen genes identified as involved in cataract formation.
What is the most common pattern of inheritance for genetic mutations causing bilateral cataracts?
Autosomal dominant, although it can also be X-linked or autosomal recessive.
Name some systemic associations of bilateral congenital cataracts.
Metabolic disorders such as galactosemia, Wilson disease, hypocalcemia, and diabetes, as well as syndromes like trisomy 21.
What intrauterine infections can cause bilateral congenital cataracts?
Rubella, herpes simplex, toxoplasmosis, varicella, and syphilis
How are most unilateral cataracts different in terms of inheritance and systemic disease association?
Most unilateral cataracts are not inherited or associated with systemic disease and have unknown etiology.
What ocular conditions may be associated with unilateral cataracts?
Local dysgenesis and other ocular dysgenesis such as persistent fetal vasculature (PFV), posterior lenticonus, or lentiglobus.
What is a known cause of pediatric cataracts besides genetic or systemic factors?
Trauma.
What should be considered if a child presents with an acquired cataract but no known history of trauma?
Investigation for signs suggestive of child abuse.
Why is prompt treatment of visually significant cataracts necessary in children?
To allow proper development of vision.
What exam is extremely useful for estimating the size and location of a cataract within the visual axis?
The red reflex exam
What are some ocular abnormalities that may accompany cataracts?
Microcornea, megalocornea, coloboma of the iris, aniridia, and zonular dehiscence.
What symptoms may raise concern in infants with cataracts?
Lack of reaction to light, strabismus, failure to notice toys and faces, or an apparent delay in development.
What symptom might mild cataracts cause in bright lights?
Photophobia.
What is leukocoria, and how is it related to cataracts?
Leukocoria is a white reflection from the pupil, which can be mistaken for cataracts. It is important to differentiate between cataracts and other conditions that cause leukocoria.
What condition characterized by leukocoria is a malignant tumor of the retina?
Retinoblastoma.
How can persistent fetal vasculature (PFV) be differentiated from cataracts?
PFV is identified through a complete exam of the anterior and posterior segment, often requiring ultrasound to detect the presence of persistent fetal blood vessels.
Which condition related to premature birth can cause leukocoria and how is it differentiated from cataracts?
Retinopathy of prematurity. It can be differentiated by examining the retina for abnormal blood vessel growth, often with the aid of retinal imaging.
What are chorioretinal colobomas and how can they be distinguished from cataracts?
Chorioretinal colobomas are congenital defects in the eye structure, typically identified by examination of the retina for missing or malformed tissue.
What parasitic infection can cause leukocoria and how is it differentiated from cataracts?
Toxocariasis, a parasitic infection, can be identified by looking for signs of inflammation and retinal granulomas during an eye examination.
How is Coats disease differentiated from cataracts?
Coats disease is identified by the presence of retinal telangiectasia and exudation, visible during a retinal examination.
What condition involves bleeding into the eye and can be mistaken for cataracts?
Vitreous hemorrhage, which can be distinguished by the presence of blood in the vitreous humor detected during a comprehensive eye exam.
What tool is often used to aid in differentiating these conditions from cataracts?
Ultrasound, which helps in visualizing structures within the eye that are not visible through standard examination.
What size of cataract is considered visually insignificant and may not require surgery?
Cataracts less than 3mm in diameter.
What type of cataract does not affect vision and is considered visually insignificant?
Blue-dot cataract
What indicates a good red reflex in the context of cataract evaluation?
A good red reflex can be seen with a direct ophthalmoscope or retinoscope.
What are some non-surgical management options for visually insignificant cataracts?
Observation with regular monitoring, pharmacologic pupillary dilation, and occlusion of the other eye in unilateral cases.
Why should cycloplegic drops be avoided in non-surgical management of cataracts?
Because they can cause loss of accommodation and may lead to amblyopia.
When is surgical treatment indicated for cataracts?
For any cataract that is visually significant, such as those with >3mm central opacity or causing strabismus or nystagmus.
What is the recommended timing for surgery in unilateral cataracts?
As early as possible between 4-6 weeks of age
What are the risks of operating on a child with unilateral cataracts before 4 weeks of age?
Increased risk of complications from general anesthesia and aphakic glaucoma.
What is the recommended timing for surgery in bilateral cataracts?
Surgery should be performed by 6-8 weeks of age, with each eye operated on one week apart
What is an alternative approach for bilateral cataract surgery if the child is a high-risk case for general anesthesia?
Both eyes can be simultaneously operated on by an experienced surgeon using a completely different set of instruments for each eye.
