Regular followup crucial to correct paediatric cataract,says study

Pune-based researcher Dr Parikshit Gogate who along with Lions National Association of Blind (NAB) Eye Hospital in Miraj and Orbis International (an international non-governmental developmental organization working for combating avoidable blindness globally) presented the findings at the Congress.

Outcomes of paediatric cataract vary with time as a child grows and develops,unlike that of an adult. While an adult operated for cataract may have an average life-span of a decade or two,a child operated for cataract would have three to four times longer life span.

According to the World Health Organization,an estimated 1.4 million children are needlessly blind. Three quarters of those children live in the poorest regions of Africa and Asia. Each year,almost half a million children go blind – approximately one child every minute.

Because a child’s eye is very different from an adult’s – it is especially susceptible to nutritional deficiencies and infections. Gogate said they had examined records for 374 bilateral paediatric cataract surgeries performed between 2004 and 2007,129 patients were identified and either transported to the hospital with their parents for examination or examined in their homes. Most children who were operated were between ages 6 and 10. Congenital cataract performed poorly with only 37 per cent achieving 20/63 vision.

“We also had over 100 cases of white cataracts of which only 38 per cent were 20/63 or better. Older children did better,because their visual system had already developed at the time of the surgery,” says Gogate.

Phacoemulsification procedure (which removes cataract using an ultrasound probe through a minute incision) led to better results than manual small incision. Children who had a regular follow up did better.

With cataract surgery and refractive surgery merging into one specialty,there is now a need to address astigmatism at the same time as the phacoemulsification procedure,the researcher has stressed.

Traumatic cataracts

Traumatic cataracts form a separate category of cataracts and the causes of trauma may be different in rural regions.

During 2004-2008,82 traumatic cataracts in children had been operated upon and were re-examined in 2009-10. They belonged to 81 children of whom 50 were boys. A 10-year-old girl had bilateral traumatic cataracts after a fall. Fifty children were boys and 40 suffered from blunt injuries while 32 were from sharp trauma.

The commonest cause was wooden stick injury and 23 children suffered from them while sharp injuries caused by thorns had affected 14 others. Sharp trauma and open globe injury had poorer outcomes At least 18 out of 82 eyes needed more than one surgery.

Visual acuity outcomes were satisfactory and were poor in sharp injuries and non-use of phacoemulsification. A total of 64.7% had vision better than 20/60 after surgery for traumatic cataract.

Even in developing country rural setting,satisfactory visual outcome is possible on long term,Gogate pointed out.