Chitra, S (2013) Visual outcome in the management of cataract in children with congenital rubella syndrome. Masters thesis, Madras Medical College, Chennai.
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Abstract
Congenital cataract refers to a lens opacity present at birth. Incidence of congenital cataract is one in every 2000 live births. Congenital cataracts are aetiologically heterogeneous and show a great range of phenotypes depending on their appearance and location in the lens. Both genetic and non-genetic factors contribute to the cause of congenital cataract. Viral infections, metabolic disorders, certain antibiotics and exposure to certain ionizing radiation during pregnancy and rarely chromosomal abnormalities contribute to the occurrence of congenital cataract. In majority of cases the etiology is unknown. Maternal infection with the rubella virus, a RNA toga virus cause fetal damage if infection occurs during the first trimester of pregnancy. The term rubella is a latin word meaning “little red”. Cataracts resulting from congenital rubella syndrome are characterized by pearly white nuclear opacification. Cataract may occur alone or part of classic triad of congenital rubella syndrome. Cataract is the most common ocular sign in congenital rubella syndrome. The occurrence of cataract is characteristic of the incidence of the rubella rash during the fifth or sixth week of gestation when the primary fibres of the lens are being laid down. Cataract removal in congenital rubella syndrome may be complicated by excessive post operative inflammation caused by release of these live virus particles. Live virus particles may be recovered from the lens as late as three years after birth. Younger children had greater incidence of PCO which was treated with capsulotomy either by yag or surgical. All children with rubella cataract should be treated with cataract extraction as early as possible with intensive control of post operative inflammation. The most common age group in which the congenital rubella cataract noted was 4 – 6 years of age. Least presentation was in the age group of 1- 3 years and above 10 years . •Incidence of congenital cataract was more in males compared to females. This dominance was noted in all age groups. •Defective vision was the most common presenting complaint. After this, the most common presentation was white reflex. •Antenatal history was uneventful in most of the mothers of the study children. •Milestone was delayed only in five patients with congenital rubella cataract. •In this study, the most common systemic abnormality was mental retardation and hearing defect. Cardiovascular abnormality and rash was found in one children each.. •In most of the children rubella vaccination status was unknown. •Bilateral cataract was common compared to unilateral cataract. •The most common morphology of congenital rubella cataract was central dense cataract. •Most often there was no associated ocular abnormalities. •Most of the children at the time of presentation had visual acuity of not fixing and following light to 5/60. •Regarding TORCH titre, in congenital rubella cataract most of the patients were positive for IgG only in high titres. IgM was noted in children less than one year of age group. All the cases were operated with intraocular lens implantation. •Incidence of iritis was more in the younger age group and those who were initially IgM positive at the time of presentation . Resolution of all cases of iritis was noted with intensive cycloplegic therapy and topical steroids. •Comparing the visual acuity pre operatively and post operatively there was statistically significant improvement in vision at two weeks, six weeks and six months. •The proportion of children with good visual acuity after surgery was decreased in six months follow up due to PCO. Incidence of PCO increases with time and more in the younger age group. •Visual rehabilitation was given to all children with best refractive error correction and amblyopia therapy if needed. •To conclude, children with congenital rubella cataract should be operated as early as possible under topical antibiotics coverage. Post operative inflammation should be properly treated with intensive cycloplegics and topical steroids. Proper follow up and visual rehabilitation should be done.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | visual outcome; management; cataract; children; congenital rubella syndrome |
| Subjects: | MEDICAL > Ophthalmology |
| Depositing User: | Devi S |
| Date Deposited: | 20 Jul 2017 09:02 |
| Last Modified: | 20 Jul 2017 09:02 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/1987 |
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