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Home , Childhood cataract

AL-AZHAR ASSIUT MEDICAL JOURNAL AAMJ ,VOL 13 , NO 4 , OCTOPER 2015

EPIDEMIOLOGY OF PEDIATRIC IN DAKAHLIA: UNI-CENTER STUDY Walid M. Gaafar Department, Ophthalmic Center, Mansoura University, Egypt ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ Abstract Purpose: to study the prevalence and the different epidemiological aspects of pediatric cataract in our locality. Methods: A retrospective study included reviewing of medical records of children (≤18 years) diagnosed with cataract, recruited from the Mansoura ophthalmic center, Egypt from 2010 to 2015. The charts were reviewed to gather epidemiological, clinical and surgical data. Results:A total of records of 1320 eyes (940 patients) were retrieved. Median age at diagnosis was 6 years (2 days - 18 years). Almost half (52%) of them were male. The ratio of unilateral to bilateral was 1.2 to1. Positive family history was found in 212 (22.5%) of the patients. Most of the (CC) cases were idiopathic (37%). Traumatic cataract was the most common diagnosis in acquired cases (83%). was the most common presenting symptom in CC (63%). was more common in acquired cataract (57%).Nuclear cataract was the most frequent type (48%) in CC, while cortical cataract predominated in acquired type (51%).A total of 1288(97%) eyes had undergone cataract surgery with mean follow-up of4±1.6 years. Conclusion:Pediatric cataract represents a true challenging condition in our locality. Key words: Cataract; congenital; Dakahlia, Egypt; epidemiology; Pediatric.

INTRODUCTION possible mechanisms of cataractogenesis. To Pediatric cataract is one the leading date, there is limited public awareness regarding causes of treatable blindness in children, this conditionespecially in developing affecting almost about 1 to 15 child per 10,000 communities as well aslimited published children all over the world1. The incidence is literaturedescribing the epidemiological aspects even higher in Arab countries owing to the high of pediatric cataract in our region. degree of consanguinity among parents. The Thus, we conductedthe current study to prevalence of childhood cataract in Saudi shed light on the prevalenceof pediatric cataract Arabia was estimated to be 14.7 per 10,000 in our locality and to gatherthechief children, which by far is considered the highest epidemiological factsin order to path the way international global incidence2. Despite the fact for the development of national screening being quite rare compared to adult cataract, strategies. pediatric cataract affects the quality of child's vision as it is encountered during the most PATIENTS AND METHODS sensitive phase of the development of the visual A retrospective study included reviewing system that might results in irreversible of medical records of children (≤18 years) impairment 3. diagnosed with cataract, recruited from the Even with the immense efforts advocated Mansoura ophthalmic center, Mansoura to improve the lines of management of pediatric University, Egypt during the period from cataract and the recent innovative leap January 2010 to January 2015. Records with experienced in the surgical techniques, incomplete data were excluded from the study. treatment is still the most challenging in The charts were reviewed to gather ophthalmology. Besides; the underlying epidemiological data as age, gender, family etiology stays mostly undetermined 4.Two history of cataract, possible etiology and the etiological types are usually identified; presence of any systemic syndromes. Clinical congenital and acquired cataract. Congenital data were also collected including laterality, cataract (CC) is a well known condition coined presenting symptoms, visual acuity, anterior and opacity discovered on birth or even early in posterior segment examination data, cataract childhood period5.Congenital cataract includes morphologyand intraocular pressure. Surgical either idiopathic, genetic, cataract associated details were obtained as operative timing, type with syndromes as well asintrauterine of surgical approach, recorded intra-and infections. Acquired cataractcomprises postoperative complications and follow-up traumatic, metabolic and iatrogenic cataracts6. period. No surgeon –to surgeon comparisons Consistent estimates about the were carried out. epidemiological profile of pediatric cataract are Statistical analysis crucial clues for better understanding of the

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Walid M. Gaafar AAMJ ,VOL 13 , NO 4 , OCTOPER 2015

Collected data were analyzed by In cc; bilateral cataracts were recorded in 360 Statistical Package of Social Science (SPSS, inc patients (75%). In total; the ratio of unilateral to Chicago, USA, version 16). Normality of data bilateral cataractswas 1.2 to1. Positive family was tested by Shapiro-Wilk test. Parametric data history was found in 212 (22.5%) of the was described in means± SD (standard patients. Most of the congenital cataract cases deviation) and non-parametric data was were idiopathic (37%)and only 8% were described in medians with min-max (minimum- associated with intrauterine infections. Ninety- maximum). Categorical data was described in eight(11.7%) patients had trisomy 21. In number and percent (%). 38(4.5%) eyes; cataract was associated with secondary to rubella RESULTS syndromeand42(5%)eyespresented with A total of records of 1320 eyes (940 persistent fetal vasculature (PHPV). Traumatic patients) were diagnosed with pediatric cataract cataract was the most common diagnosis in during the defined period. Median age at acquired cases (83%).Table (1) gives detailed diagnosis was 6 years (ranged from 2 days - 18 information about the demographic and detected years). Almost half (52%) of them were male. underlying etiology among the studied patients. Table (1): Demographic and possible etiologies in the studied group. Parameters value Age(years) Median 6 Min-max (2days-18 years) Gender Male: Female 489:451 ratio 1,1:1 Laterality(n=patients) Unilateral/ Bilateral 518/422 Ratio 1.2:1 Positive family history(n of patients\%) 172 (18%) Etiology (n of eyes\%) Congenital 840 Idiopathic 312(37%) Hereditary 288(34%) Genetic syndromes 172(21%) Intrauterine infections 68(8%) Acquired 480 Traumatic 398(83%) Metabolic syndromes 66(13.75%) others 16(1.25%) during routine ocular examinations.Visual Table (2) illustrates the detailed clinical impairment was more common in cases with data retrieved from the clinical roasters. acquired cataract (57%).Detected morphological Leukocoria was the most common clinical types are listed in table (2).Nuclear cataract was presenting symptom in congenital cataract the most frequent type (48%) in congenital representing 63% of the cases; followed by cataract, while cortical cataractpredominated in ocular motility disorders as and acquired type (51%). comprising 40% of the congenital cases. In 6% of the eyes, ccwas diagnosed Table (2): baseline clinical and morphological data among the studied group. Value Parameter Total n=1320 Presenting symptoms (n of eyes\ %) Leukocoria 563 (43%) Ocular motility disorder 386(29%) Visual acuity impairment 274(21%) Routine examination 97(7%) Morphology(n of eyes\ %) Nuclear 403 (30.5%) Total 382(29%) Polar 234(18%) Subcapsular 206(16%) Lamellar 87(6%) Sutural 8(0.5%) In total 1288(97%) eyes had undergone months). Unilateral cataracts had shorter surgical interference. Mean age at surgery was interval with mean±SD of 4.4±0.8 months. 7years (ranged from 14days – 18 years) with 7 Phacoaspirationand posterior capsulotomywith months median interval from time of diagnosis anterior vitrectomywas the most frequent used to date of surgery (ranged from 33 days to 9 technique. In patients under 2 years old at

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Walid M. Gaafar AAMJ ,VOL 13 , NO 4 , OCTOPER 2015

surgery, primary intraocular lens (IOL) cases. This was in line with the findings implantation was carried out in 119 eyes with reported in previous published studies 12, 13. unilateral cataract. Eyes with bilateral cataract Regarding the etiology; idiopathic in the same age group were left aphakic. Mean cataract was the most frequent cause in the cc in age at secondary IOL implantation was 2.8± the current series, accounting for 37% of the 1.1with median lapse intervalof2 years after congenital cases with 34% of the cases showing primary cataract surgery. Anterior approach was hereditary nature with strong positive family recorded in 632(75%) eyes with cc and posterior history. Perucho-martínezet al. 9reported lower approach was recorded in 192(25%) eyes with incidence of hereditary cataract (17%) in their cc. No major intraoperative complications were epidemiological study in Spain. This difference recorded. Postoperative complications were may be attributed in part to the higher incidence found in 581(44%) of the patients. Aphakic of consanguinity between the parents in our occurred in 208(16%), posterior community compared to their study group. synechiae in 541(41%), myopic shift in 244 Rubella syndrome is a commoncause of (3%) and posterior capsular opacificationin 405 cc. In south India; it accounts for more than (31%). Mean follow-up time was 4±1.6 years 25% of all new casesof cc 14. In our series; the after surgery. incidence was much lower (4.5%). This may be related to the routine vaccination program DISCUSSION practiced in our nation. Surplus epidemiological studies Down syndrome was the most frequent evaluating pediatric cataract have been carried genetic syndrome recorded in our series out in the developed countries aiming to representing 11.7% of the CC. In previous determine the possible contributing causes. published studies, the prevalence of cataracts Meanwhile; the literature in this aspect is still associated with Down syndrome in childrenfalls deficient among developing countries 6-8.The between 1 and 13%13, 15. objective of this study was to expand our Morphology of CC usually shows wide knowledge concerning epidemiological and heterogeneous presentations. Besides, various clinical uniqueness of pediatric cataracts in our morphologies can coexist. In the current study, population that entails positive impact upon nuclear and total cataracts were most\ improvement of management, especially prompt prevailing. This finding was in consistent with diagnosis in order to reduce the risk of other studies 9,10. development of . Timing of surgical interferenceas well We conducted a retrospective study asproper postoperative visual rehabilitation are approach involved reviewing the medical crucial steps to circumvent amblyopia. The records of the children diagnosed with cataract approach for dealing with cataractrelies on along 5 years attending Mansoura ophthalmic various factors specially the patient’s age. center, Mansoura University. Our Center is Children above 2 years old, who were likely to considered the tertiary referral center for have their IOL implanted primarily, often children all over the Dakahelia serving patients underwent anterior approach. For younger from different parts of the government. children, the approach was optional. The current study included a relatively Posterior capsularopacificationwas the large number of records for pediatric cataract most frequent complication encountered in compared to previous published articles in almost all the children less than four years old16, different regions. In a retrospective study 17.The incidence in our series had fallen conducted in Spain for a longer period (18 tremendously in the recent years as we routinely years); only 79 patients were recorded 9. Over incorporated the step of primary capsulotomy 25 year, 421 eyes with pediatric cataract were with anterior vitrectomy in all the cataract retrieved in southern Australia 10. On the other surgeries in pediatric age group particularly hand, in a prospective study in Western-India those less than 8 years old. that lasted for only one year; 172 patients were included in the study 11. This striking difference CONCLUSION should draw more concern regarding a true The high prevalence of pediatric cataracts vision threatening condition among different in our locality reflects a true national problem communities. that is in need of establishingplansfor Our results regarding laterality showed a prevention, early diagnosis and prompt predominance of bilateral cases (75%) in cc treatment strategies. Therapeutic success entailsan apt approach. Treatment should be

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AL-AZHAR ASSIUT MEDICAL JOURNAL AAMJ ,VOL 13 , NO 4 , OCTOPER 2015

tailored for each case and strict extended 10- Wirth M G, Russell-Eggitt I M, Craig J E, follow-upshould be issuedfor proper visual Elder J E, Mackey D A. Aetiology of rehabilitation as well as managing any congenital and paediatric cataract in an complications. Australian population. Br J Ophthalmol 2002;86:782–786. CONFLICTS OF INTEREST 11- KaidJoharS R, SavaliaNK, VasavadaAR, The author declares no conflicts ofinterest Gupta PD. Epidemiology based etiological during writing thecurrent manuscript. study of pediatric cataracts in western India. Indian J Med Sci. 2004;58(3):115-121. FINANCIAL SUPPORT 12- Tartarella MB, Britez-Colombi GF, The author declares no financial support during Milhomem S, Lopes MC, Fortes Filho JB. writing the current manuscript Pediatric cataracts: clinical aspects, frequency of strabismus and chronological, REFERENCES etiological, and morphological features. Arq 1- Foster A, Gilbert C, Rahi J. Epidemiology Bras Oftalmol. 2014; 77:143-147. of cataract in childhood: a global 13- Haargaard B, Wohlfahrt J, Fledelius H, perspective. J Cataract Refract Surg. Rosenberg T, Melbye M. A nationwide 1997;23: 601-604. Danish study of 1027 cases of 2- Khan AO, Hereditary pediatric cataract on congenital/infantile cataracts: etiological and the Arabian Peninsula. Saudi J ophthalmol. clinical classifications. Ophthalmology. 2012;26:67-71 2004;111:2292-2298. 3- SanGiovanni, J. P. et al. Infantile cataract in 14- Eckstein M, Vijayalakshmi P, Killedar M, the collaborative perinatal project: Gilbert C, Foster A. Aetiology of childhood prevalence and risk factors. Arch cataract in South India. Br J Ophthalmol Ophthalmol 2002;120:1559–1565 . 1996;80:628-632. 4- Rahi, J. S. &Dezateux, C. Measuring and 15- da Cunha RP, Moreira JB. Ocular findings interpreting the incidence of congenital in Down`s syndrome. Am J Ophthalmol. ocular anomalies: lessons from a national 1996;122:236-244. study of congenital cataract in the UK. 16- Apple DJ, Solomon KD, Tetz MR, Assia EI, Invest Ophthalmol Vis Sci. 2001;42: 1444– Holland EY, Legler UF, et al. Posterior 1448. capsule opacification. SurvOphthalmol. 5- Jain, I. S., Pillay, P., Gangwar, D. N., Dhir, 1992;37:73-116. S. P. &Kaul, V. K. Congenital cataract: 17- Stager DR Jr, Weakley DR Jr, Hunter JS. etiology and morphology. J Long-term rates of PCO following small PediatrOphthalmol Strabismus 1983;20: incision foldable acrylic intraocular lens 238–242. implantation in children. 6- Lim Z, Rubab S, Chan YH, Levin AV. JPediatrOphthalmol Strabismus. 2002; Pediatric cataract: the Toronto experience- 39:73-76. etiology. Am J Ophthalmol. 2010;149:887- 892. 7- Fakhoury O, Aziz A, Matonti F, Benso C, Belahda K, Denis D. Epidemiologic and etiological characteristics of congenital cataract: study of 59 cases over 10 years. J FrOphthalmol. 2015; 38:295-300. 8- American Academy of Ophthalmology. Childhood cataracts and other pediatric lens disorders. In: Basic and clinical science course, section 6. San Francisco: Pediatric Ophthalmology and Strabismus; 2014-2015. p. 291-308. 9- Perucho-martínez s, de-la-cruz-bertolo j, tejada-palacios p. Pediatric cataracts: epidemiology and Diagnosis. Retrospective review of 79 cases. Arch socespoftalmol 2007; 82: 37-42.

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