An analytical study of visual outcome in paediatric cataract surgery.

INTRODUCTION Paediatric blindness presents an enormous problem to developing countries in terms of human morbidity, economic loss, and social burden. One of the common cause of paediatric blindness is paediatric cataract. Managing cataracts in children remains a challenge: presentation is often delayed, diagnosis and assessment requires multitude of investigations, treatment is often difficult, tedious, and requires a dedicated team effort. Post op complications continue to be a major concern. The risk of post op complications is higher due to greater inflammatory response after paediatric intra ocular surgery. To assure the best long term outcome for cataract blind children, appropriate paediatric surgical techniques need to be applied and children have to be monitored and managed by a team comprising paediatric ophthalmologist, orthoptists, optometrists, skilled teachers, social workers and more importantly aware and patient parents. EPIDEMIOLOGY As per recent WHO statistics there are 1.4 million children with severe visual impairment or blindness in the world. The burden of disability in terms of blind years is approximately 70 million (1.4 million x 50yrs of age) because of the child’s life expectancy after developing the visual disability. The proportion of blindness in children due to cataract is estimated to be 14% or 1,90,000 children. Of the 70 million blind-person years caused by childhood blindness, about 10 million blind-person years is due to childhood cataract. It is a priority in all blindness control program for children, as loss of vision in children influences their education, employment and social life. AIM OF THE STUDY To study the Morphological Pattern and Presentation of patients with Congenital and Developmental Cataract. To study the Ocular Morbidity and Visual out come after Cataract Surgery in Paediatric age group. To study the Post Op Complications and Capsule behaviour pattern in Paediatric Cataract. To study the Visual outcome after YAG LASER and Surgical Capsulotomy. MATERIALS AND METHODS 50 children who presented with developmental cataract in the age group of 2- 12years to the Regional Institute of Ophthalmology and Government Ophthalmic Hospital during the period February 2004 to February 2006 were included in this study. CONCLUSION Childhood cataract is an important cause of blindness in children and imposes a huge socio economic burden on society. There was male predominance in this study. Total cataract and lamellar cataract were the common type of cataract, which led to significant reduction in visual function. Most of the children brought, were less than or equal to 6 years of age, even if their cataract wasn’t visually significant, showing the awareness amongst the parents, teachers and the paediatricians. Strabismus due to visual deprivation in this study stresses the need for early intervention, especially in unilateral cases. Children less than 6 years who underwent primary posterior capsulotomy with or without anterior vitrectomy showed good visual outcome, supporting the role of primary posterior capsulotomy and anterior vitrectomy. PCO is the commonest complication and a major cause for visual obscuration following surgery, though the incidence of PCO has been brought down with modified surgical techniques and newer IOL designs. The incidence of Pupillary capture and IOL decentration was less probably due to the, in the bag fixation of the IOL, made possible by CCC. Children who needed YAG/surgical capsulotomy had significant visual gain by showing improvement by more than two Snellen lines