2010 서울성모병원 안과 개원의 컨퍼런스 소아 백내장 환자를 보았을 때 서울성모병원 안과 박 신 혜

Pediatric cataracts Is this cataract is truly visually significant ?? 2010 서울성모병원 안과 개원의 컨퍼런스 Pediatric cataracts Is this cataract is truly visually significant ?? When to operate ?? What kind of systemic work-up ?? How to manage ??

Is this cataract is truly visually significant ?? 2010 서울성모병원 안과 개원의 컨퍼런스 Is this cataract is truly visually significant ?? Visual development occurs very early. The first 2-3 months of life represent the critical period of visual development Early cataract surgery - Normal visual development - eliminate their accommodative ability When to operate  Detection of visually significant cataract !!!

Is this cataract is truly visually significant ?? 2010 서울성모병원 안과 개원의 컨퍼런스 Is this cataract is truly visually significant ?? Red reflex test by direct ophthalmoscope / retinoscope : an integral part of pediatric eye exam

Is this cataract is truly visually significant ?? 2010 서울성모병원 안과 개원의 컨퍼런스 Is this cataract is truly visually significant ?? Evaluation of vision - Fix and Follow (+) - nystagmus (+) : bilateral sensory deprivation - eye-to-eye comparison – unilateral - strabismus (+) - The trade-off of losing accommodation for gaining VA is probably reasonable only when visual acuity is diminished to the 20/70 level or worse. Evaluation of cataract morphology

Is this cataract is truly visually significant ?? 2010 서울성모병원 안과 개원의 컨퍼런스 Is this cataract is truly visually significant ?? : poor view of retinal detail with the indirect ophthalmoscope : involving the central visual axis > 3mm : posterior cataract : nuclear – non-progressive, bilateral

When to operate ?? Evaluation of vision 2010 서울성모병원 안과 개원의 컨퍼런스 When to operate ?? Evaluation of vision Evaluation of cataract morphology  onset, prognosis

Morphological classification 2010 서울성모병원 안과 개원의 컨퍼런스 Morphological classification Lens anatomy - Embryonic nucleus - Fetal nucleus - Y-suture

Morphological classification 2010 서울성모병원 안과 개원의 컨퍼런스 Morphological classification Nuclear Lamellar Anterior polar Posterior polar Persistent hyperplastic primary vitreous (PHPV)

Morphological classification 2010 서울성모병원 안과 개원의 컨퍼런스 Morphological classification Nuclear Lamellar Anterior polar Posterior polar PHPV

Morphological classification 2010 서울성모병원 안과 개원의 컨퍼런스 Morphological classification DDx True Congenital vs Developmental !! Some visually significant cataracts may have been partial during the critical period. Progressive cataract - lamellar - bilateral cat. without nystagmus - posterior polar - PHPV  less amblyogenic, better visual prognosis !!

2010 서울성모병원 안과 개원의 컨퍼런스 Ocular work-up A dilated ocular examination is one of the most critical aspects of the workup !!! If needed, sedation ! Unilateral  Bilateral Cataract morphology and density PHPV or posterior lenticonus Iris R/O posterior pole pathology !! USG

CASE 1. M/3m, 22608364 C/C : nystagmus (+) Red reflex (-) (OD) 2010 서울성모병원 안과 개원의 컨퍼런스 CASE 1. M/3m, 22608364 C/C : nystagmus (+) Red reflex (-) (OD) Thick post.plaque opacity (OD) Microphthalmia & optic disc coloboma (OD)

Post.polar opacity with stalk PHPV(OS) with morning glory disc (OS) 2010 서울성모병원 안과 개원의 컨퍼런스 CASE 2. M/5, 19595923 Post.polar opacity with stalk PHPV(OS) with morning glory disc (OS) BCVA 1.0 / 0.1 가림치료 1년째 좌안 교정시력 0.5

What kind of systemic work-up ?? 2010 서울성모병원 안과 개원의 컨퍼런스 What kind of systemic work-up ??

What kind of systemic work-up ?? 2010 서울성모병원 안과 개원의 컨퍼런스 What kind of systemic work-up ?? Bilateral : often inherited and may be associated with a systemic disease. : 60-70% of cases – hereditary ( AD) - identifiable causes Unilateral : local dysgenesis : neither associated with a systemic disease nor inherited. : do not require an extensive systemic w/up

Bilateral pediatric cataract 2010 서울성모병원 안과 개원의 컨퍼런스 Bilateral pediatric cataract AD inhertance pattern is the m/c identifiable cause of bilateral congenital cataracts. Intrauterine infection – syphilis , TORCH Chromosomal anomalies –Down’s syndrome Metabolic disorders - galactosemia (23085002, M/32m, 신 O성) - hypoglycemia (22764472, M/24m, 김O한) - hypoparathyroidism  unexplained bilateral cataracts in infancy

How to manage ?? Visually significant cataract 2010 서울성모병원 안과 개원의 컨퍼런스 How to manage ?? Visually significant cataract : poor view of retinal detail with the indirect ophthalmology : involving the central visual axis > 3mm : posterior cataract : dense nuclear cataract : associated with strabismus / nystagmus Visually insignificant cataract : partial cataract less than 3mm : pericentral cataract  Operation  Glasses c/s occlusion therapy

Surgical managements General anesthesia 3mm sup.limbal incision 2010 서울성모병원 안과 개원의 컨퍼런스 Surgical managements General anesthesia 3mm sup.limbal incision Manual CCC Lens aspiration c I/A handpiece Post. CCC with ant. vitrectomy IOL implantation Postop. management ; antibiotics and steroid, atropine Aphakic correction < 5YO Bilateral aphakia  2YO IOL implantation Unilateral aphakia  CL trial & OT

CASE 3. M/3 우연히 발견된 좌안 백내장 BCVA 0.63 / 0.08 2D 부등시 2010 서울성모병원 안과 개원의 컨퍼런스 CASE 3. M/3 우연히 발견된 좌안 백내장 BCVA 0.63 / 0.08 2D 부등시 Post.plaque opacity(OS)

Post.polar opacity 2mm sized with stalk (OS) Ant.PHPV (OS) 2010 서울성모병원 안과 개원의 컨퍼런스 Mittendorf’s dot 9/M Post.polar opacity 2mm sized with stalk (OS) Ant.PHPV (OS) BCVA 1.0 / 0.63

2010 서울성모병원 안과 개원의 컨퍼런스 15/M BCVA 0.63/0.5 갈수록 책보기가 힘들다 수술했으면 좋겠다

2010 서울성모병원 안과 개원의 컨퍼런스 9/M BCVA 0.63/0.63 자꾸 얼굴을 돌리고 본다. 수술하면 안 돼요?

M/8 BCVA 0.5/0.5 Pupillary membrane occluding visual axis (OU) Surgical Removal (OU)

2010 서울성모병원 안과 개원의 컨퍼런스 F/5 BCVA 0.63/0.63

2010 서울성모병원 안과 개원의 컨퍼런스 소아 백내장 환자를 보았을 때, Is this cataract is truly visually significant ?? : poor view of retinal detail with the indirect ophthalmoscope : involving the central visual axis > 3mm : posterior cataract When to operate ?? : cataract morphology  onset, prognosis : nuclear – non-progressive, bilateral What kind of systemic work-up ?? : unilateral  bilateral : family history (+), TORCH and VDRL How to manage ??

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