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 Table of Contents  
ORIGINAL RESEARCH REPORT
Year : 2017  |  Volume : 14  |  Issue : 4  |  Page : 178-181

Pattern of presentation of pediatric cataract in tribes of hills of Western India: A hospital-based retrospective study at Global Hospital Institute of Ophthalmology, Mount Abu


Department of Pediatric Ophthalmology and Strabismus, Global Hospital Institute of Ophthalmology, Sirohi, Rajasthan, India

Date of Web Publication8-Nov-2017

Correspondence Address:
Amit Mohan
Global Hospital Institute of Ophthalmology, Talehati, Abu Road, Sirohi, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcls.jcls_59_17

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  Abstract 


Context: Congenital cataract is a priority of Vision 2020: the right to sight, the global initiative to reduce the world's burden of avoidable blindness because it is an important treatable cause of visual physically challenged in childhood worldwide. Prevention and treatment require information about etiology that is currently unavailable for many regions of the world. From an epidemiologic study, the causative factors of pediatric cataract can be identified. Aims: This study aims to determine causes of childhood cataracts and to identify the preventable factors in tribes of hilly areas of Western India. Settings and Design: The present study is a hospital-based retrospective study. Materials and Methods: A retrospective study was conducted after reviewing the details of 165 patients of pediatric cataract aged between 3 months and 15 years who underwent cataract surgery in our institute from April 2011 to March 2014. A team of ophthalmologists and pediatricians attached to the center examined all the patients preoperatively. The type of cataract was determined using slit lamp biomicroscopy or operating microscope. Results: Nontraumatic cataract was 72.1% and traumatic cataract was 27.9%. Nontraumatic cataract includes hereditary (10.1%), rubella (5.0%), secondary (16.8%), and idiopathic (68.1%). In nontraumatic cataract group, 66 patients had bilateral cataract and 53 had unilateral cataract. Traumatic cataract was the most common in the age group of 6–10 years and most common cause of trauma is thorn (23.9%) followed by stone (21.7%), crackers (17.4%), wood stick (13%), finger (4.3%), chemical injury (4.3%), needle (4.3%), wire (2.2%), and others (8.7%). Conclusions: About 5% of nontraumatic bilateral cataracts in hills of Western India are due to rubella. An awareness program for precaution during pregnancy and immunization against rubella is needed to prevent it. School children must be educated for factors causing traumatic cataract and need supervised play in outdoor.

Keywords: Congenital cataract, epidemiology, rubella, traumatic cataract


How to cite this article:
Mohan A, Kaur N. Pattern of presentation of pediatric cataract in tribes of hills of Western India: A hospital-based retrospective study at Global Hospital Institute of Ophthalmology, Mount Abu. J Clin Sci 2017;14:178-81

How to cite this URL:
Mohan A, Kaur N. Pattern of presentation of pediatric cataract in tribes of hills of Western India: A hospital-based retrospective study at Global Hospital Institute of Ophthalmology, Mount Abu. J Clin Sci [serial online] 2017 [cited 2017 Dec 11];14:178-81. Available from: http://www.jcsjournal.org/text.asp?2017/14/4/178/217820




  Introduction Top


Pediatric cataract is a major cause of childhood blindness. Pediatric cataracts are responsible for more than 1 million childhood blindness in Asia.[1] In developing countries like India, 7.4%–15.3% of childhood blindness are due to cataract.[2],[3],[4] Hereditary, metabolic, some ocular or systemic disorders, and trauma are known factors responsible for cataract in children. In India, half of childhood cataracts are idiopathic.[5]

Since the discovery by Gregg in 1941[6] that maternal rubella commonly causes congenital cataract, widespread immunization programs in the developed world have resulted in a dramatic decrease in the incidence of rubella embryopathy.[7]

Congenital cataracts must be caused by changes that occur during embryonic development, whereas juvenile cataracts may result from alterations in gene expression after birth. Anterior polar cataract can arise from abnormal separation of the lens vesicle in early pregnancy. Persistent pupillary membranes, a remnant of tunica vasculosa lentis, may also be associated with anterior polar cataracts. Persistent hyperplastic primary vitreous is related to the persistence and secondary fibrosis of the primitive hyaloid vascular system.[7] This fibrovascular membrane may be quite small, such as a Mittendorf's dot, or can extend from the center of the posterior lens capsule to the ciliary processes.

Developmental genes affecting the lens development include PAX6 and PITX3, which are critical for the formation of the lens architecture.[8] Mutations of these genes cause congenital cataract often, but not exclusively, and are associated with other anterior segment anomalies.[9] One family with congenital cataracts due to a PITX3 mutation, but without anterior segment mesenchymal dysgenesis, has been described.[10],[11] Cataract is also a known feature of teratogenic exposures (e.g., rubella, varicella, cytomegalovirus).[12],[13]

Blindness from cataracts is less common in children compared with adults; however, the impact is severe in terms of vision years lost.[14] Even in developed countries, where treatment is readily available, pediatric cataract is responsible for a high proportion of childhood blindness.[15] The aim of the study is to determine causes of childhood cataracts and to identify the preventable factors in tribes of hilly areas of Western India.


  Materials and Methods Top


The present study is a hospital-based retrospective study. We reviewed all the pediatric cataract cases managed over the past 3 years at our institute from April 2011 to March 2014 including 165 patients of age group from 3 months to 15 years. A team of ophthalmologists and pediatricians attached to the center examined all the patients preoperatively. The type of cataract was determined using slit lamp biomicroscopy after full dilation of pupils. Pupils were dilated with atropine eye ointment 1% for the age group of 1–5 years, with tropicamide beyond 5 years of age. Patients who were not cooperative were examined under general anesthesia by operative microscope. Vertical-horizontal corneal diameter, intraocular pressure, keratometry, and axial length were measured and fundus status was evaluated with indirect ophthalmoscope during the same period.

Biochemical investigations include blood glucose, reducing sugar in urine, rubella specific IgG and IgM antibody (only in children <1 year of age). Information about probands cataract history, prenatal and postnatal health, child birth history, consanguinity was also collected by reviewing the patient case sheet.

The Institutional Ethics Committee on Human Subjects Research, 2013–2014, granted approval, subsequent to which data collection for the study was initiated. The statistical software, statistical product and service solutions (SPSS for Windows, Version 16.0, Chicago, SPSS Inc.) was used for the analysis of the data and Microsoft word and Excel have been used to generate graphs, tables, etc.

Clinical information of all patients was analyzed according to their etiology. Cases were divided into traumatic and nontraumatic. Traumatic patients were further classified based on causes of trauma. Nontraumatic cases were classified into four groups; (1) hereditary-cases with positive family history, (2) secondary-associated with any other ocular diseases/metabolic/systemic diseases/known syndromes, (3) rubella-diagnostically confirmed congenital rubella, and (4) idiopathic-undetermined causes.


  Results Top


In the present study, we evaluated 165 pediatric patients who underwent for cataract surgery at our institute, out of which 119 (72.12%) were nontraumatic cataract and traumatic cataract was 46 (27.88%). Mean age of the patients was 9.5 years ranging from 3 months to 15 years. Thirteen patients were below the age group of 1 year and 152 patients were beyond the age of 1 year. Cataract was twice more common in males (110) than females (55). Out of these cataract cases, only 4 (2.4%) children were offspring of consanguineous couples. Positive family history was found in 26 patients (21.9%). There was history of maternal illness in the 2nd and 3rd trimester of pregnancy in 18 cases (16.1%).

Of 165 patients of pediatric cataract, 119 (72.12%) were found to be of nontraumatic causes. This category is further classified into hereditary, rubella, secondary and idiopathic causes; the distribution of cataract was summarized among these in [Table 1]. Idiopathic is the most common cause of nontraumatic cataract which was calculated to be 81 (68.06%). Others include hereditary 12 (10.08%), secondary 20 (16.80%), and rubella 6 (5.04%). In nontraumatic cases, 66 patients were presented with bilateral cataract and 53 patients were of unilateral cataract.
Table 1: Epidemiology of nontraumatic pediatric cataract

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Cataract in infants

Etiology of various types of cataract among infants was also evaluated during the same study. Thirteen (7.87%) patients out of 165 were under the age of 1 year [Table 2]. There were 2 cases of traumatic cataract and the rest (11) were nontraumatic. Among nontraumatic cases various etiological factors include hereditary 3 cases (23.07%), rubella 3 cases (23.07%), idiopathic 3 cases (2.07%), and secondary 2 cases (15.38). Out of 13 patients, 9 (69.23%) presented with bilateral cataract and 4 (30.76%) presented with unilateral cataract. Morphological classification of nonrubella cases of infantile cataract was evaluated as total cataract (30%), posterior subcapsular (10%), lamellar (50%), and mixed (10%) [Table 3].
Table 2: Etiology of cataract in children <1 year old

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Table 3: Morphological classification of rubella and nonrubella patients <1 year old

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Rubella cataract

Rubella was diagnosed by rubella specific IgG antibody test in all the infants and was found to be positive in 3 patients. Morphologically, 2 cases of total cataract and 1 case of lamellar cataract were found [Table 3].

Traumatic cataract

Traumatic cataract was most commonly present in the age group of 6–10 years. Most common cause of cataract was thorn injury (23.9%). Various other causes of traumatic cataract [Table 4] include crackers (17.4%), wood stick (13%), finger (4.3%), chemical injury (4.3%), wire (2.2%), stone (21.7%), and others (8.7%).
Table 4: Etiology of traumatic cataract by age

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  Discussion Top


Our hospital is a tertiary eye care center serving tribal population of large area of hills of Western part of India with well-established pediatric unit. Majority of childhood cataract in this region are idiopathic. The occurrence of hereditary cataract and congenital rubella syndrome is less compare to other previous study in North and South India.[16],[17],[18] Incidence of traumatic cataract is much higher than previous studies because of locality of our hospital in tribal areas surrounded with many small trees with thorn leading to trauma to the children in outdoor. Sandblasting and stone pelting are also important cause of trauma in this locality.[19] Thorn injury is the most common cause of trauma (23.91%) and stone injury being the second most common cause of trauma (21.73%) among the traumatic cataract.

Many etiological studies on childhood cataract have been carried out in developed as well as developing countries to determine causative factors.[7],[14],[15],[16],[17],[18] Eckstein, et al.[16] performed a study in South India showed that among nontraumatic cataracts, 25% were due to hereditary, 15% were due to congenital rubella syndrome, and 51% were idiopathic. Nearly, half of nontraumatic cataracts in this population are due to potentially preventable causes such as congenital rubella syndrome and autosomal dominant disease. In North India, Angra.[17] (1987) found that 31% were idiopathic, 14% were hereditary, and 21% may have been due to rubella.[17] While Jain et al.[18] (1983) found that 20% were hereditary, 9% were due to metabolic diseases, and 5% had cataract associated with known syndrome.[18] In the present study, we found that among the nontraumatic cataract 10.08% was hereditary, 5.04% was due to congenital rubella syndrome, secondary was 16.80% and 68.06% was idiopathic. In this study, idiopathic is most common cause of pediatric cataract while rubella is least common.

Rubella is a common cause of cataract blindness in South India and accounts for more than 25% of all new cases of congenital cataract.[16] In the study, we found that 5.04% cases of congenital cataract is due to rubella which is much more <15% in South [16] and 21% in North India.[17]

Cataracts due to consanguineous marriages are less in the present study compared to previous reported studies.[16],[20] It may be due to the fact that such type of marriages is not common in this part of India.


  Conclusions Top


Nearly, 23% of no traumatic bilateral cataracts in tribes of Western India are due to preventable causes. Many of cases had been implicated due to rubella infection. Awareness program for precaution during pregnancy and immunization against rubella is needed for prevention. School children must be educated for factors causing traumatic cataract and need supervised play in outdoor.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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2.
Gilbert CE, Canovas R, Hagan M, Rao S, Foster A. Causes of childhood blindness: Results from West Africa, South India and Chile. Eye (Lond) 1993;7(Pt 1):184-8.  Back to cited text no. 2
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Goldberg MF. Persistent fetal vasculature (PFV): An integrated interpretation of signs and symptoms associated with persistent hyperplastic primary vitreous (PHPV). LIV Edward Jackson Memorial Lecture. Am J Ophthalmol 1997;124:587-626.  Back to cited text no. 8
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Sale MM, Craig JE, Charlesworth JC, FitzGerald LM, Hanson IM, Dickinson JL, et al. Broad phenotypic variability in a single pedigree with a novel 1410delC mutation in the PST domain of the PAX6 gene. Hum Mutat 2002;20:322.  Back to cited text no. 12
    
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Lloyd IC, Goss-Sampson M, Jeffrey BG, Kriss A, Russell-Eggitt I, Taylor D. Neonatal cataract: Aetiology, pathogenesis and management. Eye (Lond) 1992;6(Pt 2):184-96.  Back to cited text no. 13
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Rahi JS, Gilbert CE, Foster A, Minassian D. Measuring the burden of childhood blindness. Br J Ophthalmol 1999;83:387-8.  Back to cited text no. 14
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Eckstein M, Vijayalakshmi P, Killedar M, Gilbert C, Foster A. Aetiology of childhood cataract in South India. Br J Ophthalmol 1996;80:628-32.  Back to cited text no. 16
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Jain IS, Pillay P, Gangwar DN, Dhir SP, Kaul VK. Congenital cataract: Etiology and morphology. J Pediatr Ophthalmol Strabismus 1983;20:238-42.  Back to cited text no. 18
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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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