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R. Krishnamurthy, D. K. VanderVeen; Prevalence and Etiology of Visually Significant Pediatric Cataracts. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4840.
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Pediatric cataracts are the most common cause of treatable childhood vision impairment, accounting for 5-20% of blindness in children worldwide. Previous epidemiologic studies have focused on types of cataracts within a patient population without distinguishing their visual significance and need for cataract extraction. Additionally, the majority of these studies were conducted in foreign countries such as India and Denmark, whose populations differ substantially from ours. For comparison, we surveyed the etiologies of pediatric cataract that required surgical intervention in our U.S. tertiary care institution.
A retrospective chart review of all patients who underwent cataract surgery at Children's Hospital, Boston from 2000-2005 was conducted. Age of patient, etiology of cataract, and the date of surgery were recorded for each patient. Etiological classification of the cataracts was based on information from the medical records.
There were 159 patients <18 years at the time of surgery (80 females, 79 males); overall 96 patients had bilateral cataracts. Heritable cataracts accounted for 22% of patients with bilateral cataracts and none of the unilateral cataracts. Secondary causes for cataracts accounted for 25% of patients. Radiation treatment was the etiology of cataracts in 14% patients, trauma in 8%, uveitis in 2 and diabetes in 1%. Ocular dysmorphology (Leber’s congenital amaurosis, optic atrophy) and systemic anomalies (Down’s syndrome, CHARGE association, Lowe syndrome and developmental delay) accounted for 9% patients requiring cataract surgery. 74 patients (46%) had cataracts of unknown etiology.
Even amongst visually significant cataracts undergoing cataract extraction, the proportion of idiopathic cataracts is similar to other reported studies, at approximately 40%. Familial cataracts were much less prevalent than expected amongst patients with bilateral cataracts, accounting for less than one-quarter of the patients. This is likely because many hereditary cataracts may not be visually significant immediately and therefore do not require surgery. It is important to recognize that the majority of the visually significant bilateral cataracts were not attributed to either genetic or infectious etiologies and other causes should be explored. Secondary causes were responsible for a larger percentage of cataracts than previously published and parents should be made aware of the high risk of cataract development in patients with these underlying risk factors.
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