Increased prevalence of parent ratings of ADHD symptoms among children with bilateral congenital cataracts

AIM: To investigate the behavioral and psychological disorders and the prevalence of parent ratings of attention deficit hyperactivity disorder (ADHD) symptoms among children with bilateral congenital cataracts (CCs). METHODS: This cross-sectional study investigated children with bilateral CC aged 3-8y (CC group) using Conners’ Parent Rating Scale-48 (CPRS-48) from July to December 2016. The abnormal rates of psychological symptoms in CC children and normal vision (NV) children were compared using the Chi-square test. The scores of CC children were compared with those of NV children and the Chinese urban norm using the independent samples t-test and one-sample t-test, respectively. RESULTS: A total of 262 valid questionnaires were collected. The ratio of CC children to NV children was 119:143. The overall rate of psychological symptoms in CC children was 2.28 times higher than that in NV children (46.22% vs 20.28%, Pearson’s χ2=20.062; P<0.001). CC children showed higher scores for conduct problems, learning problems, impulsiveness/hyperactivity, anxiety, and hyperactivity index than NV children and the Chinese urban norm, particularly between the ages of 3 and 5y. Furthermore, male children aged between 6 and 8y showed a higher impulsive/hyperactive score than females of the same age (t=6.083, P<0.001). CONCLUSION: Children with bilateral CCs have a higher rate of ADHD symptoms than children with NV. This study provides clinical evidence that screening for psychological symptoms and particularly for ADHD symptoms in children with bilateral CC are recommended for an early diagnosis and timely treatment.     

Combined laser instrumental extraction of congenital cataracts in children

The authors have developed a new method for removal of congenital cataract in children, by taking into account its clinical forms, namely, combined laser instrumental extraction including YAG-laser anterior capsular rhexis, followed by removal of lens debris by the aspiration-irrigation technique. A differential technology of YAG-laser anterior capsular rhexis has been developed, by taking into account of age-specific features of the lens and eyes in children. The optimum energy modes and techniques have been defined for different clinical forms of congenital forms of congenital cataracts. An analysis of the outcomes and complications of extraction of congenital cataracts has indicated that the authors' combined laser instrumental extract procedure (75 operations) assures the better quality of anterior capsular excision, improves optical and functional effects, and reduces the frequency of some complications as compared to the routine instrumental procedure (107 operations) (p < 0.05-0.001). Clinicofunctional and immunological studies have provided evidence for that the YAG-laser technique has no significant effect on the child's eye. Combined laser instrumental extraction is indicated for the treatment of any forms of congenital cataracts in children.     

先天性白内障Ⅱ期人工晶体植入的临床观察

为了探讨先天性白内障患儿Ⅱ期植入人工晶体可靠性及视力预后,本文分析了２０例（４０眼）先天性白内障Ⅱ期植入人工晶体病例的２年随访资料。结果显示：Ⅱ期手术的视力预后与术前视力及术前的治疗措施密切相关,视力预后好;术后未发现严重并发症。结论：Ⅱ期人工晶体植入是安全可靠的。     

Autoimmune mechanisms of eye involvement in congenital cataracts in children

A total of 112 children aged 6 months to 8 years with congenital cataracts (69 ones with bilateral and 43 with unilateral forms) and 34 mothers of these children were examined to estimate the activity of local and systemic autoimmune reactions to lenticular crystallines and retinal S antigen, differentiation between and diagnosis of congenital cataract pathogenetic forms. Lacrimal fluid antibodies were measured in 80 eyes with congenital cataracts and 29 ones with strabismus, blood serum antibodies in 72 children with cataracts, 20 without cataracts, 34 mothers of children with cataracts and 20 mothers of children without cataracts by the passive hemagglutination test (micromethod) with stable erythrocytic diagnostic agents. alpha, Bh, Bl, gamma crystallines and summary extracts of the cortical and nuclear layers were tested. The studies have demonstrated the significance of autoimmune reactions to lenticular crystallines in the pathogenesis of congenital cataracts and in involvement of the retina in the immunopathologic process.     

Development of visual acuity in infants with congenital cataracts.

The visual acuity of 4 infants with congenital cataracts was measured serially during the first year of life by a preferential looking technique. Two infants with bilateral cataracts and no measurable acuity before surgery showed rapid development of acuity to normal levels for age after surgery and optical correction. In an infant with a unilateral cataract and an infant with a cataract and persistent hyperplastic primary vitreous marked differences in monocular acuities were found after surgery. Acuities became equal in the latter case after occlusion of the normal eye, while the other infant recovered acuity with 'bi-ocular' viewing. These acuity measurements demonstrate the sensitivity of the human visual system to binocular and monouclar visual form deprivation in the first year of life.     

先天性白内障的综合治疗

目的 探讨先天性白内障的综合治疗方法和疗效观察。方法 22例42眼先天性白内障分别行白内障超声乳化吸出联合人工晶体植入术，白内障超声乳化吸出联合后囊撕囊，白内障超声乳化吸出联合人工晶体植入及格栅状虹膜植入术，术后出现后发障行Nd：YAG激光治疗。患者随访12～36个月并观察视力情况。结果 22例42眼中，有20例（40眼）术后视力明显提高。10例18眼行Nd：YAG激光治疗后发障安全有效。结论 先天性白内障患儿应尽早手术，小于3．5岁患儿术后应长期配戴框架眼镜、弱视训练。婴幼儿行Nd：YAG激光治疗后发障方便易行，并发症少。     

Management of congenital cataracts

The management of congenital cataracts at the Wilmer Institute is presented, with emphasis on the need for careful preoperative assessment. The indications and techniques for surgery in uncomplicated cataracts are discussed, and the advantages of using vitrectomy instruments in complicated congenital cataracts, such as those associated with persistent hyperplastic primary vitreous, are described.     

Intraocular correction in the restorative therapy of children with congenital and traumatic cataracts]

A total of 140 surgeries making use of aspiration irrigation technique were carried out in 105 children with congenital and traumatic cataracts, aged 4 to 14. The Fyodorov-Zakharov iris clips lenses were implanted. The method was found highly effective and low traumatic. Grave complications, such as iridocyclitis, secondary glaucoma, macular edema, retinal detachment were recorded in late period in just few children, in 0.7-5% of cases. Vision acuity of at least 0.3 diopters was achieved in 87.1% of children with congenital and in 85.7% of those with traumatic cataracts. Binocular vision was restored in 81.4 and 83.3%, respectively.     

婴幼儿先天性白内障研究进展

婴幼儿是一个特殊的群体,先天性白内障及其弱视是婴幼儿致盲眼病之一,通过对国内外文献的研究简要阐述先天性白内障手术治疗以及人工晶状体植入的问题,旨在总结目前研究进展,引起家长及初级医师对先天性白内障疾病治疗的重视。     

Results of late surgery for presumed congenital cataracts.

We reviewed the results of cataract extraction and visual rehabilitation in 76 eyes of 47 infants and children with presumed congenital cataracts who were first seen after they were 10 months old. Eighteen patients underwent surgery for unilateral cataracts, including five patients with persistent hyperplastic vitreous, five with posterior lenticonus, one with a nuclear cataract, six with posterior subcapsular cataracts, and one with a lamellar cataract. Of these 18 patients, seven (39%) attained a visual acuity of 20/60 or better, one (6%) had a visual acuity of 20/100, and ten (60%) had a visual acuity of 20/200 or worse. Twenty-nine patients (62 eyes) underwent bilateral cataract extraction. The visual acuity could be measured in 22 patients (44 eyes). Visual acuity improved to 20/60 or better in 32 eyes (73%), was between 20/70 and 20/150 in 11 eyes (25%), and became worse than 20/200 in one eye (2%). Results were good in patients with persistent hyperplastic primary vitreous, posterior lenticonus, and bilateral cataracts.     

Familial congenital cornea guttata with anterior polar cataracts

We examined 21 members of a family with a syndrome of cornea guttata and anterior polar cataracts. Twelve members had both ocular abnormalities. An affected woman underwent penetrating keratoplasty at age 28 years. Light microscopy of the corneal button showed changes consistent with cornea guttata and corneal edema. The combination of cornea guttata and anterior polar cataracts appears to form a well-defined ocular syndrome that is inherited in an autosomal dominant fashion.     

先天性白内障病因的多因素分析

目的：探讨先天性白内障的发病因素，提醒儿科医生重视眼科检查，以求尽早发现治疗先天性白内障，从而减少弱视和盲的发生。方法：以116名1岁以内的先天性白内障患儿作为观察组；选取102名健康儿童为对照组，进行病例对照研究，对18种危险因素进行Logistic回归分析。结果：母亲孕期存在贫血或缺钙、孕早期宫内病毒感染、自然分娩、异常分娩、家族史、早产双胎、窒息史、缺氧缺血性脑病、吸氧持续时间等9种危险因素，观察组与对照组有显著性差异，多因素Logistic回归分析均表明吸氧持续时间、孕早期宫内病毒感染、家族遗传是先天性白内障的主要危险因素。结论：通过研究先天性白内障的主要危险因素，特别提示儿科医生在儿童各阶段体检时应注意不要遗漏眼部检查，注意询问患儿吸氧情况，对那些开始吸氧时间早、持续时间长的患儿，建议请眼科医生详细检查患儿眼部情况，防止延误病情。