|Year : 1982 | Volume
| Issue : 5 | Page : 445-448
SK Angra, Madan Mohan
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, A.LLM.S., New Delhi, India
S K Angra
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, A.LLM.S., New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Angra S K, Mohan M. Rubella cataract. Indian J Ophthalmol 1982;30:445-8
The management of congenital cataract has to be taken as a semi-emergency as the delay can cause serious impediments in the visual acuity, physical and mental development. The rubella cataract adds another problem of severe post operative ueitis due to possible persistence of virus in the lens.
An endeavour has been made to appraise the management of rubella cataract.
41 cases of history positive rubella cataract, out of 485 cases of congenital cataracts, were taken in this study. In these 78% had clinical rubella syndrome. In 83% the mother's serology was positive and in 17% child's. Positive lens culture was demonstrated in 7.3% only. 33 bilateral cases and 5 unilateral cases were selected for surgical management. Only one eye of each patient was oparated upon in all cases. Simultaneous aspiration and irrigation under magnification, with variations in technique based on morphological characters of the cataract, was performed. Irid ctomy was only done in cases where pupil could not be dilated. These cases were put on our management schedule which essentially consists of use of atropine and systemic steroids (one day before to 15 days after surgery). The dose regulation of systemic theory of corlico steroids was monitored by the postoperative uveitic reaction. even upto six months postoperatively.
| Materials and methods|| |
| Observations|| |
The prevalence of rubella cataract in our series was 11.8% with 33 (80.4%) bilateral and (19.5%) unilateral eye involvement. The age at which the patient presented was, in majority, within 1-5 months in bilateral cases and 6 months to 1 year in unilateral cases. There were a variety of morphological types of cataracts seen [Table - 1], [Figure - 1]. We have done surgery as early as 3-4 months in majority of our cases after stabilising their medical conditions. In the postoperative period it was observed that the cases where iridectomy had been done, got the maximum iridocyclitis more than even the cases in which two stage surgery was performed [Table - 2] [Figure - 2]
| Discussion|| |
The suspicion of rubella cataract could arise from the history and associated ocular anomalies. The suspicion of diagnosis is very important to put the patient on the proper management schedule which tend to improve the prognosis.
Though in majority, the type of cataract is incomplete or complete with a hard nucleus, we observed other morphological varieties of cataracts also that could arise from rubella affection.
The majority of our cases when presented, were operated upon in one eye only. This is very important as one can not predict the outcome of surgery with certainty.
The two stage surgery in rubella cataract is not favoured. Bonius et al. believed that it is the second surgery which, due to further release of intracellar viral antigens, precipitate immuno-pathological uveal reaction and is responsible for phthisis bulbi. We feel this is the retained lens material following surgery which act as constant source for uveal reaction. Thus we advocate complete
removal of this material in single or two stage procedure in quick succession (24 hours following fragmentation). This timing of second surgery is important as by this time immunopathological changes have not occurred.
Surgery when combined with iridectomy however has produced marked reaction. This may be due to surgical trauma (resulting in possible release of prostaglandins) triggering uveitis or exposing the cut margins of iris to viral particles (antigens) to precipitate more than usual reaction.
This is contrary to the views of Yenoff et ale who advocate sector iridectomy at 6 months of age and lens removal at 2 year of age. Thus we feel that iridectomy should only be done when pupil fail to dilate. We would differ with Hiles et a1  who advocate iridectomy to avoid pupillary block and to have a look into the fundus.
This increased incidence of post-operative uveitis and phthisis bulbi reported in literature following surgery of rubella cataract has caused controversy in timing the optimal management. In our series, the surgical results when correlated with age at which the surgery has been performed did not differ statistically. This might be due to institution of corticosteroids therapy very early and for a longer period.
In view of this we must alleviate ourselves of the fear complex of not managing these eyes an early 3-4 months of age to provide stimulus for visual development. We are of opinion that we should operate on these children with congenital rubella syndrome as early as medically possible. The surgical results are also dependent on the associated ocular obnormalies i. e. small cornea and retinal pathology etc. which affect the anatomical and visual outcome.
In conclusion, early surgery of simultaneous aspiration irrigation, on one eye only, preferably in a single stage procedure, ur der magnification, without iridectomy and with full cover of corticosteroids therapy, is recommended in rubella cataract.
| Summary|| |
The data regarding 41 cases of Rubella Cataract has been presented with appraisal of its management.
| References|| |
Boniuk, V. and Boniuk, M., 1970, Trans. Amer. Acad. Ophthalmol. Otolaryngol. 74:360
Yanoff, M, Schaffer, D. B. and Schie, H.G., 1968, Trans. Amer. Acad. Ophthalmol & Orolaryngol, 72:896.
Hiles, D. A., Schaffer. D. and Plotkins S. A., 1977, Int. Ophthalmol. Clinic 17:141.
Angra. S. K., 1980, Proc, 39th Congress of allInd. Ophth. Soc. (Ped. Symp) Manipal.
[Figure - 1], [Figure - 2]
[Table - 1], [Table - 2]