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   Table of Contents      
ARTICLES
Year : 1982  |  Volume : 30  |  Issue : 5  |  Page : 445-448

Rubella cataract


Dr. Rajendra Prasad Centre for Ophthalmic Sciences, A.LLM.S., New Delhi, India

Correspondence Address:
S K Angra
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, A.LLM.S., New Delhi
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Angra S K, Mohan M. Rubella cataract. Indian J Ophthalmol 1982;30:445-8

How to cite this URL:
Angra S K, Mohan M. Rubella cataract. Indian J Ophthalmol [serial online] 1982 [cited 2020 Nov 27];30:445-8. Available from: https://www.ijo.in/text.asp?1982/30/5/445/29223

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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.


  Materials and methods Top
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.


  Observations Top


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 Top


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.[1] 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 [3] 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[4]. 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 Top


The data regarding 41 cases of Rubella Cataract has been presented with appraisal of its management.

 
  References Top

1.
Boniuk, V. and Boniuk, M., 1970, Trans. Amer. Acad. Ophthalmol. Otolaryngol. 74:360  Back to cited text no. 1
    
2.
Yanoff, M, Schaffer, D. B. and Schie, H.G., 1968, Trans. Amer. Acad. Ophthalmol & Orolar­yngol, 72:896.  Back to cited text no. 2
    
3.
Hiles, D. A., Schaffer. D. and Plotkins S. A., 1977, Int. Ophthalmol. Clinic 17:141.  Back to cited text no. 3
    
4.
Angra. S. K., 1980, Proc, 39th Congress of all­Ind. Ophth. Soc. (Ped. Symp) Manipal.  Back to cited text no. 4
    


    Figures

  [Figure - 1], [Figure - 2]
 
 
    Tables

  [Table - 1], [Table - 2]



 

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