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The causes of infantile cataracts

Question: My best friend called and told me this week that doctors of the University of Gent, Belgium, have detected a cataract on one eye of his 9-month old baby. I went to your Web site to find answers to his questions, but still have one: What are the possible causes of pediatric cataracts?

Dr. Stefaan Bataille Kortrijk,
Belgium, Europe

Answer: For almost all infantile cataracts that are unilateral, there is an isolated developmental abnormality of the lens or associated eye structures. We don't usually know the exact cause. Very often in unilateral cases, the cataract is caused by what we call persistent fetal vasculature—though we don't know why that occurs—or there is an isolated abnormality of the lens development, and we don't know why. In almost all cases, if the cataract is moderate or advanced in one eye (enough that surgery is warranted) and the other lens is normal, there is almost no risk of developing an abnormality of the other eye. However, if the cataract is faint or not very pronounced, the other eye should be monitored, since sometimes there is asymmetry at the initial presentation.

Systemic conditions, treatments (e.g. corticosteroids), infections/problems during pregnancy and gene mutations (familial cataracts) would be expected to cause cataract in both eyes, which are usually fairly symmetric. Fortunately, early intervention that includes cataract surgery and correction of the focus of the eye (with a contact lens, intraocular lens or eyeglasses) leads to a good outcome and can allow reasonably good vision even in unilateral cases.

Deborah VanderVeen, MD
Associate in Ophthalmology
www.childrenshospital.org/eyes

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