Eckstein, Michael B.; (1998) Childhood cataract in South India: Aetiology, management and outcome. Doctoral thesis (M.D), UCL (University College London).

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Abstract

Background: Cataract accounts for up to 20% of childhood blindness. Despite this, very little is known about the aetiology and visual outcome of children with cataract in the developing world. Objectives The aims of this thesis were: i. to determine the aetiology of childhood cataract in south India and to assess whether the potentially preventable condition of congenitally acquired rubella was a significant cause. ii. to determine whether examination of saliva for rubella specific IgM would be an equally reliable but less invasive and more practical test for confirming the diagnosis than examination of serum iii. to determine the most appropriate surgical treatment for children with bilateral cataract in south India. Methods: An observational and case control study was undertaken to search for associations between events in pregnancy and the development of cataract. Cataract aetiology was determined using interview data, clinical examination and laboratory investigations. Saliva and serum samples were taken from infants with cataract and were analysed for rubella specific IgM by an antibody capture radioimmunoassay. A randomised clinical trial comparing lensectomy to lens aspiration with a primary capsulotomy (ECCE) was undertaken on children with bilateral cataract. Results: One quarter of non-traumatic cataracts were hereditary and 15% were due to congenitally acquired rubella. Mothers of children with cataract were more likely to have taken abortifacients than a group of age matched controls. Congenital rubella infection was confirmed using saliva in 25 out of 95 (26.3%) infants with cataract under 1 year of age. The clinical trial showed no significant difference between the two surgical groups in rates of complication or of visual outcome 1 year after surgery (p=0.57). If secondary procedures to clear the visual axis had been unavailable, lensectomy would have been the method of choice (p=0.019). Conclusions: i. Congenitally acquired rubella remains an important and preventable cause of infantile cataract in south India. ii. Diagnosis using saliva is reliable and is particularly useful in areas remote from testing centres. iii. Both lensectomy and lens aspiration with primary capsulotomy are effective surgical treatments for bilateral cataract in this population. If surgical intervention is to be kept to a minimum then lensectomy may be preferable.

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