Characteristics of Anterior Lens Opacities in Children

Abstract

Background:Anterior lens opacities (ALO) are found in 3-14% of pediatric patients with cataracts. No clear guidelines exist in the management and treatment of these cataracts.Objective:To evaluate pediatric patients with anterior lens opacities and assess rate of amblyopia and need for surgery over time.Methods:A retrospective chart review was performed on patients with unilateral and bilateral anterior lens opacities (ALOs) seen between January 2008 and December 2014. Size, location, and type of ALO were noted. Refractive error, necessity for treatment of amblyopia, and interventions were recorded.Results:A total of 31 patients were included in the study. 17 patients had unilateral ALOs and 14 had bilateral ALOs. The majority of the cataracts (90.3%) were centrally located. The most common type of cataract was the polar type of cataract and the vast majority (48.4%) was < 1mm in size. 38.7% of patients had concurrent ocular conditions and 9.7% had systemic associations. 28.6% of patients with bilateral cataracts and 35.3% of the patients with unilateral cataracts were treated for amblyopia. Three patients required cataract surgery.Conclusion:About half of anterior lens opacities are less than 1mm in size and the majority are of the polar type. Risk of amblyopia in these patients is higher than in the general population. Anisometropia is the most common cause of amblyopia. Ocular associations are seen at a relatively high frequency and systemic associations can occur but are uncommon. The need for surgical intervention is infrequent; however, growth of ALOs and associated cortical changes may be risk factors for surgery.

Anterior lenticular opacities in Costello Syndrome

“…The age of onset can be inferred from the association between the layer of opacity and the fetal nucleus. 5 In our patient, the nuclear opacities correspond to adult nucleus, thus it may be categorized as a developmental cataract. Studies have shown that the human lens grows throughout life by a process of cell turn over, wherein the anterior layers of lens epithelial cells grow to form a central mass of fibers.…”

“…Out of these, anterior lens opacities (ALO) are found in 3–14% of pediatric patients. 5 About half of anterior lens opacities are less than 1mm in size and do not contribute in decrease in vision. Our patient had two types of opacities, one on the anterior capsular as a plaque and other as a speck of nuclear opacity.…”

“…There are no specific guidelines on the management of these opacities; small lens opacities do not progress and are visually non significant, whereas others can be central, involving the visual axis and can cause severe visual impairment leading to amblyopia if not treated at the right age. 5 We followed up our patient closely as there was presence of a small central cataract, which may grow later in life and may need surgical intervention.…”