PHILIPPINE JOURNAL OF

VOL. 29 • NO. 3 Ophthalmology JULY - SEPTEMBER 2004

ORIGINAL ARTICLE

Jose V. Tecson, III, MD
Alvina Pauline D. Santiago, MD Profile of childhood
Department of Ophthalmology
and Visual Sciences
University of the Philippines
cataract cases at the
Philippine General Hospital
Manila, Philippines Philippine General Hospital

ABSTRACT

Objective
The study determined the major causes of childhood cataract among
patients seen at the pediatric ophthalmology clinic of the University of the
Philippines-Philippine General Hospital (UP-PGH).

Methods
Case records of all patients seen at the pediatric ophthalmology clinic of
UP-PGH from January 1, 2000 to August 31, 2003 were reviewed. Included
were patients less than 21 years old diagnosed with cataract not associated
with trauma. Cases were classified as to presumptive etiology: idiopathic,
familial, or secondary to a systemic or an ocular disorder.

Results
The cause of cataract was identified in 37.6% of the 218 cases reviewed.
Rubella was the leading cause (20.5%), followed by suspected rubella infection
(8.2%). There were 2 cases of varicella and 1 case of cytomegalovirus (CMV)
infections. Down syndrome and Lowe syndrome had one case each. Three
cases (1.4%) were familial. Cataract was idiopathic in 133 cases (61.0%).

Conclusion
The pattern of childhood cataract in this study is typical of a developing
country where rubella infection is the major cause.

Correspondence to
Jose V. Tecson III, MD
Department of Ophthalmology and Visual Sciences
University of the Philippines
Philippine General Hospital
Taft Avenue, Ermita
1000 Manila, Philippines
Tel. +63-2-5210007
Email: jvt3@yahoo.com Key words: Cataract,Congenital, Blindness, Rubella
The authors have no proprietary or financial interest in
any product used or cited in this study. PHILIPP J OPHTHALMOL 2004; 29(3): 140-143 © PHILIPPINE ACADEMY OF OPHTHALMOLOGY

140 PHILIPP J OPHTHALMOL VOL 29 NO. 3 JULY - SEPTEMBER 2004 PHILIPPINE ACADEMY OF OPHTHALMOLOGY

diagnosis. one- by amblyopia. Patients less 37 . The following parameters were recorded: demographic information. The cataract was bilateral 1. RESULTS Jamaica Sri Lanka Philippines India West Africa Chile Over 4 years. preventable or curable. of consultation were also computed. The data obtained would 37 . surveys in developing countries have shown that 10 to 40% In contrast. associated clinical findings 30 ------------------------------------------------------------------------------------. (whether idiopathic. Childhood blindness caused by cataract in developing countries. visual assistance.6 Suspected Rubella There was no presumptive etiology in 133 cases. one million of them in Asia. 40 ------------------------------------------------------------------------------------. an ocular disorder). Eighty- 2. 61 3. and associated syndromes. 3 JULY . Age and sex distribution of patients at the time of cataract productivity are serious concerns.4-8 cataract in India had been traced to congenital rubella Approximately 75% of childhood blindness in developing syndrome.35 Infection Central Nervous two were secondary to a systemic or ocular disorder and 3 0.50 Uveitic Cytomegalovirus Familial Cataract 0.11 Of those with an identified world are blind. reported the incidence of galactosemia at 1:71. and result of galactosemia 25 ------------------------------------------------------------------------------------. 68 January 1.36 35 33 .2 About 1. ness9 placed the incidence of childhood blindness at Childhood cataract must be diagnosed and managed 0. ract was not present in the patient that had galactosemia.13 Cata- In the Philippines.95 Down Syndrome Varicella 0. presentation. male. about half of all congenital handicap worldwide.15 Syndrome 37. and lost Table 1. maternal drug ingestion. an increasing percentage of childhood of childhood blindness is due to cataract (Figure 1).44%. Long-term rehabilitation. screening.95 System were familial in nature (Table 2).12 No data were given on the association of countries is associated with an infectious agent that is cataract with galactosemia. onset of cataract by history. 2000 to August 31. 5 ------------------------------------------------------------------------------------- 0 ------------------------------------------------------------------------------------. Age distribution of patients at consultation per type of cataract. 54 7 .50 Lowe Syndrome The cataract was deemed familial when one of the 0. or was aphakic from PHILIPPINE ACADEMY OF OPHTHALMOLOGY PHILIPP J OPHTHALMOL VOL 29 NO. The age range and median at the time 10 ------------------------------------------------------------------------------------. the Third National Survey on Blind. CATARACT in infancy is a significant cause of visual In the developed world. maternal illness during pregnancy. Fifty percent were Figure 1.4 8.50 Aniridia parents was shown to have childhood-onset cataract on Figure 2.SEPTEMBER 2004 141 .50 Familial Secondary ation was 24. Cataract is one of the primary causes. 218 index cases of childhood cataract were 1998 1994 1993 1994 1993 1993 identified and included in the study.3 Rubella is the major infectious In the Philippines.5 million children throughout the fifth had familial cataract.60 11 9 serve as basis for formulating policy recommendations for > 60 15 13 prevention.60 19 5 1 25 than 21 years old diagnosed with cataract by ocular > 60 57 12 2 71 examination and not associated with trauma were included Total 133 82 3 218 in the study. aggressive newborn screening in 2001 agent associated with childhood cataract. METHODOLOGY Age (months) A review of all available case records of patients seen at Idiopathic Seconday Familial Total the pediatric ophthalmology clinic of the UP-PGH from 0-6 22 32 .10 In an Australian study.36 20 25 General Hospital (UP-PGH).593. familial or secondary to a systemic or 15 ------------------------------------------------------------------------------------. The median age at the time of consult- 20. Cases were classified as to presumptive etiology Percent 20 ------------------------------------------------------------------------------------.1 The loss of vision is mainly caused cataract cases are idiopathic. Profile of childhood cataract (%) clinical history or examination. early to avoid blindness and other serious complications. The youngest patient was 1 month old and the oldest Idiopathic was 20 years old.5 months (Table 1). 2003 was done. This study determined the major causes of childhood Age (months) Female Male cataract among patients seen at the pediatric ophthalmol- 0-6 63 62 ogy clinic of the University of the Philippines-Philippine 7 . the most common is Down syndrome. 35 ------------------------------------------------------------------------------------. Total 109 109 Table 2.3 Recent etiology. and management of the disease. 0. history of cataract in the family.20 Congenital Rubella in 70% of cases.

35% of cases.2 was the most common entities. Several problems were encountered by the investiga- Idiopathic Cataract tors in the conduct of this study. A and cytomegalovirus (0. however. common identifiable cause in 45 cases of congenital an X-linked recessive disorder. In other were classified as suspected rubella infection where there series. 2 cases with uveitis. one each with Lowe syndrome and aniridia. Rubella.5%). 2 3 Eckstein1996 1 2 3 4 Wirth 2002 India (n=200) India (n=366) Australia (n=421) Philippines (n=218) 4 Tecson 2004 Country Figure 3. Children who present lower than those found in Brazil (13%) and Australia with heart disease should prompt the ophthalmologist to (6%). Congenital Percent 40 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 34 Rubella 31 30 -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------. Many parents rubella syndrome is often diagnosed based on systemic may not bring their children with Down Syndrome for findings. Three cases (1. present in these cases.11 but similar to that in China (2.7 %). The presence of cataract in a family member in India. 142 PHILIPP J OPHTHALMOL VOL 29 NO. there (2.15 Thus.15 This low investigate the possibility of rubella infection.4 %) were documented as familial. cerebral palsy or epilepsy.2%). an since some forms of cataract are peculiar to certain disease infectious but preventable etiology. the retrieval of some case records and information was lacking in others. present as arcuate opacities along the equator of the lens nucleus visible only on slit-lamp examination. Galactosemia screening was negative.surgery performed during childhood. Congenital figure may be attributed to several factors. Clinical findings of conge. 3 JULY .15 %) with central Idiopathic cases or those not associated with any ocular nervous system (CNS) abnormalities manifesting as pathology. All were with the condition. The low incidence rate of detailed family history should be elicited with examination these two factors was consistent with the findings in other of the parents and siblings.12 Other causative agents were varicella (0.2 Under- was unconfirmed history of maternal rubella illness during reporting of familial cases may occur when there is no the first trimester of pregnancy. In these cases. Other causes included 7 cases (3. The birth and maternal history studies.85%) with Down syndrome.14 may yield important information as to the etiology if Down syndrome was the cause in only 2. opportunity to examine parents and siblings. Idiopathic 51 Familial 50 -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------. Syndrome 21 25 19 20 Others 20 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 14 16 17 12 8 10 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 2 1 1 Angra 1987 0 -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------. infection was suspected as a cause. lens opacification associated with a typical facie and frontal nital heart defects and history of maternal rubella were bossing. DISCUSSION The need for a more thorough evaluation of childhood Studies in other countries have shown that the etioloy cataract by the appropriate specialty is apparent.4%) cases of familial cataract involving siblings. or syndromes accounted for delayed development. The initial investigation of any pediatric cataract should Congenital rubella was the most common cause of include exploring possible familial or hereditary diseases secondary cataract in this study. Expensive confirmatory tests are reserved for 70 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 63 61 60 -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------. rubella was the most The lone case of cataract attributed to Lowe syndrome. presented with bilateral rubella syndrome (Figure 2). There were three early eye consultation because of the stigma associated (1. Eighteen cases (8. ocular and systemic disorders were the described or documented by photographs or drawings most common causes in developed countries. Secondary Cataract subjective complaints may go unnoticed. similar to results reported (Figure 4). 8 to 23% of reported cases were hereditary. cause in developing countries (Figure 3). 5 cases almost two-thirds of cases in this study.SEPTEMBER 2004 PHILIPPINE ACADEMY OF OPHTHALMOLOGY . The of childhood cataract was determined in only 35 to 40% of character and location of the lens opacity must be cases. Among secondary cataract cases. Causes of childhood cataract in different studies.11-12 Heredity. There was difficulty in The cause could not be ascertained in 133 cases (61%).95%) should alert the clinician to a possible familial cause. Cataract in Down syndrome may bilateral. systemic disorders. and was no family history and heart findings were normal.

Epidemiology of visual impairment in children. comanaged with a pediatrician. Pediatr Neurol 1997. and referral to a geneticist for west Africa. Eye 1995. Developments in the treatment of cataract. ed. Causes of childhood blindness: results from syndrome is considered. et al. 9: 545-550. 50: 132-140. Killendar M. Syndromes Galactosemia Child with cataract   Yes Yes  No No No No Family Maternal History?  Measles?  Dysmorphic  Galactosemic?  Idiopathic Yes Yes   No Suspected Heart Familial Disease?  Rubella Infection Yes  Congenital Rubella Syndrome Figure 4. 6. ed. Aetiology of childhood cataract in south India. Childhood blindness in India: causes in work-up is beneficial. Foster A. Sripathi S. In: Taylor D. 1997: 455. Hagan M. Trans Ophthalmol Soc UK 1982. London: References Blackwell Science. Br J Ophthamol 1988. Gilbert CE. 17: 184-188. World Health Organization. Prevention of childhood blindness. Lens. Institute of Ophthalmology. 3 JULY . Foster A. Philipp J Pediatr 2001. 2nd ed. Gilbert C. 15. 2004. 80: 628-632. 11. 102: 441-452. Gilbert C. Int Ophthalmol 1993. 9. 1992. the benefit of an exhaustive laboratory Child 1976. Flowchart of diagnostic work-up for childhood cataract. Causes of childhood blindness in Sri Lanka: results from children attending six schools for the blind. London: Blackwell Science. Ocular abnormalities in Down syndrome. The differential diagnosis of cataracts in infancy and childhood. 17: 229-234. 86: 782-786. In: Taylor D. 2. Russell-Eggitt IM. Rahi JS. Eckstein M. 12. 1997: 3-12. Philippine National Survey on Blindness. Craig JE. galactosemia and stand to benefit from diet modification 8. Newborn screening can help identify infants who have 7. 13. Wirth MG. south India and Chile. et al.SEPTEMBER 2004 143 . Paediatric Ophthalmology. Padilla CD. Eckstein MB. 311-314. Kohn BA. Childhood blindness in Jamaica. 72: 65-67. 1318 blind school students in nine states. In children who are otherwise well with an isolated diag. Foster A. Br J Ophthalmol 1995. 14. Geneva: WHO. Lambert S. Gilbert CE. or to reverse its course. 1. Causes of blindness in children attending 4 schools for the blind in Thailand and the Philppines. Br J Ophthalmol 1996. Work-up for other disor. Wong V. PHILIPPINE ACADEMY OF OPHTHALMOLOGY PHILIPP J OPHTHALMOL VOL 29 NO. 16: Paediatric Ophthalmology. Taylor D. Moriarty BJ. Foster A. Am J Dis nosis of cataract. those with atypical presentations. et al. 4. Gilbert C. Manila: University of the Philippines Manila. Aetiology of congenital and paediatric work up is inconclusive. If the child is dysmorphic 3. 10. 2nd ed. Implementation of newborn screening in the Philippines.Canovas R. Ho D. ders may be done when there are suspected findings. Br J Ophthalmol 2002. These patients should be cataract in an Australian population. 79: to prevent the development and worsening of lens opacity 633-636. or developmentally delayed. Vijayalakshmi P. 130: 184-192. the possibility of a genetic 5. Eye 1993.