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Comprehensive Management of Congenital Cataract in Dizygotic Twin Babies

Introduction: One of the leading causes of infant blindness is cataract. The prevalence of congenital cataract has been estimated in the range between 1 and 15 per 10.000 children globally. Congenital cataract in twin babies is a rare case. This case will report the outcome of comprehensive management of congenital cataract in dizygotic twin babies. Case presentation: Eight months old dizygotic twin babies came to our clinic with the primary complaint of whitish appearance in the pupil of both eyes since birth. They were born aterm with cesarean delivery. The birth weight was 2.700 g and 3.100 g respectively. They were the fourth and fifth children in the family. There was no family history of congenital cataract. The visual acuity of both eyes was positive response to light stimuli. The cataract was bilateral and dense on both babies. Fundus reflex and TORCH examinations were negative. Ultrasonography (USG) of the retina was normal on both babies. Conclusions: Isolated congenital cataract in twin babies is an unusual condition that should be treated comprehensively. Congenital cataract may cause deprivation amblyopia, refractive amblyopia, and permanent vision impairment. Early diagnosis and quick treatment, such as surgical timing and visual rehabilitation, are critical to perform successful management. Comprehensive care is required to monitor the visual result of cataract surgery.


Introduction
Pediatric cataract is one of the leading causes of avoidable childhood blindness, affecting over 200.000 children globally. Congenital cataract has been found to affect 1 to 15 per 10.000 children globally, with an estimated frequency of three to six per 10.000 live births. [1] The incidence in the United States is 2.0 per 10.000 births. [1] In China, congenital cataract cases are about 5.0 per 10.000 births, and 22-30% of childhood blindness is attributed to congenital cataract in the absence of appropriate treatment. Delayed presentation to hospital and late surgical treatment being the significant causes of blindness and visual impairment. [2] Congenital cataract etiology was hereditary origin, particular metabolic diseases, accompanying ocular abnormalities or systemic findings. Optical correction for congenital cataracts with aphakic glasses, contact lenses, or Intraocular Lenses (IOL) implantation was strongly suggested. [1], [2], [3] Isolated congenital cataract in dizygotic twin infants is unusual to find. The clinical condition, initial therapy, and follow-up visual rehabilitation management are all covered in this case report. This condition necessitates comprehensive therapy.
Early identification and quick treatment result in a favorable visual outcome.

Case presentation
Eight-month-old dizygotic twin baby boys came to our clinic with complaints of whitish appearance in the pupil of both eyes since birth. There was also nystagmus on both babies since they were three months old. These babies were born at term with section cesarean delivery. The birth weight was 2.700 g and https://e-journal.unair.ac.id/VSEHJ 3.100 g, and they were the fourth and fifth children in the family. There was no history of congenital cataract in the family. The visual acuity of the right and left eye was fix and follow with light stimuli. Anterior segment examination reveals a dense bilateral cataract on both babies ( Figure 1). Fundus reflex and posterior segment of the eyes were unable to evaluate. TORCH serology examination was negative, and Ultrasonography (USG) of both eyes was normal on both babies ( Figure 2).   After first surgery, both left eyes were aphakia ( Figure   3). Streak retinoscopy result of the first twin LE was +16.00      [1], [2], [3], [4], [5], [6], [7], [8] We chose a lensectomy technique without intraocular lens implantation for these dizygotic twin babies because We plan to implant the IOLs when these babies become two years old to enhance satisfactory visual outcomes.
In children with congenital cataracts, a primary IOL will provide satisfactory structural and functional outcomes. Comprehensive management can provide a satisfactory result. [4], [5], [6], [7] [4] reported that SRK/II was the most predictive formula across all age subgroups, and Hoffer-Q was the least predictive for patients who received IOL implantation surgery during their first decade. The Lee et al. research [4] found a substantial connection between age at IOL implantation and prediction error derived by the SRK/II, SRK/T, and Hoffer-Q formulas.
After ten years, all three formulas had the same level of predictability; however, of the three formulas tested, the SRK/ II formula consistently delivers the best meaningful prediction in individuals with congenital cataracts Isolated congenital cataract in dizygotic twin babies is a rare case. Congenital cataracts produce deprivation amblyopia, refractive amblyopia and lead to lifelong visual impairment. Awareness of the specific causes and visual condition of the twin babies must be diagnosed and treated earlier. Appropriate and comprehensive management will provide a satisfactory visual outcome. [8]