SURGICAL SOLUTIONS AND ETHICAL DILEMMAS IN CHILDREN SUFFERING FROM DOWN’S SYNDROME AND CONGENITAL CATARACT

C. I. Tataru, L. M. Voinea, M. Zemba, G. Sima, C. P. Tataru

Abstract: Congenital cataract is a transparency anomaly of the crystalline present from birth. Statistics in literature report a frequency of about one case in 2,000 newborns, most of which have visual disturbances/defects. Along with systemic anomalies children suffering from Downs syndrome can also have visual anomalies, including congenital cataract. Surgical approach in congenital cataract is much more complex than in adults because the former occurs in the process of normal/natural development of the visual function. Relying on our experience, shared by most ophthalmologists, we believe that per primam implantation of a an IOL in the posterior chamber is a rule in the surgery of congenital cataract as it ensures optimal conditions for the treatment of amblyopia and yields the best visual functional results. However, the selection of the power of the IOL that is based on rough biometrical formula, is still unpredictable. Therefore, up to two years of age of the child postsurgery aphakia in bilateral congenital cataract remains an acceptable alternative. In clinical practice we encounter borderline cases, between surgical pseudophakia and aphakia, whose complex ethical implications are shown in the paper below. We present the conclusions of our investigation carried out on a group of 14 children suffering from Downs syndrome and congenital cataract, i.e. on 26 eyes operated at the Clinical Hospital for Ophthalmological Emergency between 1.01 2010- 1.01 2020 as well as two illustrative cases. We also bring forward the ehical issues, e.g. the benefit for the patient, non maleficenta, informed agreement, standardization of the procedures when we choose pseudophakia or aphakia, with the aim at achieving the best result.
Keywords: congenital cataract, Downs syndrome, pseudophakia, aphakia, moral dilemmas.