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DESCRIPTION: Maternal rubella (German measles) in the first trimester of pregnancy is generally responsible for a triad of defects in the fetus: heart defects, hearing problems and eye problems; mental retardation also often accompanies these defects. Ocular involvement is typically cataracts (bilateral in 75% of the cases) but also may include uveal colobomas, searching nystagmus, microphthalmus, strabismus, retinopathy, and infantile glaucoma.

TREATMENT: Cataract surgery is usually delayed until at least age 2, since the live rubella virus remains in ocular tissues for many months after birth. Unfortunately, this preferred delay also results in a poor prognosis for visual functioning following cataract removal. Monitoring of ocular status (for complications) is recommended.

Educational adjustments will vary, according to functional vision. Optical aids and/or illumination levels should be according to individual needs. Glare may be a factor.

IMPLICATIONS: Some physicians are recommending therapeutic abortion in cases of maternal rubella, since the probability of serious congenital anomalies is so high.

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