23 congenital cataract
TRANSCRIPT
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CONGENITAL CATARACT
• In healthy neonates• In unwell neonates
2. Classification
3. Causes
1. Important facts
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Important facts
• 33% - idiopathic - may be unilateral or bilateral• 33% - inherited - usually bilateral• 33% - associated with systemic disease - usually bilateral• Other ocular anomalies present in 50%
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Classification of congenital cataract
Anterior polar Posterior polar Coronary Cortical spoke-like
Lamellar Central pulverulent Sutural Focal dots
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Anterior polar cataract May be dominant inheritance
Capsular Pyramid
With persistent pupillary membrane
With Peters anomaly
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Posterior polar cataract
Ocular associations• Persistent hyaloid remnants• Posterior lenticonus• Persistent hyperplastic primary vitreous
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Coronary (supranuclear) cataract
• Round opacities in deep cortex• Surround nucleus like a crown
Usually sporadic
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Cortical spoke-like cataract
Systemic associations• Fabry disease• Mannosidosis
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Lamellar cataract
Systemic associations• Galactosaemia• Hypoglycaemia• Hypocalcaemia
• Round central shell-like opacity surrounding clear nucleus• May have riders
Usually dominant inheritance
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Central pulverulent cataract
• Spheroidal opacity within nucleus• Relatively clear centre• Non-progressive
Dominant inheritance
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Sutural cataract
Opacity follows shape of Y suture
Usually X-linked inheritance
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Focal dot opacities
• Blue dot cortical opacities• Common and innocuous• May co-exist with other opacities
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Causes of cataract in healthy neonate
Hereditary (usually dominant)
Idiopathic
With ocular anomalies. PHPV• Aniridia• Coloboma• Microphthalmos• Buphthalmos
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Causes of cataract in unwell neonate
Intrauterine infections• Rubella
• Toxoplasmosis
• Cytomegalovirus
• Varicella
Metabolic disorders• Galactosaemia
• Hypoglycaemia
• Hypocalcaemia
• Lowe syndrome