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Congenital & Infantile
Cataract
Prof. Naimatullah Khan Kundi
Khyber Teaching Hospital
Peshawar
Congenital & Infantile Cataract
 Congenital Cataract


When lens opacities that present at birth

 Infantile Cataract
...
Congenital & Infantile Cataract
 Classification


Morphology



Presumed aetiology



Metabolic disorders



Associat...
Congenital & Infantile Cataract
 In General


1/3

of cataracts associated with other

syndromes


1/3

occurs as inher...
Morphological classification of
congenital and infantile cataracts
1.

Polar

2.

Sutural

3.

Nuclear

4.

Capsular

5.

...
Congenital and infantile cataracts
Polar


These lens opacities involve






sub capsular cortex
lens capsule

Anter...
Congenital and infantile cataracts
Polar


Posterior Polar cataracts:





Stable/Progressive (Occasionally)
Sporadic/...
Congenital and infantile cataracts
Polar


(cont’d)

Familial:





BL
Autsomal dominant

Larger and positioned closer...
Congenital and infantile cataracts
Sutural (Stellate) Cataract


Opacification of ”Y” – sutures of fetal nucleus



BL

...
Congenital and infantile cataracts
Nuclear


Opacification of the:


Embryonic nucleus or



Embryonic + fetal nucleus
...
Congenital and infantile cataracts
Capsular Cataract


Opacification of the:


Lens epithelium and



Anterior lens cap...
Congenital and infantile cataracts
Lamellar (zonular) cataracts


Most common type of congenital/infantile cataract



B...
Congenital and infantile cataracts
Lamellar (zonular) cataracts


Clinically the cataract visible as a layer of
Opacifica...
Congenital and infantile cataracts
Complete (Total) Cataract
1.

Opacification of all the lens fibers

2.

Red reflex comp...
Congenital and infantile cataracts
Membraneous Cataract
1.

When lens proteins are resorbed from:
•
•

1.

Intact lens
Tra...
Congenital and infantile cataracts
Rubella Cataract


Maternal infection – RNA Toga Virus



Congenital Rubella Syndrome...
Congenital and infantile cataracts
Rubella Cataract


(cont’d)

Other Ocular Manifestations:
1. Diffuse pigmentry retinop...
Congenital & infantile cataract
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Congenital & infantile cataract

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Transcript of "Congenital & infantile cataract"

  1. 1. Congenital & Infantile Cataract Prof. Naimatullah Khan Kundi Khyber Teaching Hospital Peshawar
  2. 2. Congenital & Infantile Cataract  Congenital Cataract  When lens opacities that present at birth  Infantile Cataract  Lens opacities that develop during 1st yr of life  Fairly common (1 in 2000 live birth)  UL / BL
  3. 3. Congenital & Infantile Cataract  Classification  Morphology  Presumed aetiology  Metabolic disorders  Associated ocular anomalies  Systemic disorders
  4. 4. Congenital & Infantile Cataract  In General  1/3 of cataracts associated with other syndromes  1/3 occurs as inherited trait  1/3 undetermined causes
  5. 5. Morphological classification of congenital and infantile cataracts 1. Polar 2. Sutural 3. Nuclear 4. Capsular 5. Lamellar 6. Complete 7. Membranous
  6. 6. Congenital and infantile cataracts Polar  These lens opacities involve     sub capsular cortex lens capsule Anterior and posterior Polar Anterior Polar:     BL, Small, Symmetric, Non progressive autosomal dominant (frequently) Less effects on vision Sometimes associated with other ocular anomalies like:  Micro-ophthalmos  Persistent pupillary membrane  Anterior lenticonus
  7. 7. Congenital and infantile cataracts Polar  Posterior Polar cataracts:    Stable/Progressive (Occasionally) Sporadic/Familial Sporadic:  UL,  May be associated with remnants of tunica vasculosa Lentis,  Lenticonus,  Lentiglobus
  8. 8. Congenital and infantile cataracts Polar  (cont’d) Familial:    BL Autsomal dominant Larger and positioned closer to the nodal point of the eye  Produce more visual impairment
  9. 9. Congenital and infantile cataracts Sutural (Stellate) Cataract  Opacification of ”Y” – sutures of fetal nucleus  BL  Symmetric,  Autosomal dominant pattern  Seldom impair vision
  10. 10. Congenital and infantile cataracts Nuclear  Opacification of the:  Embryonic nucleus or  Embryonic + fetal nucleus  BL  Opacity may involve the:  Complete nucleus  Discrete layers within the nucleus
  11. 11. Congenital and infantile cataracts Capsular Cataract  Opacification of the:  Lens epithelium and  Anterior lens capsule  It spares the cortex  They protrude into the anterior chamber (Cf. Anterior Polar cataract)  Vision not adversely affected
  12. 12. Congenital and infantile cataracts Lamellar (zonular) cataracts  Most common type of congenital/infantile cataract  BL, Symmetrical  Effect on vision vary (size/density)  Causes:  Toxic influence  Hereditary (autosomal dominant)  Early toxic influence – opacity small and deeper  Opacities – in specific layers/zones of the lens
  13. 13. Congenital and infantile cataracts Lamellar (zonular) cataracts  Clinically the cataract visible as a layer of Opacification that surrounds a clear center and itself surrounded by a layer of clear cortex  Disc shaped configuration when viewed from the front  Additional arcuate opacities within cortex straddle the equator of the lamellar cataract. These Horseshoe shaped opacities are called Riders
  14. 14. Congenital and infantile cataracts Complete (Total) Cataract 1. Opacification of all the lens fibers 2. Red reflex completely obscured 3. No retinal view obtained with direct /indirect ophthalmoscope 4. UL/BL 5. Produce profound visual impairment
  15. 15. Congenital and infantile cataracts Membraneous Cataract 1. When lens proteins are resorbed from: • • 1. Intact lens Traumatized lens The anterior and posterior lens capsules fuse into one dense membrane 2. The resulting opacity and lens distortion causes significant visual disability
  16. 16. Congenital and infantile cataracts Rubella Cataract  Maternal infection – RNA Toga Virus  Congenital Rubella Syndrome:  Pearly white nuclear opacification  Sometimes complete cataract / cortex may liquefy  Histopathology:  Retention of nuclei deep within lens substance   Live virus may be recovered from the lens as late 3 yrs after birth Cataract removal may be complicated by excessive posterior operative inflammation caused by release f these live virus
  17. 17. Congenital and infantile cataracts Rubella Cataract  (cont’d) Other Ocular Manifestations: 1. Diffuse pigmentry retinopathy 2. Micro ophthalmos 3. Corneal clouding (Transient/Permanent) 4. Glaucoma  Although congenital rubella syndrome may cause cataract or glaucoma, both conditions are not characteristically present in the same eye
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