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Developmental cataract 9

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  • 1. Developmental cataract
  • 2. Definition
    • Congenital cataract:
    • Cataract present at birth
    • Involves embryonic or fetal nucleus
    • Developmental cataract:
    • Occurs from infancy to adulthood
    • May involve infantile or adult nucleus, deeper layers of cortex or the capsule
  • 3. Etiology
    • Heredity:
    • Accounts for 1/3 rd of congenital cataracts
    • Dominant pattern
    • Common cataracts which are inherited are: cataracta pulverulenta, zonular cataract, coronary cataract, total cataract
  • 4.
    • Maternal factors:
    • Malnutrition
    • Infections: TORCH
    • Drugs: thalidomide, corticosteroids
    • Radiation exposure
  • 5.
    • Fetal or infantile factors:
    • Deficient oxygenation due to placental haemorrhage
    • Metabolic disorders: hypocalcemia, storage disorders, galactosemia, neonatal hypoglycemia
    • Other congenital syndromes: Lowe’s, myotonica dystrophica, etc
    • Birth trauma
    • Malnutrition
    • Idiopathic
  • 6. Clinical types
    • Punctate cataract:
    • Commonest form
    • Blue dot cataract (cataracta coerulea): tiny blue dots seen on oblique illumination
    • Sutural cataract:opacities involving Y sutures
    • Cataracta centralis pulverulenta: powdery fine opacities within embryonic or fetal nucleus
  • 7.  
  • 8.  
  • 9.  
  • 10.
    • Zonular cataract
    • Constitutes 50% of all visually significant cataract
    • Development is affected at a later stage and a zone surrounding embryonic nucleus (usually fetal nucleus) becomes opacified, its extent depending on the duration of inhibiting factor
    • Sharply demarcated opacity with area within and surrounding the opacity being clear
    • Linear spoke like opacities running towards equator: “riders”
    • Usually bilateral
    • Etiology: genetic (dominant inheritance), environmental (malnutrtion late fetal or early infantile life, vitamin D deficiency)
  • 11.  
  • 12.  
  • 13.
    • Fusiform cataract
    • Also called as spindle shaped cataract/ axial or coralliform cataract
    • Anteroposterior spindle shaped opacity, sometimes with off-shoots giving an appearance resembling a coral
    • Etiology: genetic
  • 14.
    • Nuclear:
    • Results when development of lens is inhibited at an early age, so that the central nucleus remains opaque- embryonal nuclear cataract
    • Progressive form of nuclear cataract- rubella
  • 15.  
  • 16.
    • Coronary cataract:
    • Development affected around puberty, thereby involving deep layers of cortex and most superficial layers of adolescent nucleus
    • Club shaped opacities near the periphery of the lens, axial region remaining clear: vision usually not affected
    • Non progressive
  • 17.  
  • 18.
    • Anterior polar cataract:
    • Involves the central part of anterior capsule and the adjacent cortex
    • Etiology: delayed formation of anterior chamber during development (congenital), perforation of corneal ulcer in ophthalmia neonatorum resulting in contact of cornea with anterior lens capsule (acquired)
    • May also result in formation of anterior pyramidal cataract (white plaque projecting forwards into the anterior chamber)
  • 19.  
  • 20.
    • Sometimes an anterior cortical cataract may form (due to opacification of underlying cortex)
    • Reduplicated cataract/ imprint cataract: when subcapsular epithelium grows between the capsular and cortical opacities, clear lens fibres separate the 2 opacities forming an imprint cataract (buried opacity)
    • Usually non progressive, do not interfere with vision
  • 21.  
  • 22.
    • Posterior polar cataract:
    • Due to persistence of posterior part of vascular sheath of the lens (posterior hyaloid artery)
    • Usually visually insignificant
  • 23.  
  • 24.
    • Total cataract
    • Congenital membranous cataract : due to total or partial absorption of a congenital cataract. Very rare