Kanski Ophthalmology

1. CONGENITAL CATARACT
• In healthy neonates
• In unwell neonates
2. Classification
3. Causes
1. Important facts

2. 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%

3. Classification of congenital cataract
Anterior polar Posterior polar Coronary Cortical spoke-like
Lamellar Central pulverulent Sutural Focal dots

4. Anterior polar cataract
May be dominant inheritance
Capsular Pyramid
With persistent pupillary
membrane
With Peters anomaly

5. Posterior polar cataract
Ocular associations
• Persistent hyaloid remnants
• Posterior lenticonus
• Persistent hyperplastic primary vitreous

6. Coronary (supranuclear) cataract
• Round opacities in deep cortex
• Surround nucleus like a crown
Usually sporadic

7. Cortical spoke-like cataract
Systemic associations
• Fabry disease
• Mannosidosis

8. Lamellar cataract
Systemic associations
• Galactosaemia
• Hypoglycaemia
• Hypocalcaemia
• Round central shell-like opacity
surrounding clear nucleus
• May have riders
Usually dominant inheritance

9. Central pulverulent cataract
• Spheroidal opacity within nucleus
• Relatively clear centre
• Non-progressive
Dominant inheritance

10. Sutural cataract
Opacity follows shape of Y suture
Usually X-linked inheritance

11. Focal dot opacities
• Blue dot cortical opacities
• Common and innocuous
• May co-exist with other opacities

12. Causes of cataract in healthy neonate
Hereditary
(usually dominant)
Idiopathic
With ocular anomalies
. PHPV
• Aniridia
• Coloboma
• Microphthalmos
• Buphthalmos

13. Causes of cataract in unwell neonate
Intrauterine infections
• Rubella
• Toxoplasmosis
• Cytomegalovirus
• Varicella
Metabolic disorders
• Galactosaemia
• Hypoglycaemia
• Hypocalcaemia
• Lowe syndrome