This document discusses congenital and infantile cataracts. It describes different types of cataracts including polar, sutural, nuclear, capsular, lamellar, complete, and membranous cataracts. It provides details on the morphology, presumed etiology, associated ocular anomalies, and systemic disorders for each type of cataract. The document also discusses rubella cataracts and their association with congenital rubella syndrome.

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

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. Congenital & Infantile Cataract
 Classification

Morphology

Presumed aetiology

Metabolic disorders

Associated ocular anomalies

Systemic disorders

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. Morphological classification of
congenital and infantile cataracts
1.
Polar
2.
Sutural
3.
Nuclear
4.
Capsular
5.
Lamellar
6.
Complete
7.
Membranous

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. 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

9. 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

10. Congenital and infantile cataracts
Sutural (Stellate) Cataract

Opacification of ”Y” – sutures of fetal nucleus

BL

Symmetric,

Autosomal dominant pattern

Seldom impair vision

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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