Lecture on Congenital Cataract For 4th Year MBBS Undergraduate Students By Prof. Dr. Hussain Ahmad Khaqan

Lecture on Congenital Cataract For 4th Year MBBS Undergraduate Students By Prof. Dr. Hussain Ahmad Khaqan

• 1.
  Congenital Cataract Prof. Dr.Hussain Ahmad Khaqan  MD  FRCS(Glasgow)  FCPS(Ophth.)  FCPS(Vitreo Retina)  MHPE (KMU)  CICO(UK)  CMT(UOL)  Fellowship in Medical Retina (LMU, Munich)  Fellowship in Vitreo Retinal Surgery (LMU, Munich)  Consultant Ophthalmologist & Retinal Surgeon Professor of Ophthalmology Lahore General Hospital, Lahore Ameer Ud Din Medical College, Lahore Post Graduate Medical Institute, Lahore Shaukat Khanum Memorial Cancer Hospital & Research Centre ,Lahore
• 2.
  SIGNS • Opacity ofthe lens at birth • A white fundus reflex (leukocoria) • Absent or asymmetric red pupillary reflex • Abnormal eye movements (nystagmus) in one or both eyes • Strabismus
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  Figure: Bilateral cataractwith esotropia Figure: Left eye leukocoria
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  TYPES • Zonular (lamellar):Most common type of congenital cataract. White opacities that surround the nucleus with alternating clear and white cortical lamella resembling an onion skin. • Polar: Small opacities of the lens capsule and adjacent cortex on the anterior or posterior pole of the lens. • Nuclear: Opacity within the embryonic/fetal nucleus. • Posterior lenticonus: A posterior protrusion, usually opacified, in the posterior capsule. • Posterior subcapsular: Opacification of the area immediately anterior to the posterior capsule.
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  Infantile Cataracts Cataract Comments Anteriorpolar cataract Dominantly inherited, well defined opacities of the anterior capsulate may affect the vision Spear cataract Dominantly inherited, polymorphic cataract with needle like clusters of opacities in a rod shape it is called a fusiform cataract. Coralliform cataract Dominantly inherited cataract that consists of round and oblong opacities grouped in the axial region which may not affect vision Floriform cataract A rare rings shaped bluish white cataract in the axial region Lamellar cataract A common , bilateral and symmetrical round , gray shell of opacity that surrounds a clear nucleus. Cataract centralis pulverulenta Dominantly inherited nonprogressive cataract consisting of fine white powdery dots within the embryonic or fetal nucleus Congenital punctate cerulean cataract Bilateral , nonprogressive small bluish dots scattered throughout the lens with little effect on vision Mittendorf’s Dot A small (about 1 mm diameter) nonprogressive, white condensation occurs on the posterior pole of the lens capsule
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  Figure: Zonular orLamellar cataract. Figure: Anterior polar cataract Figure: Posterior polar cataract Figure: Congenital nuclear cataract
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  Figure: Posterior lenticonusFigure: Posterior subcapsular cataract Figure: Coralliform cataract Figure: Congenital stellate cataract
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  WORK-UP • History: Maternalillness or drug ingestion during pregnancy? Systemic or ocular disease in the infant or child? Radiation exposure or trauma? Family history of congenital cataracts? Steroid use? • Visual assessment of each eye individually by using techniques for nonverbal children (tumbling E’s, pictures, Teller cards, or by following small toys or a light). • Ocular examination: Attempt to determine the visual significance of the cataract by evaluating the size and location of the cataract. • Cycloplegic refraction. • B-scan • Other tests as suggested by the systemic or ocular examination.
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  TREATMENT 1. Referral toa pediatrician to treat any underlying disorder. 2. Treat associated ocular diseases. 3. Cataract extraction, usually within days to weeks of discovery to prevent irreversible amblyopia, is performed in the following circumstances: • Visual axis is obstructed, and the eye’s visual development is at risk. • Cataract progression threatens the health of the eye
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  4. After cataractextraction, treat amblyopia 5. A dilating agent (e.g. , phenylephrine 2.5%, t.i.d. or cyclopentolate 1% b.i.d.) may be used as a temporizing measure, allowing peripheral light rays to pass around the lens opacity and reach the retina. If the cataract is small, and the red reflex is good around the peripheral lens, this may be the only treatment needed. 6. Unilateral cataracts that are not large enough to obscure the visual axis may still result in amblyopia despite not needing cataract extraction. TREATMENT