1. Cataract in the 21st century Liana Al-Labadi, O.D. Lecture 9 Thanks To The Ohio State College of Optometry

2. Presenile cataracts Presenile Cataract: Myotonic Dystrophy Diabetes Atopic Dermatitis Blue-Dot Cataract

3. Presenile cataracts Juvenile Diabetic Cataract: Characterized by rapidly progressing white “snowflake” opacities in the anterior & posterior subcapsular locations May mature within few days Adult Diabetic Cataract: Results in cortical & subcortical lens opacities Age-related cataract form earlier in diabetics Caused by shifts in the glucose, electrolyte, & water balance within the lens Fluctuating vision & rapid shift to near sightedness are symptoms of diabetes http://lessons4medicos.blogspot.com/2009/02/cataracts-few-interesting-types.html

4. Presenile cataracts Atopic Dermatitis Cataract: Anterior subcapsular plaque aka shield cataract Causes wrinkles in the anterior capsule Develops in 10% of cases between ages 15-30 Bilateral in 70% Frequently becomes mature cataract http://lessons4medicos.blogspot.com/2009/02/cataracts-few-interesting-types.html

5. Presenile cataracts Blue-Dot Cataract AKA cerulean cataracts Not uncommon Clinical features: Often an incidental finding during routine eye exam Asymptomatic Develops at an adult younger age Seen in down syndrome patients Signs: Discrete punctate bluish opacities throughout the cortex http://dro.hs.columbia.edu/bldot.htm http://www.sarawakeyecare.com/Atlasofophthalmology/anteriorsegment/anteriorsegment65bluedots.htm http://www.opt.indiana.edu/NewHorizons/Cerulean.html

6. Traumatic cataract Traumatic cataract causes: Penetrating injuries Concussion injuries Electric shock Radiation

7. Traumatic cataract Traumatic cataract: Most common complication of non-perforating & perforating injuries to the globe Intraocular trauma by surgical instruments, lodged FB or intraocular filtration tube are possible causes Clinical Features: Cataract formation after non-penetrating injury (contusion or concussion) may occur without any damage to lens capsule Cataract formation may be slowly progressive or mature suddenly No always easy to observe initial changes of the lens Vossius ring- seen as a circular iris pigment imprinted on the surface of the lens anterior capsule Deposit of melanocytes from pupillary border of iris as a result of a concussion Rosette cataract aka “flower-shaped” Caused secondary to head &/or ocular contusion with or without lens rupture One or more feather or flower-like petals radiating out from the lens axis Trauma may also produce anterior or posterior subcapsular opacities May explain a unilaterally elevated IOP- must R/O angle recession http://www.atlasophthalmology.com/atlasimg/Img0086_39_low.jpg

8. Traumatic cataract Early Rosette Cataract: Appears hours, weeks, or even months post-traumatically May be transient though usually it is permanent & stationary Feather-like, rounded opacities with suture lines positioned centrally Initially develops in the anterior subcapsular region May becomes buried within the lens with time http://www.opt.indiana.edu/NewHorizons/Rosette.html

9. Traumatic cataract Late Rosette Cataract: Appears years after the traumatic event Once developed, it is usually permanent & stationary Feather-like, rounded opacities with suture lines positioned centrally Suture lines positioned between the slightly pointed lobes Usually found at the interface of the anterior cortex & the anterior nucleus http://www.opt.indiana.edu/NewHorizons/Rosette.html

10. Toxic Cataract Chloropromazine Cataract: Used in the treatment of psychotic disorders & hyperexcitability Cataract begins as fine particulate deposits in the anterior subcapsular area which progresses to a star- shaped opacity Usually develops after treatment for at least 2 years with more than 300mg/day http://www.opt.indiana.edu/NewHorizons/Chlorpromazine.html

11. Toxic Cataract Toxic Cataract: Steroids Long-acting miotics Amiodarone Busulfan- cancer drug

12. Secondary cataract Secondary PSC can develop with: Chronic anterior uveitis Ciliary body tumor Ionizing Radiation MRI causes NS, CC, ASC High myopia Hereditary fundus dystrophies RP Leber congenital Amaurosis Gyrate Atrophy Wagner & Stickler Syndrome Angle closure glaucoma Glaucomflecken

13. Secondary cataract Glaukomflecken Focal cortical opacities resulting from: Acute closure glaucoma Sudden IOP spike Results in central, anterior subcapsular opacities Subepithelial lens opacification Due to lens epithelial cells ischemia & necrosis caused by elevated IOP

14. Glaukomflecken

15. Metabolic Cataract Wilson Disease- Metabolic AR disease Multi-system disorder due to impaired hepatic excretion of copper Results in low serum ceruloplasmin level & subsequent elevated serum & urine copper levels Excess copper in CNS, liver, kidney, cornea & other organs This copper deposition leads to liver & brain damage

16. Metabolic Cataract Wilson Disease- Metabolic AR disease Symptoms: Ocular complaints are rare May experience sx of cirrhosis, neurological disorders, psychiatric problems, or renal disease Begins typically between 5 to 40 years of age Signs Kayser-Fleisher ring A 1-3mm brown, green, or red band that represents copper deposition in the peripheral descemet membrane Present in 50-60% of patients with isolated hepatic involvement Present in more than 90% of patients with neurological manifestation “Sunflower” cataract- due to anterior & posterior subcapsular copper deposition

17. Wilson Disease