2 Definition: Causes Of Congenital Cataract i. Malnutrition of mother. Lens opacity, which is present at birth or shortly after.Causes Of Congenital Cataracti. Malnutrition of mother.ii. Maternal infection by virus, e.g. rubella in the first trimester.iii. Deficient oxygenation, e.g. placenta praevia.
3 Symptoms: Given by mother. 1. Defective vision. 2. White pupil (leucocoria).3. Abnormal movements of the eye due to squint or nystagmus.
4 Signs: 1.By torch light: White reflex within pupil. 2.By Ophthalmoscopic examination: cataract3. Another Congenital anomalies:Dental anomalies.Microphthalmos.Mental retardation.Congenital heart diseaseMicroencephaly.Deafness
7 1.Anterior polarEtiology (touch between cornea & ant. Capsule of lens)1.Delayed formation of AC Irritation of the subcapsular epithelium cataract2. perforation of a corneal ulcer, as in ophthalmia neonatorum.
8 2.Posterior polar cataract EtiologyPersistent hyaloid arteryClinicallyopacity at the posterior poleVisionmarkedly diminishedas the opacity is closeto the nodal point
9 3.Lamellar cataract Etiology most common congenital cataract Definition:lens opacity involving one or more lamellae of the lens.EtiologyMalnutrition of mother and lackof vitamins during pregnancy lamellar cataract + erosion ofpermanent teeth.
10 Lamellar cataract looks like steering wheel Why this happen?Vitamin D deficiency formationof opaque lens fibers.On recovery from this deficiency, formation of clear lens fibers, pushing the opaque fibersonward , opaque lamella.Riders are due to unequalrecovery of the equatorial cellsat the same time
11 Round opacities surround nucleus like a crown 4.Coronary cataractRound opacities surround nucleus like a crown
12 Usually X-linked inheritance Opacity follows shape of Y suture 5. Sutural cataractUsually X-linked inheritanceOpacity follows shape of Y suture
13 Blue dot cortical opacities 6. Blue dot opacitiesBlue dot cortical opacitiesDo not affect VA
14 7. Total cataractIt is due to rubella infection to the pregnant mother in the first trimesterThe cataract extraction operation is risky due to:Associated cardiac anomaly (risk of GA)The virus remains dormant inside the lens for 3 years which may lead to postoperative endophthalmitis
15 Management of Developmental Cataract Fixation develops between 2-4 months of age.Uniocular cataractif vision is affected early surgery, (to avoid amblyopia and nystagmus).if vision is not affected:*No treatment*Mydriatics- if opacity is central
16 Management of congenital Cataract Bilateral cataract a. Bilateral Dense cataract – early surgeryb. Bilateral partial cataract –surgery at the age of 2 yearsP.S. the risks of cataract operation before 6 months are:AC is shallow.Pupil will not dilate properly (dilator muscle is not well developed).
17 Management of congenital Cataract Operative procedureIrrigation and Aspiration with primary posterior capsulotomy as well as anterior vitrectomyLensectomy (Pars plana or anterior route)
18 Management of congenital Cataract Post-operative visual rehabilitation:1.(younger than 2 yrs)Contact lens –for uniocular cataractGlasses - In bilateral cataract .2.(older than 2 yrs) insert IOLPS. Occlusion therapy for treatment of amblyopi.