Congenital cataract

Definition: Causes Of Congenital Cataract i. Malnutrition of mother. Lens opacity, which is present at birth or shortly after. Causes Of Congenital Cataract i. Malnutrition of mother. ii. Maternal infection by virus, e.g. rubella in the first trimester. iii. Deficient oxygenation, e.g. placenta praevia.

Symptoms: Given by mother. 1. Defective vision. 2. White pupil (leucocoria). 3. Abnormal movements of the eye due to squint or nystagmus.

Signs: 1.By torch light: White reflex within pupil. 2.By Ophthalmoscopic examination: cataract 3. Another Congenital anomalies: Dental anomalies. Microphthalmos. Mental retardation. Congenital heart disease Microencephaly. Deafness

Bilateral opacity: interferes Unilateral cataract: squint , Complications Bilateral opacity: interferes with foveal development nystagmus Unilateral cataract: squint , and amplyopia.

Types of congenital cataract

1.Anterior polar Etiology (touch between cornea & ant. Capsule of lens) 1.Delayed formation of AC  Irritation of the subcapsular epithelium  cataract 2. perforation of a corneal ulcer, as in ophthalmia neonatorum.

2.Posterior polar cataract Etiology Persistent hyaloid artery Clinically opacity at the posterior pole Vision markedly diminished as the opacity is close to the nodal point

3.Lamellar cataract Etiology most common congenital cataract Definition: lens opacity involving one or more lamellae of the lens. Etiology Malnutrition of mother and lack of vitamins during pregnancy  lamellar cataract + erosion of permanent teeth.

Lamellar cataract looks like steering wheel Why this happen? Vitamin D deficiency  formation of opaque lens fibers. On recovery from this deficiency,  formation of clear lens fibers,  pushing the opaque fibers onward , opaque lamella. Riders are due to unequal recovery of the equatorial cells at the same time

Round opacities surround nucleus like a crown 4.Coronary cataract Round opacities surround nucleus like a crown

Usually X-linked inheritance Opacity follows shape of Y suture 5. Sutural cataract Usually X-linked inheritance Opacity follows shape of Y suture

Blue dot cortical opacities 6. Blue dot opacities Blue dot cortical opacities Do not affect VA

7. Total cataract It is due to rubella infection to the pregnant mother in the first trimester The 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

Management of Developmental Cataract Fixation develops between 2-4 months of age. Uniocular cataract if vision is affected early surgery, (to avoid amblyopia and nystagmus). if vision is not affected: *No treatment *Mydriatics- if opacity is central

Management of congenital Cataract Bilateral cataract a. Bilateral Dense cataract – early surgery b. Bilateral partial cataract –surgery at the age of 2 years P.S. the risks of cataract operation before 6 months are: AC is shallow. Pupil will not dilate properly (dilator muscle is not well developed).

Management of congenital Cataract Operative procedure Irrigation and Aspiration with primary posterior capsulotomy as well as anterior vitrectomy Lensectomy (Pars plana or anterior route)

Management of congenital Cataract Post-operative visual rehabilitation: 1.(younger than 2 yrs) Contact lens –for uniocular cataract Glasses - In bilateral cataract . 2.(older than 2 yrs) insert IOL PS. Occlusion therapy for treatment of amblyopi.

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