1. Congenital cataract

2. 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.

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: cataract
3. Another Congenital anomalies:
Dental anomalies.
Microphthalmos.
Mental retardation.
Congenital heart disease
Microencephaly.
Deafness

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

6. Types of congenital cataract

7. 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.

8. 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

9. 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.

10. 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

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

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

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

14. 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

15. 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

16. 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).

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

18. 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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