Congenital cataract

Definition: 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.

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:

cataract3. Another Congenital anomalies:

Dental anomalies. Microphthalmos. Mental retardation. Congenital heart disease Microencephaly. Deafness

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

Clinicallyopacity at the posterior pole

Visionmarkedly diminished as the opacity is close to the nodal point

3.Lamellar cataractmost common congenital cataract

Definition:lens opacity involving one or more

lamellae of the lens.EtiologyMalnutrition of mother and lack of vitamins during pregnancy lamellar cataract + erosion of permanent teeth.

Lamellar cataract looks like steering wheelWhy 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

4.Coronary cataract

Round opacities surround nucleus like a

crown

5. Sutural cataractUsually X-linked inheritance

Opacity follows shape of Y suture

6. Blue dot opacities

Blue dot cortical opacitiesDo not affect VA

7. Total cataractIt 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 cataracta. Bilateral Dense cataract – early surgeryb. 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 procedure1. Irrigation and Aspiration with

primary posterior capsulotomy as well as anterior vitrectomy

2. 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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