developmental cataract 9
TRANSCRIPT
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Developmental cataract
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Definition
Congenital cataract: - Cataract present at birth- Involves embryonic or fetal nucleus Developmental cataract:- Occurs from infancy to adulthood- May involve infantile or adult
nucleus, deeper layers of cortex or the capsule
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Etiology Heredity: - Accounts for 1/3rd of congenital
cataracts- Dominant pattern- Common cataracts which are
inherited are: cataracta pulverulenta, zonular cataract, coronary cataract, total cataract
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Maternal factors: - Malnutrition- Infections: TORCH- Drugs: thalidomide, corticosteroids- Radiation exposure
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Fetal or infantile factors:- Deficient oxygenation due to placental
haemorrhage- Metabolic disorders: hypocalcemia,
storage disorders, galactosemia, neonatal hypoglycemia
- Other congenital syndromes: Lowe’s, myotonica dystrophica, etc
- Birth trauma- Malnutrition Idiopathic
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Clinical types Punctate cataract:- Commonest form- Blue dot cataract (cataracta coerulea):
tiny blue dots seen on oblique illumination- Sutural cataract:opacities involving Y
sutures- Cataracta centralis pulverulenta: powdery
fine opacities within embryonic or fetal nucleus
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Zonular cataract- Constitutes 50% of all visually significant
cataract- Development is affected at a later stage and a
zone surrounding embryonic nucleus (usually fetal nucleus) becomes opacified, its extent depending on the duration of inhibiting factor
- Sharply demarcated opacity with area within and surrounding the opacity being clear
- Linear spoke like opacities running towards equator: “riders”
- Usually bilateral- Etiology: genetic (dominant inheritance),
environmental (malnutrtion late fetal or early infantile life, vitamin D deficiency)
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Fusiform cataract- Also called as spindle shaped
cataract/ axial or coralliform cataract- Anteroposterior spindle shaped
opacity, sometimes with off-shoots giving an appearance resembling a coral
- Etiology: genetic
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Nuclear:- Results when development of lens
is inhibited at an early age, so that the central nucleus remains opaque- embryonal nuclear cataract
- Progressive form of nuclear cataract- rubella
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Coronary cataract: - Development affected around puberty,
thereby involving deep layers of cortex and most superficial layers of adolescent nucleus
- Club shaped opacities near the periphery of the lens, axial region remaining clear: vision usually not affected
- Non progressive
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Anterior polar cataract:- Involves the central part of anterior capsule
and the adjacent cortex- Etiology: delayed formation of anterior
chamber during development (congenital), perforation of corneal ulcer in ophthalmia neonatorum resulting in contact of cornea with anterior lens capsule (acquired)
- May also result in formation of anterior pyramidal cataract (white plaque projecting forwards into the anterior chamber)
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Sometimes an anterior cortical cataract may form (due to opacification of underlying cortex)
Reduplicated cataract/ imprint cataract: when subcapsular epithelium grows between the capsular and cortical opacities, clear lens fibres separate the 2 opacities forming an imprint cataract (buried opacity)
Usually non progressive, do not interfere with vision
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Posterior polar cataract:- Due to persistence of posterior
part of vascular sheath of the lens (posterior hyaloid artery)
- Usually visually insignificant
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Total cataract Congenital membranous cataract :
due to total or partial absorption of a congenital cataract. Very rare