CONGENITAL CATARACT

Asso. Prof. KONG PISETH

Deputy Director of PADH
Chairman of Ophthalmology Department UHS
CONGENITAL CATARACT
1. Important facts

2. Classification

3. Causes
• In healthy neonates
• In unwell neonates
 IMPORTANT FACTS

• 33% - idiopathic - may be unilateral or bilateral

• 33% - inherited - usually bilateral
• 33% - associated with systemic disease - usually bilateral
• Other ocular anomalies present in 50%
 CLASSIFICATION of congenital cataract
Anterior polar Posterior polar Coronary Cortical spoke-like

Lamellar Central pulverulent Sutural Focal dots

 Anterior polar cataract
May be dominant inheritance

Capsular Pyramid

With persistent pupillary With Peters anomaly

membrane
Posterior polar cataract

Ocular associations
• Persistent hyaloid remnants
• Posterior lenticonus
• Persistent hyperplastic primary vitreous
Coronary (supranuclear) cataract
Usually sporadic

• Round opacities in deep cortex

• Surround nucleus like a crown
Cortical spoke-like cataract

Systemic associations
• Fabry disease
• Mannosidosis
 Lamellar cataract
Usually dominant inheritance

• Round central shell-like opacity Systemic associations

surrounding clear nucleus • Galactosaemia
• May have riders • Hypoglycaemia
• Hypocalcaemia
Central pulverulent cataract
Dominant inheritance

• Spheroidal opacity within nucleus

• Relatively clear centre
• Non-progressive
 Sutural cataract
Usually X-linked inheritance

Opacity follows shape of Y suture

Focal dot opacities

• Blue dot cortical opacities

• Common and innocuous
• May co-exist with other opacities
CAUSES OF CATARACT IN HEALTHY NEONATE

Hereditary
(usually dominant)
Idiopathic
With ocular anomalies
. PHPV
• Aniridia
• Coloboma
• Microphthalmos
• Buphthalmos
CAUSES OF CATARACT IN UNWELL NEONATE
Intrauterine infections
• Rubella
• Toxoplasmosis
• Cytomegalovirus
• Varicella

Metabolic disorders
• Galactosaemia
• Hypoglycaemia
• Hypocalcaemia
• Lowe syndrome
ETIOLOGY OF PEDIATRIC CATARACTS
 EVALUATION OF PEDIATRIC CATARACT
• Family history (autosomal • Ocular examination, including
dominant, X- linked, autosomal – Corneal diameter
recessve) – Iris configuration
• Detailed history of the child's – Anterior chamber depth
growth, development, and – Lens position
systemic disorders – Cataract morphology
• Pediatric physical examination – Posterior segment
– Intraocular pressure
EVALUATION OF PEDIATRIC CATARACT
• Laboratory studies for bilateral cataracts
– Disorders of galactose metabolism: urine for reducing substances;
galactose-1-phosphate uridyltransferase; galactokinase
– Infectious diseases: TORCH and varicella titers, VDRL
– Metabolic diseases: urine amino acids test (Lowe syndrome);
serum calcium (low in hypoparathyroidism), phosphorus (high in
hypoparathyroidism ), glucose (high in diabetes mellitus), and
ferritin (high in hyperferritinemia)
 SURGERY FOR PEDIATRIC CATARACT
• Timing of procedure
• Intraocular lens use in children
COMPLICATION OF CATARACT SURGERY IN
PEDIATRIC PATIENT
• postoperative infections and bleeding
• Glaucoma
• (rare) Retinal detachments, macular edema, and
corneal abnormalities
Thank you for your attention!