Metabolic cataract

Presentation by:
Yasaman karimdadi 1801928
GALAXY Hadis Alamfard 1701939

Modern ophthalmology
Tkhelidze Nino M.D
Spring 2024-2025
 INTRODUCTION TO
LENS AND CATARACT
A cataract usually is defined as an opacification
of the lens or its capsule In this sense Transparent biconvex structure
• Placed between iris & vitreous , suspended by zonule of
zinn from ciliary body
• Radius of curvature
Anterior 10mm
Posterior 6mm
• Diameter of lens 8.8 to 9.2mm
• Refractive index 1.37
Lacking a blood supply and innervation
Dioptric power of lens 15-18D
• Thickness 4mm
• Weight at birth 65mg
at 80 yrs 258mg
• Accommodative power at birth --------14-16D
at 25 yrs------ 7-8D
at 50yrs------- 2D Function of lens
• Maintenance of transparency
• Refraction
• Accommodation
CLASSIFICATION OF CATARACT

Etiological classification: 4.Skin Diseases – Atopic Morphological classification

Dermatitis 1. Capsular
-Congenital and Developmental
5.Traumatic Cataract : 2. Subcapsular
-Acquired 3. Cortical
Trauma 4. Supranuclear
1.Age related (senile)
Electric Shock 5. Nuclear
2.Cataract associated with ocular
diseases(complicated or secondary) Radiation 6. Polar

3.Cataract associated with systemic 6. Drug induced cataract :

diseases:
Corticosteroids,
Diabetes, Hypoglycaemia, Anticholinesterases,
Hypoparathyroidism
Chlorpromazine, Busulfan,
Choroquine
DIFFERENT TYPE OF CATARACT
AGE-RELATED
• increased mass and thickness, Chemical modification and
proteolytic cleavage
• lead to nuclear sclerosis and protein aggregation, causing light
scattering and reduced transparency.

• Chemical modifications result in pigmentation changes,

contributing to lens opacity.

• Biochemical alterations, such as decreased glutathione and

potassium concentrations and increased sodium and calcium
concentrations, further exacerbate the condition.
DRUG-INDUCED CATARACT
• corticosteroids, antipsychotics, statins.

• Mechanisms include oxidative stress and

lens metabolism disruption.

Methotrimeprazine-induced Corneal Deposits

and Cataract
TRAUMA-INDUCED
CATARACT

rosette-shaped

• result from mechanical, physical, or chemical injury, including blunt trauma, radiation, electrical
current.
• Blunt injuries can lead to traumatic cataracts, presenting as stellate or rosette-shaped
opacifications affecting the posterior lens capsule.
• Disruption of zonular fibers may cause lens dislocation and cataract formation, leading to
symptoms like fluctuating vision and diplopia.
• Penetrating injuries result in rapid opacification of the cortex.
• chemical injuries alter aqueous pH, glucose, and ascorbate levels, causing cataracts.
METABOLIC CATARACT
DIABETES MELLITUS
• Impact of Diabetes Mellitus on Lens: Diabetes mellitus affects
lens clarity, refractive index, and accommodative amplitude,
with increased blood glucose levels leading to elevated
glucose content in the aqueous humor. snowflake
• Diabetic Cataracts: Cataracts are a common cause of visual
impairment in diabetic patients, with acute diabetic cataract,
or "snowflake" cataract, characterized by bilateral,
widespread subcapsular lens changes of abrupt onset,
typically in young individuals with uncontrolled diabetes
mellitus.
• Age-Related Lens Changes in Diabetic Patients: Diabetic
patients develop age-related lens changes similar to
nondiabetic individuals but tend to occur at a younger age
due to factors such as sorbitol accumulation, nonenzymatic
glycosylation of lens proteins, and increased oxidative stress.
• Cataract in Pediatric Patients with Diabetes Mellitus: Cataract
is the leading cause of visual impairment among children and
adolescents with diabetes mellitus, often appearing within 6
months of diagnosis, with an incidence ranging from 0.7% to
3.4%.
• Screening Recommendations: There is no consensus
guideline for screening pediatric patients with diabetes for
cataract, but some authors suggest an eye examination at the
• an inherited disorder, leads to galactose accumulation due
GALACTOSEMIA
to an enzyme deficiency.
(GALT)
unprocessed galactose(dulcitol) builds up in lens This draws
water in and cause swollen lens fibers disrupt the normal
clarity of the lens

• symptoms of malnutrition, hepatomegaly, jaundice, and

intellectual deficiency present within the first few weeks
of life.
• the nucleus and deep cortex become increasingly
opacified in individuals with this condition, causing an
“oil droplet”
• Classic galactosemia presents with symptoms like
malnutrition and cataracts, which can be fatal if
untreated.
• Diagnosis involves detecting galactose in urine.
• Treatment includes eliminating milk products from the oil droplet” cataract
diet. Cataracts may require surgery if not resolved by
dietary intervention.
HYPOCALCEMIA
• Cataracts may develop in association with any
condition that results in hypocalcemia.
Hypocalcemia may be idiopathic, or it may
occur as a result of unintended destruction of
the parathyroid glands during thyroid surgery.
Vitamin D deficiency
• calcium ions required for proper lens protein
stability and transparency. Bilateral hypocalcemic cataract after total
thyroidectomy
• Usually bilateral, hypocalcemic (tetanic)
cataracts are punctate iridescent opacities in the
anterior and posterior cortex. They lie beneath
the lens capsule and are usually separated from
it by a zone of clear lens.
• These discrete opacities may remain stable or
may mature into complete cortical cataracts.
 WILSON DISEASE

• Wilson disease (hepatolenticular degeneration) is an inherited

autosomal recessive disorder of copper metabolism.
• The characteristic ocular manifestation of Wilson disease is
the Kayser-Fleischer ring, a golden-brown discoloration of
Descemet membrane around the periphery of the cornea . In
addition, a characteristic sunflower cataract often develops.
• Reddish-brown pigment (cuprous oxide) is deposited in the
anterior lens capsule and subcapsular cortex in a stellate
shape that resembles the petals of a sunflower . In most cases,
the sunflower cataract does not cause serious visual
impairment.

Slit-lamp image of Kayser-Fleischer

MYOTONIC DYSTROPHY
• Myotonic dystrophy is an inherited autosomal dominant
condition characterized by delayed relaxation of contracted
muscles, ptosis, weakness of the facial musculature, cardiac
conduction defects, and prominent frontal balding in affected
male patients. can develop in teenagers or young adults
• Patients with this disorder typically develop polychromatic
iridescent crystals in the lens cortex . with sequential PSC
that progresses to complete cortical opacification. Protein
abnormalities, nutrient .
• These polychromatic iridescent crystals are composed of
whorls of plasmalemma from the lens fibers.
• posterior subcapsular cataract."This type affects the back
capsule of the lens, causing a characteristic appearance.

• Iridescent crystals that are similar in appearance are

occasionally seen in the lens cortex of patients who do not
have myotonic dystrophy; those crystals are thought to be
caused by cholesterol deposition in the lens.
CHRISTMAS TREE CATARACT (CTC)
Christmas Tree Cataract (CTC) is a unique type of cataract distinguished by its appearance during an eye exam. It presents
with multi-colored, needle-shaped crystals arranged in a crisscrossing pattern within the lens of the eye, resembling a
Christmas tree.
Treatment:There is no treatment to prevent
or reverse CTC.Treatment focuses on
managing cataract symptoms once they
become bothersome.Cataract surgery is the
only effective treatment to improve vision.
Symptoms:CTC itself may not cause any specific symptoms
initially.However, cataracts in general can cause:Blurred visionDifficulty
seeing at night or in low lightIncreased glare sensitivityDifficulty reading
Diagnosis:Slit-lamp examination by an ophthalmologist is the primary
method for diagnosing CTC.The characteristic appearance of the
crystals under magnification is key to identification.
Causes:The exact cause is unknown, but it's believed to be associated
with:Abnormal protein breakdown: Elevated calcium levels might trigger the
breakdown of proteins in the lens into these needle-like crystals.
Myotonic dystrophy (DM): This genetic muscle disorder is linked to an
increased risk of CTCs.Unlike most cataracts, age isn't a major risk factor for
CTCs..
Association with Myotonic Dystrophy (DM):Nearly all (around
90-100%) individuals with Myotonic Dystrophy (both type 1 and
2) will develop CTC.However, CTC can occur in people without
DM.