Cataract in the 21st century

Liana Al-Labadi, O.D.Lecture 9

Thanks To The Ohio State College of Optometry

Presenile cataracts

Presenile Cataract:

Myotonic Dystrophy

Diabetes

Atopic Dermatitis

Blue-Dot Cataract

Presenile cataractsJuvenile Diabetic Cataract:

Characterized by rapidly progressing white “snowflake” opacities in the anterior & posterior subcapsular locations

May mature within few days

Adult Diabetic Cataract:

Results in cortical & subcortical lens opacities

Age-related cataract form earlier in diabetics

Caused by shifts in the glucose, electrolyte, & water balance within the lens

Fluctuating vision & rapid shift to near sightedness are symptoms of diabetes

http://lessons4medicos.blogspot.com/2009/02/cataracts-few-interesting-types.html

Presenile cataractsAtopic Dermatitis Cataract:

Anterior subcapsular plaque

aka shield cataract

Causes wrinkles in the anterior capsule

Develops in 10% of cases between ages 15-30

Bilateral in 70%

Frequently becomes mature cataract

http://lessons4medicos.blogspot.com/2009/02/cataracts-few-interesting-types.html

http://lessons4medicos.blogspot.com/2009/02/cataracts-few-interesting-types.html

Presenile cataractsBlue-Dot Cataract

AKA cerulean cataracts

Not uncommon

Clinical features:

Often an incidental finding during routine eye exam

Asymptomatic

Develops at an adult younger age

Seen in down syndrome patients

Signs:

Discrete punctate bluish opacities throughout the cortex

http://dro.hs.columbia.edu/bldot.htm

http://www.sarawakeyecare.com/Atlasofophthalmology/anteriorsegment/anteriorsegment65bluedots.htm

http://www.opt.indiana.edu/NewHorizons/Cerulean.html

Traumatic cataract

Traumatic cataract causes:

Penetrating injuries

Concussion injuries

Electric shock

Radiation

Traumatic cataractTraumatic cataract:

Most common complication of non-perforating & perforating injuries to the globe

Intraocular trauma by surgical instruments, lodged FB or intraocular filtration tube are possible causes

Clinical Features:

Cataract formation after non-penetrating injury (contusion or concussion) may occur without any damage to lens capsule

Cataract formation may be slowly progressive or mature suddenly

No always easy to observe initial changes of the lens

Vossius ring- seen as a circular iris pigment imprinted on the surface of the lens anterior capsule

Deposit of melanocytes from pupillary border of iris as a result of a concussion

Rosette cataract aka “flower-shaped”

Caused secondary to head &/or ocular contusion with or without lens rupture

One or more feather or flower-like petals radiating out from the lens axis

Trauma may also produce anterior or posterior subcapsular opacities

May explain a unilaterally elevated IOP- must R/O angle recession

http://www.atlasophthalmology.com/atlasimg/Img0086_39_low.jpg

Traumatic cataractEarly Rosette Cataract:

Appears hours, weeks, or even months post-traumatically

May be transient though usually it is permanent & stationary

Feather-like, rounded opacities with suture lines positioned centrally

Initially develops in the anterior subcapsular region

May becomes buried within the lens with time

http://www.opt.indiana.edu/NewHorizons/Rosette.html

Traumatic cataractLate Rosette Cataract:

Appears years after the traumatic event

Once developed, it is usually permanent & stationary

Feather-like, rounded opacities with suture lines positioned centrally

Suture lines positioned between the slightly pointed lobes

Usually found at the interface of the anterior cortex & the anterior nucleus

http://www.opt.indiana.edu/NewHorizons/Rosette.html

Toxic Cataract

Chloropromazine Cataract:

Used in the treatment of psychotic disorders & hyperexcitability

Cataract begins as fine particulate deposits in the anterior subcapsular area which progresses to a star-shaped opacity

Usually develops after treatment for at least 2 years with more than 300mg/day

http://www.opt.indiana.edu/NewHorizons/Chlorpromazine.html

Toxic CataractToxic Cataract:

Steroids

Long-acting miotics

Amiodarone

Busulfan- cancer drug

Secondary cataract

Secondary PSC can develop with:

Chronic anterior uveitis

Ciliary body tumor

Ionizing Radiation

MRI causes NS, CC, ASC

High myopia

Hereditary fundus dystrophies

RP

Leber congenital Amaurosis

Gyrate Atrophy

Wagner & Stickler Syndrome

Angle closure glaucoma

Glaucomflecken

Secondary cataract

Glaukomflecken

Focal cortical opacities resulting from:

Acute closure glaucoma

Sudden IOP spike

Results in central, anterior subcapsular opacities

Subepithelial lens opacification

Due to lens epithelial cells ischemia & necrosis caused by elevated IOP

Glaukomflecken

Metabolic Cataract

Wilson Disease- Metabolic AR disease

Multi-system disorder due to impaired hepatic excretion of copper

Results in low serum ceruloplasmin level & subsequent elevated serum & urine copper levels

Excess copper in CNS, liver, kidney, cornea & other organs

This copper deposition leads to liver & brain damage

Metabolic Cataract

Wilson Disease- Metabolic AR disease

Symptoms:

Ocular complaints are rare

May experience sx of cirrhosis, neurological disorders, psychiatric problems, or renal disease

Begins typically between 5 to 40 years of age

Signs

Kayser-Fleisher ring

A 1-3mm brown, green, or red band that represents copper deposition in the peripheral descemet membrane

Present in 50-60% of patients with isolated hepatic involvement

Present in more than 90% of patients with neurological manifestation

“Sunflower” cataract- due to anterior & posterior subcapsular copper deposition

Wilson Disease