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CONGENITAL CATARACT

Prepared by: Muhammad Shukri Bin Johar 070100441 J2 2012

Department Of

Outlines           Lens Anatomy Definition Epidemiolgy Pathophysiology Etiology Clinical features Investigations Differential diagnoses Management Prognosis .

Lens Anatomy .

elips biconvex structure in the eye  Anterior to the lens: iris & Posterior to the lens: vitreous body. the lens receives all its nourishment from the aqueous humor. . the hyaloid artery begin to regres .Lens Anatomy The crystalline lens : Function: refract light to be focus on the retina. The anterior surface is less curved than the posterior. the lens is surrounded and nourished by tunica vasculosa lentis (derived from the hyaloid artery). Beginning in the fourth month of development.  The lens is suspended in place by the suspensory ligaments and connects to the ciliary body.  By nine weeks into human development.  Transparent.

Congenital cataract (Developmental Cataract) means that cataract that presents at birth. or develop soon after birth .Definition  term any opacity of the lens or capsules causing visual impairment is called cataract.

Epidemiology  Opacity in lens  Can be: Visually significant or not Stable or Progressive Congenital or Acquired Unilateral or Bilateral Partial or Complete Congenital: incidence 6/10 000 10% of childhood blindness  .

Pathophysiology    At birth. the embryonic and fetal nuclei make up most of the lens. cortical lens fibers are laid down from the conversion of anterior lens epithelium into cortical lens fibers Any insults to the nuclear/lenticular fiber can result opacity . Postnatally.

Etiology .

Clinical Features History:  Painless loss of vision  Refraction disturbance and glare Physical examination:  Several types of congenital cataract are recognized with slit-lamp biomicrosocpe. (Morphologically) .

Morphology : Examples .

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Investigations    Screen newborns with red reflex test History : Family Maternal infections Examination: systemic diseases or syndromes Workup: Bilateral cases without known hereditary basis TORCH screen s-glucose s-calcium. phosphate Urine: reducing substances (galactosaemia) amino acids ( Lowe syndrome) haematuria (Alport syndrome)  .

visually evoked potentials Density and position of cataract   Morphology Associated ocular pathology Indicators of severe visual impairment : No fixation Nystagmus Strabismus   .Ocular examination  Formal estimate of vision not possible in neonate Special tests: Preferential looking test.

Differential Diagnose   Retinoblastoma Ablatio retina .

but wearing heavy spectacles (+15D/>) should be considered •Extended-wear soft contact lens: especially for uniocular aphakia but require commitment of the parents. A posterior capsulorhexis with/without vitrectomy is helpful to prevent PCO in younger group . the surgery ASAP •Bilateral cases: 1 week apart •Non visually significant cases : careful observation. possible pupillary dilation •Conventional aphakic glasses: only useful for bilateral aphakia. •If in dense cataract (bilateral/ unilateral) or partial cataract with vision less than 6/18. •Most ophthalmologists opt for surgery much earlier. •The incidence of posterior ocular opacification (PCO) after ECCE with PCIOL is very high in young children. ideally when patients are younger than 2 months. •Planned extracapsular cataract extraction (ECCE): a posterior chamber intraocular lens (PCIOL) may be considered ECCE if child older than 3 years age. Surgical Techniques •Pars plana lansectomy with vitrectomy: most suitable for cengenital cataract.•surgery (treatment of choice) •should be performed btwn 6w6m.

70% develop visual acuity of 20/60 or better). 40% develop visual acuity of 20/60 or better while bilateral congenital cataracts. glaucoma. amblyopia. Associated with systemic or other ocular defects (poor prognosis) Commitment of the parents Sometimes patient can develop with complications such as loss of vision even with aggressive surgical and optical treatment.Prognosis     Uni/Bilateral (unilateral congenital cataracts. strabismus and retinal detachment .

THANK YOU Prepared by: Muhammad Shukri Bin Johar 070100441 J2 2012 Department Of .