Congenital Cataract

Anatomy of Lens
 Lens consist of
1. Capsule: Transparent, elastic envelope.Varies in
thickness at different points
2. Epithelium:Single layer of cubiodal cell. Present
behind anterior lens capsule
3. Lens Fiber: Outer recently form cortex and central
old nucleus.Produced by anterior epithelial cell
present in equatorial region
4. Zonules:Hold lens in a position behind
Iris.Originate from cilliary body and attached to
the lens capsule anterior and posterior to equator
 Compostion of len: 66 %water and 34% protein
 Congenital Cataract

 Cataract:Opacification of crystalline lens of human eye

 Congenital Cataract: Opacification of lens by birth.
 Calssification:
1. Capsular
2. Polar
3. Nuclear
4. Lamellar: Opacification in certain circular lamella both anteriorly and posteriorly with
clear lens fiber around and within the opacity.
5. Sutural: opcity follow the anterior and posterior Y suture
6. Generalized:It includes
 Coronary: cataract lies in cortex that surround the nucleus like a crown.Center portion of
lens is clear so vision is unaffected
 Blue dots: Cataract dots are stationary and does not effect vision.
 Membranous: lens material is absorbed leaving behind thin membranous cataract
 Total:Child born with dense white nuclear cataract.
 Etiology
 Maternal Causes:
1. Infection:Rubella
2. Placenta insufficiency:preclampsia and eclampsia
3. Radiation: x Rays ,gamma Ray’s etc
4. Drug: Corticosteroid etc
5. Endocrine disorder: Diabetes mellitus
 Fetal Causes:
1. Heriditary:Atosomal dominant
2. Trauma:Birth injury
3. Chromosomal abnormalities: Trisomy 21 down syndrome.
4. Ocular abormalites:Aniridia and pressitent hyperplastic primary
vitreous
Clinical Feature:

1. Decreased vision
2. Leukocoria
3. Squint usually convergent
4. Nystagmus: repetitive involuntary to ad fro oscillation of eye.
 Treatment:

 Extracapsular cataract extraction:Removal of lens nucleus and cortex through an

opening in anterior capsule leaving behind posterior capsule
1. Phacoemulsification: Cataract is fragmented and aspirated with probe of
phecoemulsifier.Advangtes of this process include small incision is given which can heal
rapidly,less astigmatism, early visual rehabilitation
2. Manual small incision cataract surgery: Cataract is removed through suture less self
healing sclerocornea tunnel incision.Inexpensive instrument require compared to phaco
emulsification
 Intracapsular cataract extraction: Cataract is removed with capsule.
1. Arruga’s Method: Capsule of lens is grab with arruga forcep and lens is delivered.
2. Cryoextraction: Capsule of lens is fixed with tip of cryoprobe by freezing mechanism
and lens is removed