Congenital Cataracts - Keerthi L

BIOLOGY INVESTIGATORY
PROJECT
CONGENITAL AND
DEVELOPMENTAL CATARACTS
DONE BY :
KEERTHI L
12 - A
7125
2022-2023
[1]
[2]
ACKNOWLEDGEMENTS
I would like to express my greatest gratitude to our school principal Mrs.

Sankari Avudaiappan Ravi and our vice principal Dr. Meenakshi . J who
have given me this golden opportunity to work on this project. I must express
my profound gratitude to Dr. Meenakshi . J , our Biology teacher to whom I
am extremely thankful and indebted to for sharing expertise, and sincere and
valuable guidance and I take this opportunity to express my gratitude to my
fellow mates who helped and supported me through this venture. I also thank
my parents and my well wishers for the unceasing encouragement, support
and attention and The Almighty to make my project successful without any
hassles.
[3]
[4]
INDEX
SNO CONTENTS PAGE

NO
1 INTRODUCTION
2 CONGENITAL AND DEVELOPMENTAL CATARACTS 7
3 CAUSES OF CONGENITAL CATARACTS 9
4 CAUSES OF DEVELOPMENTAL CATARACTS 11
5 TYPES OF CONGENITAL AND DEVELOPMENTAL CATARACTS 13
6 SURGICAL PROCEDURES 21
7 CONCLUSION 23
[5]
[6]
INTRODUCTION
The word 'cataract' dates from the Middle Ages and has been derived from the
Greek word 'katarraktes' which means 'waterfall'. This term was coined assuming
that an 'abnormal humour' developed and flowed in front of the lens to decrease
the vision.
The present definition of cataract came much later after the understanding of the
lens anatomy and of the fact that normal lens is a transparent structure.
As of today, the term cataract refers to development of any opaciry in the lens or
its capsule. Cataract, thus may occur, either due to formation of opaque lens fibres
(congenital and developmental cataracts) or due to degenerative process leading
to opacification of the normally formed transparent lens fibres (acquired cataract).
Clinically, the term cataract refers to an opacification of sufficient severity to

impair the vision
[7]
[8]
CONGENITAL AND
Congenital and developmental cataracts occur due to some disturbance in the

normal growth of the lens. When the disturbance occurs before birth, the child is
born with a congenital cataract. Therefore, in congenital cataract the opacity is
limited to either embryonic or foetal nucleus. Developmental cataract may occur
from infancy to adolescence. Therefore, such opacities may involve infantile or
adult nucleus, deeper parts of cortex or capsule. Developmental cataract typically
affects the particular zone which is being formed when this process is disturbed.
The fibres laid down previously and subsequently are often normally formed and
remain clear. Congenital and developmental opacities assume most variegated
appearance and minute opacities (without visual disturbance) are very common
in normal population. These are detected with the beam of slit-lamp under full
mydriasis.
[9]
[10]
CAUSES OF CONGENITAL
CATARACTS
• Heredity : About one-third of all congenital cataracts are hereditary. In

these cases, the mode of inheritance is usually autosomal dominant.
• Malnutrition during pregnancy has been associated with non familial
zonular cataract.
• Infections : Maternal infections like rubella are associated with cataract
in 50% of cases. Other maternal infections associated with congenital
cataract include toxoplasmosis and cytomegalic inclusion disease.
• Drugs ingestion : Congenital cataracts have also been reported in the
children of mothers who have taken certain drugs during pregnancy (e.g.
thalidomide, corticosteroids)
• Radiation : Maternal exposure to radiation during pregnancy may cause
congenital cataracts.
• Deficient oxygenation (anoxia) owing to placental haemorrhage.
• Cataracts associated with other congenital anomalies, e.g. as seen in
Down's syndrome, Lowe's syndrome, rnyotonia dystrophica and
congenital icthyosis.
[11]
[12]
CAUSES OF DEVELOPMENTAL
CATARACTS
• Due to ocular diseases associated with developmental cataract :

persistent hyperplastic primary vitreous (PHPV), aniridia anterior chamber
cleavage syndrome retinopathy of prematurity, lenticonus posterior and
microphthalmos
• Malnutrition in early infancy may also cause developmental cataract .
• Birth trauma, may cause cataract.
• Metabolic disorders of the foetus or infant such as galactosemia,
galactokinase deficiency and neonatal hypoglycemia.
[13]
[14]
TYPES OF CONGENITAL AND
I. CONGENITAL CAPSULAR
CATARACTS
• Anterior capsular cataracts are nonaxial, stationary and visually

insignificant.
• Posterior capsular cataracts are rare and can be associated with persistent
hyaloid artery remnants.
[15]
[16]
II. POLAR CATARACTS
• Anterior polar cataract It involves the central pan of the anterior capsule
and the adjoining superficial-most cortex. It may arise in the following
ways:
➢ Due to delayed development of anterior chamber. In this case, the opacity is
congenital usually bilateral, stationary and visually insignificant
➢ Due to corneal perforation. Such cataracts may also be acquired in infantile
stage and follow contact of the lens capsule with the back of cornea, usually
after perforation due to ophthalmia neonatorum or any other cause.
• Posterior polar cataract It is a very common lens anomaly and consists of

a small circular circumscribed opacity involving the posterior pole.
[17]
[18]
III. CONGENITAL NUCLEAR CATARACTS
• Cataracta centralis pulverulenta : Cataracta centralis pulverulenta is an

embryonic nuclear cataract. It has dominant genetic trait occurs due to
inhibition of the lens development at a very early stage and thus, involves
the embryonic nucleus. The condition is bilateral and is characterised by a
small rounded opacity lying exactly in the centre of the lens. The opacity
has a powdery appearance (pulverulenta) and usually does not affect the
vision.
• Lamellar cataract : Lamellar or Zonular cataract refer to the
developmental cataract in which the opacity occupies a discrete zone in
the lens. lt is the most common type of congenital cataract presenting with
visual impairment. It accow1ts for about 50% of the cases.
• Sutural and axial cataracts: Sutural cataracts are comparatively of
common occurrence and consist of a series of punctate opacities scattered
around the anterior and posterior Y-sutures. Such cataracts are usually
static, bilateral and do not have much effect on the vision. The individual
opacities vary in size and shape and have different pattern .
• Total nuclear cataract : Total ,nuclear cataract usually involves the
embryonic and foetal nucleus and sometimes infantile nucleus as well. It
is characterized by a dense chalky white central opacity seriously
impairing vision. The opacities are usually bilateral and non-progressive.
[19]
[20]
IV. GENERALIZED CATARACTS
• Coronary cataract : Coronary cataract is an extremely common form of

developmental cataract occurring about puberty; thus involving either the
adolescent nucleus or deeper layer of the cortex. The opacities are often
many hundreds in number and have a regular radial distribution in the
periphery of lens (corona of club-shaped opacities) encircling the central
axis. Since, the opacities are situated peripherally, vision is usually
unaffected. Sometimes the associated large punctate opacities may
marginally reduce the vision.
• Blue dot cataract : It is also called cataracta-punctata-caerulea. Perhaps
this is the most common type of congenital cataract. It usually forms in the
first two decades of life. The characteristic punctate opacities are in the
form of rounded bluish dots situated in the peripheral part of adolescent
nucleus and deeper layer of the cortex. Opacities are usually stationary
and do not affect vision. However, large punctate opacities associated with
corona1y cataract may marginally reduce the vision.
• Total congenital cataract : lt is a common variety and may be unilateral
or bilateral . In many cases, there may be hereditary character. Its other
important cause is maternal rubella.
• Congenital membranous cataract : Sometimes, there may occur total or
partial absorption of congenital cataract, leaving behind thin membranous
cataract. Rarely, there is complete disappearance of all the lens fibres and
only a fine transparent lens capsule remains behind. Such a patient may be
misdiagnosed as having congenital aphakia . This is associated with
Hallermann -Streiff-Francois Syndrome.
[21]
[22]
INDICATIONS FOR PAEDIATRIC
CATARACT SURGERY
• Partial cataracts and small central cataracts

• Bilateral dense cataracts
• Unilateral dense cataract
SURGICAL PROCEDURES
Childhood cataracts (congenital, developmental as well as acquired) can be

dealt with extracapsular cataract extraction technique involving anterior
capsulorrhexis and irrigation aspiration of tl1 e lens matter (lens aspiration) or
lensectomy.
CORRECTION OF PAEDIATRIC
APHAKIA
• Children above the age of 2 years can be corrected by implantation of

posterior chamber intraocular lens during surgery.
• Children below the age of2 years should preferably be treated by
extended wear contact lens. Spectacles can be prescribed in bilateral cases.
Later on secondary IOL implantation may be considered.
[23]
[24]
CONCLUSION
Cataract does not essentially involve elders but can also affect children . Cataract
is a common condition wherein researches are done extensively to understand its
pathophysiology and its interaction with other commonly seen conditions such as
diabetes , hypertension , etc . Surgical intervention keeps evolving over time in
order to provide better outcome with minimal complications .
[25]
[26]
BIBLIOGRAPHY
• Comprehensive Ophthalmology – A K Khurana (

7th Edition )
• www.allaboutvision.com
[27]
[28]
THANK YOU
[29]

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BIOLOGY INVESTIGATORY

I would like to express my greatest gratitude to our school principal Mrs.

SNO CONTENTS PAGE

2 CONGENITAL AND DEVELOPMENTAL CATARACTS 7

3 CAUSES OF CONGENITAL CATARACTS 9

4 CAUSES OF DEVELOPMENTAL CATARACTS 11

5 TYPES OF CONGENITAL AND DEVELOPMENTAL CATARACTS 13

Clinically, the term cataract refers to an opacification of sufficient severity to

Congenital and developmental cataracts occur due to some disturbance in the

• Heredity : About one-third of all congenital cataracts are hereditary. In

• Due to ocular diseases associated with developmental cataract :

• Anterior capsular cataracts are nonaxial, stationary and visually

• Posterior polar cataract It is a very common lens anomaly and consists of

• Cataracta centralis pulverulenta : Cataracta centralis pulverulenta is an

• Coronary cataract : Coronary cataract is an extremely common form of

• Partial cataracts and small central cataracts

Childhood cataracts (congenital, developmental as well as acquired) can be

• Children above the age of 2 years can be corrected by implantation of

• Comprehensive Ophthalmology – A K Khurana (

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