102 CHAPTER 8 Lens disorders
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108 |
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109 |
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108, 109 Asymmetric bilateral sutural cataracts in a 3-year-old.Note the associated lamellar opacities,worse in the left eye.
Sutural cataracts
These congenital opacities involve the nuclear Y-sutures. They may be unilateral or bilateral (108, 109). When bilateral, sutural cataracts are often associated with an AD inheritance pattern. Autosomal recessive (AR) and X-linked recessive patterns have also been described.7 They can be progressive and the visual significance may vary widely (110).
Anterior subcapsular cataracts
Anterior subcapsular opacities occur immediately beneath the anterior lens capsule. They are usually acquired and most commonly associated with abnormalities of the anterior capsule anatomy (anterior lenticonus seen with Alport syndrome) or with trauma (111). They may also be idiopathic. The visual significance is generally not severe, but may be variable.
Posterior subcapsular cataracts
Posterior subcapsular opacities are most often idiopathic, but may be associated with trauma (112, 113), chronic corticosteroid use, uveitis, or Down’s syndrome.5 They may also develop in conjunction with posterior polar cataracts seen with posterior lenticonus. They are located
immediately anterior to the posterior lens capsule and are generally highly visually significant.
Cerulean (blue-dot) cataracts
These are multiple, small, bluish-white opacities seen diffusely throughout the peripheral lens cortex and are almost always bilateral (114). Inheritance pattern is usually AD.8 They may also be idiopathic or seen in association with Down’s syndrome. They may be slowly progressive, but are generally only minimally visually significant.
Complete cataracts
The entire lens is opacified and the red reflex is obscured. Complete cataracts may be present at birth or may progress from other subtotal opacities. Trauma is another common etiology. They may be unilateral or bilateral and produce severe visual impairment (115).
Cataracts 103
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110 |
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111 |
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110 Mild sutural cataract seen at the slit-lamp. The opacity was asymptomatic in this 12-year-old.
111 Anterior subcapsular cataract due to trauma from a paintball gun.Note the wrinkling of the anterior capsule from fibrosis and peripheral cortical vacuoles.
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112 |
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113 |
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112, 113 Posterior subcapsular cataracts associated with a history of blunt trauma.Note the multiple peripheral cortical vacuoles (113).
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114 |
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115 |
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114 Cerulean cataract in a 10-year-old. Similar opacities were seen in the contralateral eye as well as in the mother.
115 Unilateral complete cataract in a 16-year- old from unknown etiology.