Congenital & Developmental Cataract

CONGENITAL & DEVELOPMENTAL CATARACT

Q. 1

What should be treatment modality in a case of congenital cataract involving visual axis?

 A

Wait and watch

 B

Operated when the baby reaches an appropriate age

 C

Mydriatic s are given

 D

Operate immediately

Q. 1

What should be treatment modality in a case of congenital cataract involving visual axis?

 A

Wait and watch

 B

Operated when the baby reaches an appropriate age

 C

Mydriatic s are given

 D

Operate immediately

Ans. D

Explanation:

If a lenticular opacity is in the visual axis, it is considered visually significant and may lead to blindness. Immediate surgery is indicated in such groups. If the cataract is small, in the anterior portion of the lens, or in the periphery, no visual loss may be present.

  • Extracapsular cataract extraction with primary posterior capsulectomy and anterior vitrectomy is the procedure of choice (via limbal or pars plana approach).
  • Intracapsular cataract extraction in children is contraindicated because of vitreous traction and loss at the Wieger capsulohyaloid ligament.

Q. 2

A baby is brought to ophthalmology department with congenital cataract involving the visual axis. What is the MOST appropriate management in this baby?

 A

Immediate operation

 B

Wait & watch

 C

Mydriatics

 D

Operate in adult

Q. 2

A baby is brought to ophthalmology department with congenital cataract involving the visual axis. What is the MOST appropriate management in this baby?

 A

Immediate operation

 B

Wait & watch

 C

Mydriatics

 D

Operate in adult

Ans. A

Explanation:

If the opacity is small enough so that it does not occlude the pupil, adequate visual acuity is attained by focusing around the opacity. 

If the pupillary opening is entirely occluded, however, normal sight does not develop, and visual deprivation may lead to nystagmus and profound irreversible amblyopia. 
 
Good visual results have been reported with both unilateral and bilateral cataracts treated by early surgery and prompt correction of aphakia and amblyopia therapy.
 
Ref: Fredrick D.R. (2011). Chapter 17. Special Subjects of Pediatric Interest. In P. Riordan-Eva, E.T. Cunningham, Jr. (Eds), Vaughan & Asbury’s General Ophthalmology, 18e.

Q. 3

Which is the commonest congenital cataract which presents as visual impairment?

 A

Nuclear

 B

Zonular

 C

Capsular

 D

Coralliform

Q. 3

Which is the commonest congenital cataract which presents as visual impairment?

 A

Nuclear

 B

Zonular

 C

Capsular

 D

Coralliform

Ans. B

Explanation:

Lamellar or Zonular cataract refer to the developmental cataract in which the opacity occupies a discrete zone in the lens. It is the most common type of congenital cataract presenting with visual impairment. It is usually bilateral. Typically this cataract occurs in a zone of fetal nucleus surrounding the embryonic nucleus.

 

Ref: Ophthalmology by A K Khurana, 4th edition, Page 172.

Quiz In Between


Q. 4

Treatment of congenital cataract is:

 A

Needing and aspiration

 B

Intracapsular extraction

 C

Extracapsular extraction

 D

Cryotherapy

Q. 4

Treatment of congenital cataract is:

 A

Needing and aspiration

 B

Intracapsular extraction

 C

Extracapsular extraction

 D

Cryotherapy

Ans. A

Explanation:

A i.e. Needling & aspiration 

Surgical techniques employed for removal of paediatric (congenital or developmental) cataract include – lens aspirationQ, lens aspiration with anterior vitrectomy, lensectomy (via limbal or pars plana route), and extracapsular cataract extraction (ECCE) preferrably by phacoemulsificationQ. Presently the technique of intracapsular cataract extraction (ICCE), discission (needling) and linear extraction (curette evacuation) are obsolete procedures and sparingly performed world wide. Surgery in pediatric patients involve anterior capsulorrhexis, aspiration of lens matter, capsulorrhexis of posterior capsule, limited anterior vitrectomy, and IOL implantationQ, if appropriate.

Method

 Advantage

Disadvantage

Indication

Lens

Limbal route + either single

Can implant IOL in

Theoretical risk of

Preferred method

aspiration

incision or two port bimanual

bag and manoeuvre

astigmatism &

when intraocular

 

technique + 5mm anterior

capsulorrhexis

with poorly dilated

pupil

endothelial loss

lens implanted Q

Lens

Limbal route + 5mm anterior

Reduces chances of

Risk of cystoid

Preferred method in

aspiration

and 4 mm planned posterior

posterior capsular

macular oedema

infants less than 2

with anterior

vitrectomy

capsulorrhexis + anterior

vitrectomy

opacification

 

years

Lensectomy

Limbal or Pars plana route. The

No posterior

– Incarceration of the

In neonates &

 

lens is completely eaten away

capsular

vitreous in the

infants less than 2

 

with a vitrectomy instrument +

opacification

scleral incision

years of age but is

 

peripheral rim of capsule for

 

– Risk of retinal

not preferred by

 

secondary lens implanation is

left by some surgeon.

 

detachment

some surgeons

 

 

 

– Surgery hindered if

pupil constricted

 


Q. 5

Is the most common type of congenital cataract:

 A

Lamellar cataract

 B

Cataracta centralis pulverulenta

 C

Coronary cataract

 D

Coralliform cataract

Q. 5

Is the most common type of congenital cataract:

 A

Lamellar cataract

 B

Cataracta centralis pulverulenta

 C

Coronary cataract

 D

Coralliform cataract

Ans. A

Explanation:

Ans. Lamellar cataract


Q. 6

Visual prognosis is poor in:

 A

Bilateral congenital cataract

 B

Unilateral congenital cataract

 C

Zonular cataract

 D

Cataract pulverulenta

Q. 6

Visual prognosis is poor in:

 A

Bilateral congenital cataract

 B

Unilateral congenital cataract

 C

Zonular cataract

 D

Cataract pulverulenta

Ans. B

Explanation:

Ans. Unilateral congenital cataract

Quiz In Between


Q. 7

Complete unilateral congenital cataract should preferably be operated:

 A

Within a few weeks of birth

 B

At the age of 6 months

 C

At the age of 2 years

 D

At the age of 5 years

Q. 7

Complete unilateral congenital cataract should preferably be operated:

 A

Within a few weeks of birth

 B

At the age of 6 months

 C

At the age of 2 years

 D

At the age of 5 years

Ans. A

Explanation:

Ans. Within a few weeks of birth


Q. 8

Developmental cataract is seen in:

 A

Rubella

 B

Galactosemia

 C

Mongolian idiocy

 D

All of the above

Q. 8

Developmental cataract is seen in:

 A

Rubella

 B

Galactosemia

 C

Mongolian idiocy

 D

All of the above

Ans. D

Explanation:

Ans. All of the above


Q. 9

True about zonular cataract is:

 A

Bilateral

 B

Stationary

 C

Autosomal dominant

 D

All of the above

Q. 9

True about zonular cataract is:

 A

Bilateral

 B

Stationary

 C

Autosomal dominant

 D

All of the above

Ans. D

Explanation:

Ans. All of the above

Quiz In Between


Q. 10

A child has got a congenital cataract involving the visual axis which was detected by the parents right at birth. This child should be operated:

 A

Immediately

 B

At 2 months of age

 C

At 1 year of age when the globe becomes normal sized

 D

After 4 years when entire ocular and orbital growth becomes normal

Q. 10

A child has got a congenital cataract involving the visual axis which was detected by the parents right at birth. This child should be operated:

 A

Immediately

 B

At 2 months of age

 C

At 1 year of age when the globe becomes normal sized

 D

After 4 years when entire ocular and orbital growth becomes normal

Ans. A

Explanation:

Ans. Immediately


Q. 11

Most common type of congenital cataract is:

 A

Capsular

 B

Zonular

 C

Coralliform

 D

Blue dot

Q. 11

Most common type of congenital cataract is:

 A

Capsular

 B

Zonular

 C

Coralliform

 D

Blue dot

Ans. D

Explanation:

Ans. Blue dot


Q. 12

Minimum vision loss with which cataract:

 A

Blue dot cataract

 B

Zonular cataract

 C

Anterior polar cataract

 D

Posterior polar cataract

Q. 12

Minimum vision loss with which cataract:

 A

Blue dot cataract

 B

Zonular cataract

 C

Anterior polar cataract

 D

Posterior polar cataract

Ans. A

Explanation:

Ans. Blue dot cataract

Quiz In Between


Q. 13

Commonest type of concussion cataract is:

 A

Punctate cataract

 B

Early rosette-shaped cataract

 C

Late rosette-shaped cataract

 D

Zonular cataract

Q. 13

Commonest type of concussion cataract is:

 A

Punctate cataract

 B

Early rosette-shaped cataract

 C

Late rosette-shaped cataract

 D

Zonular cataract

Ans. A

Explanation:

Ans. Punctate cataract


Q. 14

Most visually handicapping cataract is:

 A

Rosette cataract

 B

Nuclear cataract

 C

Posterior subcapsular cataract

 D

Cortical cataract

Q. 14

Most visually handicapping cataract is:

 A

Rosette cataract

 B

Nuclear cataract

 C

Posterior subcapsular cataract

 D

Cortical cataract

Ans. C

Explanation:

Ans: C i.e. Posterior subcapsular cataract

Reduced visual acuity (gradual, painless, progressive) & visual field loss are manifestations of all types of cataracts

Cataracts & their effects

  • Nuclear cataract manifest as colour shift (more obvious after surgery), second sight/ myopic shift, frequent change of glasses etc.
  • Loss of ability to see objects in bright sunlight, blinding by light of oncoming headlamps when driving at night or glare may be the symptom of posterior subcapsular cataract
  • Cortical cataract may manifest as frequent change of glasses, monocular diplopia/ polyopia, glare or coloured halos around light

Q. 15

Second sight phenomenon is seen in:

 A

Nuclear cataract

 B

Cortical cataract

 C

Senile cataract

 D

Iridocyclitis

Q. 15

Second sight phenomenon is seen in:

 A

Nuclear cataract

 B

Cortical cataract

 C

Senile cataract

 D

Iridocyclitis

Ans. A

Explanation:

Ans. A i.e. Nuclear cataract

Symptoms of nuclear cataract

  • Blurring of distance more than near vision (typically, but others may notice worsening of reading more than distance
  • Increasing myopia (“Second-sight” phenomenon of improved uncorrected distance vision in hyperopes and improved uncorrected near vision in emetropes
  • Poor vision in dark settings such as night driving
  • Decreased contrast and decreased ability to discern colors
  • Glare
  • Monocular diplopia

Quiz In Between


Q. 16

Surgery of choice for congenital cataract ‑

 A

Lens aspiration

 B

Lensectomy

 C

Posterior capsulectomy

 D

ICCE

Q. 16

Surgery of choice for congenital cataract ‑

 A

Lens aspiration

 B

Lensectomy

 C

Posterior capsulectomy

 D

ICCE

Ans. C

Explanation:

Ans. is ‘c’ i.e., Posterior capsulectomy

Surgery for congenital or developmental cataract

  • Cataract surgery is the treatment of choice for congenital and developmental cataract.
  • Extracapsular cataract extraction (extracapsular removal of the cataractous lens) is the surgery of choice.This is done by phacoemulsification.
  • Intracapsular cataract extraction (ICCE) in children is contraindicated because of vitreous traction and loss at the wieger capsulohyaloid ligament
  • Method for extracapsular cataract extration are :-
  1. Posterior capsulectomy and anterior vitrectomy (Procedure of choice). This can be done via limbal or pars plana approach.
  2. Lens aspiration
  3. Lensectony
  • The traditional treatment of needling or discission of congenital cataract are obsolete now.
  • After removal of cataractous lens, the resultant aphakia in children is treated by : –
  1. If child is < 2 years → Contact lens
  2. If child is > 2 years → Intraocular lens implantation

Q. 17

Most common type of congenital cataract ‑

 A

Punctate cataract

 B

Nuclear cataract

 C

Zonular cataract

 D

Lamellar cataract

Q. 17

Most common type of congenital cataract ‑

 A

Punctate cataract

 B

Nuclear cataract

 C

Zonular cataract

 D

Lamellar cataract

Ans. A

Explanation:

Ans. is ‘a’ i.e., Punctate cataract

Congenital cataract

  • Among the many morphological types, the following are common :‑

1) Punctate cataract

  • This is the most common manifestation and, in minute degress, is almost universal in occurrence. When the small opaque spots are multiple and scattered all over the lens, appearing as tiny blue dots, they are known as cataracta coerulea or blue- dot cataract. When crowed in the Y- sutures, the terms sutural cataract and anterior axial embryonic cataract have been used. Another variant is a cataract with a central spheroidal or biconvex opacity consisting of powdery fine white dots within the embryonic or foetal nucleus, called cataracta centralis pulverulenta.

2) Zonular cataract (lamellar cataract)

  • This accounts for approximately 50% of all visually significant congenital cataracts. A zone around the embryonic nucleus (usually in the area of the foetal nucleus) becomes opacified.The area of the lens within and around the opaque zone is clear, although linear opacities like spokes of a wheel (riders) may run outwards towards the equator. Lack of Vitamin D is apparently a potent factor and evidence of rickets may be found in affected children. Hypoparathyroidism during pregnancy may also cause this type of cataract

3) Fusiform cataract (Spindle- shaped/ axial/ coralliform)

  • There is an anterioposterior spindle-shaped opacity with offshoots giving an appearance resembling a coral.

4) Nuclear cataract

  • It is due to disturbance in development at a very early stage, therefore, the central nucleus remains opaque –> Embryonic nuclear cataract. It may be associated with rubella (German measles) in mother.

5) Coronary cataract

  • It occurs around puberty and appears as a corona of club shaped opacities in the periphery of the lens.

6) Anterior capsular (polar) cataract

  • It involves the central part of the anterior capsule and the adjoining superficial most cortex. It may be either due to (i) Developmental delay in formation of anterior chamber (ii) Aquired due to corneal perforation (as in penetrating injury or ophthalmia neonatorum). It may be of following types:‑
  1. Thickened white plaque
  2. Anterior pyramidal cataract Cone shaped opacity with apex towards cornea.
  3. Reduplicate (double) cataract:- A transparent zone between two opacities (one on capsule and other in cortex). The burried opacity is called imprint and the two together constitute reduplicate cata ract.

7) Posterior capsular (polar) cataract

  • This is due to persistence of the posterior part of the vascular sheath of the lens.

Q. 18

Surgery of choice for congenital cataract

 A

ECCE

 B

ICCE

 C

Needling

 D

Discission

Q. 18

Surgery of choice for congenital cataract

 A

ECCE

 B

ICCE

 C

Needling

 D

Discission

Ans. A

Explanation:

Ans. is ‘a’ i.e., ECCE 

Surgery for congenital or developmental cataract

  • Cataract surgery is the treatment of choice for congenital and developmental cataract.
  • Extracapsular cataract extraction (extracapsular removal of the cataractous lens) is the surgery of choice.This is done by phacoemulsification.
  • Intracapsular cataract extraction (ICCE) in children is contraindicated because of vitreous traction and loss at the wieger capsulohyaloid ligament

Method for extracapsular cataract extration are :-

  1. Posterior capsulectomy and anterior vitrectomy (Procedure of choice). This can be done via limbal or pars plana approach.
  2. Lens aspiration
  3. Lensectony
  • The traditional treatment of needling or discission of congenital cataract are obsolete now.
  • After removal of cataractous lens, the resultant aphakia in children is treated by : –
  1. If child is < 2 years → Contact lens
  2. If child is > 2 years  →Intraocular lens implantation

Quiz In Between



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