Eye diseases. Congenital cataract (most important)

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Eye diseases. Congenital cataract (most important)

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54. Congenital cataract

By origin, cataracts are divided into: congenital (hereditary, intrauterine); consistent due to local processes (uveitis, congenital glaucoma, injuries, etc.) and due to general diseases (infectious and neuroendocrine diseases, radiation sickness, metabolic diseases, etc.); secondary (postoperative).

By localization, cataracts are: polar, nuclear, zonular, coronary, diffuse, membranous, polymorphic, anterior and posterior (cup-shaped, rosette).

According to the absence or presence of complications and concomitant changes, cataracts are divided into: simple (except for opacities, there are no other changes), with complications (nystagmus, amblyopia, strabismus), with concomitant changes (congenital malformations of the eye, microphthalmos, aniridia, coloboma of the vascular tract, retina, optic nerve, etc., acquired by pathology of posterior and anterior synechiae, subluxation and dislocation of the lens, vitreous hernia).

According to the degree of visual impairment: the first degree of cataract visual acuity is 0,3 and above), the second is 0,20,05, the third is below 0,05.

Anterior and posterior polar cataracts (cataractae polaris anterior etposterior) are diagnosed by their location at the poles of the lens. Opacities are clearly visible in transmitted light and biomicroscopy. Anterior polar cataracts can also be detected on examination with lateral illumination. A polar cataract has the form of a dense white disc with a diameter of no more than 2 mm, quite clearly delimited from the surrounding transparent areas of the lens. When the eyeball moves, the anterior polar cataract is viewed in transmitted light moving in the direction of eye movement, while the posterior polar cataract moves in the opposite direction. These types of cataracts usually do not affect visual acuity and are not subject to surgical treatment.

Zonular (layered) cataract (cataracta zonularis) is the most common congenital pathology of the lens. In transmitted light, a zonular cataract is a gray, lighter in the center disk 56 mm in diameter with radiar processes ("riders") against the background of a pink reflex of the fundus.

In the light of a slit lamp, clouding is visible in the form of a disk located in the central sections and surrounded by a transparent substance of the lens. Along the edge of the disk, which consists of separate opacification zones, additional opacities in the form of protrusions are visible. The degree of vision loss depends on the intensity of the clouding.

Unlike other types of congenital opacities, zonular cataract can progress in the first years of a child's life.

Diffuse (complete) cataracts (cataracta diffusa) are visible even with side lighting. The pupil area is diffusely gray, vision is sharply reduced.

One of the varieties of congenital cataracts is membranous cataract (cataracta membranacea), which has a gray (white). Such cataracts also significantly reduce visual acuity and, like diffuse ones, are subject to removal.

Author: Shilnikov L.V.

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