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Year : 2022  |  Volume : 60  |  Issue : 4  |  Page : 325-327

Rare coevality of bilateral mixed morphology of developmental blue dot cataract with lamellar cataract


1 Department of Cataract and Refractive Surgery, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India
2 Department of Optometry and Visual Science, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India
3 Department of Glaucoma and Research, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India
4 Department of Paediatric Ophthalmology and Strabismus, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India

Date of Submission28-Dec-2021
Date of Decision23-Mar-2022
Date of Acceptance13-Oct-2022
Date of Web Publication19-Dec-2022

Correspondence Address:
Prasanna Venkatesh Ramesh
Mahathma Eye Hospital Private Limited, No. 6, Seshapuram, Tennur, Trichy – 620 017, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjosr.tjosr_186_21

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  Abstract 


The development of a lens in intrauterine life reacts to any insults by losing its clarity and developing opacity, which manifests as congenital or developmental cataract. Developmental mixed morphology cataracts are seen when there is occurrence of multiple forms of cataracts in a single crystalline lens. Although the prevalence of mixed morphology cataract is 23%, this combination of blue dot cataract with lamellar cataract has never been reported in the literature before, as per our knowledge. The blue dot and lamellar cataracts develop in childhood and progress throughout life. Cataract extraction is rarely necessary before adulthood and is mainly managed with periodic cataract progression assessment. In this manuscript, we have studied the morphology of this mixed morphology cataract with anterior segment imaging tools to throw more light on their optical properties and densitometry.

Keywords: AS-OCT, Blue dot cataract, Lamellar cataract, Mixed morphology cataract, Scheimpflug imaging system


How to cite this article:
Ramesh SV, Ray P, Ebenezar A, Ramesh PV, Ramesh MK, Rajasekaran R. Rare coevality of bilateral mixed morphology of developmental blue dot cataract with lamellar cataract. TNOA J Ophthalmic Sci Res 2022;60:325-7

How to cite this URL:
Ramesh SV, Ray P, Ebenezar A, Ramesh PV, Ramesh MK, Rajasekaran R. Rare coevality of bilateral mixed morphology of developmental blue dot cataract with lamellar cataract. TNOA J Ophthalmic Sci Res [serial online] 2022 [cited 2023 Feb 8];60:325-7. Available from: https://www.tnoajosr.com/text.asp?2022/60/4/329/364236



A 26-year-old male came for a regular eye check-up. On examination, the best corrected visual acuity was 20/20 in the right eye (OD) and 20/30 in the left eye (OS). A slit lamp biomicroscopic examination revealed a bilateral mixed morphology of developmental cataracts, comprising of lamellar and blue dot components [Figure 1]. Scheimpflug lens densitometry [Figure 2] and anterior segment optical coherence tomography (AS-OCT) [Figure 3] revealed a hyperreflective zone that illustrates the lamellar component and multiple hyperreflective spots in various layers of the lens illustrating the blue dot component, respectively. As per our knowledge, a bilateral mixed morphology of lamellar and blue dot cataracts have not been reported in the literature before. In this manuscript, we have objectively assessed and quantified the transparent and opacified component of the bilateral mixed morphology of blue dot and lamellar cataract, respectively. Conservative management with annual review for assessing cataract progression was advised, as there was no visual disturbance currently.
Figure 1: (a and b) Slit lamp photograph showing bilateral mixed morphology of developmental lamellar cataract and blue dot cataract in diffuse illumination of OD and OS, respectively and (c and d) retro illumination of OD and OS, respectively. (e and f) Slit lamp photograph showing lamellar cataract (red arrows) and blue dot cataract (yellow arrows) in slit illumination of OD and OS, respectively

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Figure 2: (a) Scheimpflug imaging system showing hyperreflecting zone (red arrows) of lamellar cataract and multiple hyperreflective spots (green arrows) of blue dot cataract OD in default colour. (b) Scheimpflug image of the same in inverse colour contrast. (c) Scheimpflug imaging system showing hyperreflecting zone (red arrows) of lamellar cataract and multiple hyperreflective spots (green arrows) of blue dot cataract OS in default colour. (d) Scheimpflug imaging of the same in inverse colour contrast

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Figure 3: (a and b) Anterior segment optical coherence tomography (AS-OCT) showing hyperreflecting zone (red arrows) depicting the lamellar cataract and multiple hyperreflective spots (yellow arrows) at different layers depicting the blue dot cataract in OD and OS, respectively

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Blue dot cataracts are a variant of developmental cataracts associated with genetic mutation of the human crystalline gene and lamellar cataracts involve the lamellae surrounding the fetal nucleus, peripheral to the Y suture, which is progressive in nature.[1],[2],[3] A better understanding of the morphology and optical densitometry of these rarer bilateral mixed progressive congenital cataracts by using anterior segment imaging technologies, with timely diagnosis and periodic follow-up can yield better visual outcomes. Also, whenever there is a need for cataract surgery in these eyes, better customized phacoemulsification settings can be planned rather than intraoperative adjustments to yield lower phacoemulsification time, lower needle time, and smooth flow of surgery.[4],[5]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Khokhar SK, Pillay G, Dhull C, Agarwal E, Mahabir M, Aggarwal P. Pediatric cataract. Indian J Ophthalmol 2017;65:1340-9.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Gurnani B, Kaur K, Gireesh P. Rare coexistence of bilateral congenital sutural and cortical blue dot cataracts. J Pediatr Ophthalmol Strabismus 2020;57:68.  Back to cited text no. 2
    
3.
Khokhar S, Agarwal T, Kumar G, Kushmesh R, Tejwani LK. Lenticular abnormalities in children. J Pediatr Ophthalmol Strabismus 2012;49:32-7.  Back to cited text no. 3
    
4.
Ramesh PV, Ramesh SV, Rajasekaran R, Ramesh MK. Clinical application of Scheimpflug imaging in congenital lamellar cataract-An objective preoperative densitometry museum. Indian J Ophthalmol Case Rep 2021;1:167.  Back to cited text no. 4
    
5.
Ramesh PV, Ramesh SV, Rajasekaran R, Ramesh MK. Lights, camera, action: Sparkling and twinkling X-mass tree cataract through the eyes of a Scheimpflug imaging and anterior segment optical coherence tomography. Indian J Ophthalmol Case Rep 2021;1:399-400.  Back to cited text no. 5
  [Full text]  


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  [Figure 1], [Figure 2], [Figure 3]



 

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