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PHOTO ESSAY
Year : 2021  |  Volume : 1  |  Issue : 3  |  Page : 397-398

Developmental cataract with partial aniridia or optical iridectomy? – A diagnostic dilemma


Department of IOL and Cataract Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India

Date of Submission21-Sep-2020
Date of Acceptance02-Feb-2021
Date of Web Publication02-Jul-2021

Correspondence Address:
Dr. Madhu Shekhar
Head of Department, Cataract and IOL Services , Aravind Eye Hospital, Madurai - 625020, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_3025_20

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  Abstract 


Keywords: Amblyopia, aniridia, developmental cataract, optical iridectomy


How to cite this article:
Shekhar M, Gusain P, Prasad R S, Sankarananthan R, Nagu K. Developmental cataract with partial aniridia or optical iridectomy? – A diagnostic dilemma. Indian J Ophthalmol Case Rep 2021;1:397-8

How to cite this URL:
Shekhar M, Gusain P, Prasad R S, Sankarananthan R, Nagu K. Developmental cataract with partial aniridia or optical iridectomy? – A diagnostic dilemma. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Jul 28];1:397-8. Available from: https://www.ijoreports.in/text.asp?2021/1/3/397/320099



A 53-year-old man presented with defective vision in both eyes for 2 years duration. The patient denied any history of trauma but gave history of intraocular surgery in both eyes during childhood details of which were not known. No significant family history was observed. Corrected distance visual acuity (CDVA) in right eye (RE) was 20/60 and left eye (LE) was 20/200.

On examination, both eyes revealed dense central lamellar cataract with riders, in addition to senile nuclear sclerosis in LE. Iris tissue was absent from 1 to 5 O'clock in RE and 5–8 O'clock in LE [Figure 1]a and [Figure 1]b. Fundus examination was unremarkable. Extra-ocular movements were normal in both eyes with no nystagmus. Intraocular pressure was normal. Gonioscopy showed open angle in both eyes with no trabeculo-iridodysgenesis while ultrasound B-scan and ultrasound biomicroscopy did not reveal any abnormality. The patient successfully underwent phacoemulsification with acrylic IOL implantation in LE with postoperative CDVA of 20/30.
Figure 1: (a) Slit-lamp photograph of right eye showing lamellar cataract with loss of iris tissue from 1-5 O'clock. (b) Slit-lamp photograph of left eye showing lamellar cataract with loss of iris tissue from 5-8 O'clock

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  Discussion Top


Congenital/developmental cataract is a leading cause of childhood blindness, the prevalence of which was reported as high as 1.7 to 14.7 per 10,000 children in Asia.[1] Therefore, adequate knowledge of clinical features is essential for early diagnosis and proper treatment to prevent irreversible visual impairment.

Lamellar cataract is the commonest developmental cataract presenting with visual impairment. It consists of concentric zones (lamellae) of opacities surrounding a core with clear cortex externally. It may be associated with linear spoke like opacities called riders. These cataracts are invariably bilateral and slowly progressive, leading to varying degrees of stimulus deprivation amblyopia. The current modality of treatment is early pediatric cataract surgery.[2]

Our patient presented with defective vision in LE for only 2 years duration which suggested that senile nuclear sclerosis would have set in addition to lamellar cataract. Initial clinical examination could not conclude whether the iris tissue loss was due to partial aniridia or iatrogenic. However further examinations and investigations failed to disclose any iris anomalies. Partial aniridia is usually characterized by presence of rudimentary iris tissue.[3] It can be associated with developmental cataract.[4] But History of intraocular surgery and morphology of iris tissue loss prompted us to label it as optical iridectomy. Post-operative CDVA was 20/30 which implies that the therapeutic optical iridectomy was helpful in preventing visual stimulus deprivation amblyopia. Enough evidence is available in literature pointing towards role of visual stimulus deprivation in development of amblyopia in such patients.[1],[2] Hence adequate measurements should be taken in pediatric age group to prevent visual stimulus deprivation amblyopia.

In the present scenario, treatment of choice for developmental cataract is early cataract surgery. However in resource poor settings, therapeutic optical iridectomy is still being practiced to keep stimulus deprivation amblyopia at bay.

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.
Zhu X, Du Y, He W, Sun T, Chang R. Clinical features of congenital and developmental cataract in East China: A five year retrospective review. Sci Rep 2017;7:4254.  Back to cited text no. 1
    
2.
Foster A, Khanna RC, Krishnaiah S, Mehta MK, Gogate PM. Visual outcomes of bilateral congenital and developmental cataracts in young children in South India and causes of poor outcome. Indian J Ophthalomology 2013;61:65-70.  Back to cited text no. 2
    
3.
Wang JD, Zhang JS, Xiong Y, Li J, Li XX, Liu X, et al. Congenital aniridia with cataract: Case series. BMC Ophthalmol 2017;17:115.  Back to cited text no. 3
    
4.
Lee H, Meyers K, Lanigan B, O'Keefe M. Complications and visual prognosis in children with aniridia. J Pediatr Ophthalmol Strabismus 2010;47:205-12.  Back to cited text no. 4
    


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