Autosomal dominant zonular cataract with sutural opacities localized to chromosome 17q11-12

Congenital cataracts constitute a morphologically and genetically heterogeneous group of diseases that are a major cause of childhood blindness. Different loci for hereditary congenital cataracts have been mapped to chromosomes 1, 2, 16, and 17q24. We report linkage of a gene causing a unique form of autosomal dominant zonular cataracts with Y-sutural opacities to chromosome 17q11-12 in a three-generation family exhibiting a maximum lod score of 3.9 at D17S805. Multipoint analysis gave a 1-lod confidence interval of 17 cM. This interval is bounded by the markers D17S799 and D17S798, a region that would encompass a number of candidate genes including that coding for beta A3/A1-crystallin.

Three mildly retarded siblings with congenital cataracts, sensorineural deafness, hypogonadism, hypertrichosis and short stature: a new syndrome?

We report three male siblings with mild mental retardation, congenital cataract, sensorineural deafness, hypogonadism, hypertrichosis and short stature. This combination has not been previously reported and we suggest this is a new syndrome. Although X-linked recessive inheritance cannot be fully excluded, we favour autosomal recessive inheritance because of parental consanguinity.

Modulation of amblyopia therapy following early surgery for unilateral congenital cataracts

BACKGROUND

Stimulus deprivation amblyopia is the principal cause of visual impairment in infants with unilateral congenital cataract. Even if lensectomy is undertaken at an early age, intensive postoperative occlusion of the phakic eye is essential for the development of useful vision in the aphakic eye. Despite this, the optimum method of regulating occlusion therapy is uncertain.

METHODS

Interocular acuity differences identified using clinical preferential looking techniques (Keeler cards) were used to regulate target levels of phakic eye occlusion in a prospective evaluation of 10 systemically, metabolically, and neurologically normal infants in whom dense unilateral cataract was diagnosed before 8 weeks of age, and operated upon by 10 weeks. Actual occlusion levels were recorded each day by parents in a diary. The development of preferential looking acuity in the phakic and aphakic eye were compared with prediction intervals derived from observations on 43 normal children.

RESULTS

Aphakic eye preferential looking acuities were within the normal range at last review in all but one infant. Interocular acuity differences were < or = 0.5 octave in all children older than 1 year of age at last review, and > or = 1 octave in three of four children less than 1 year old at last review (Fisher exact p = 0.033). Phakic eye acuities were within the normal range in all infants at all visits.

CONCLUSION

Within the first 2 years of life, normal preferential looking acuity may be achieved in both eyes of infants undergoing early surgery for unilateral congenital cataract if occlusion therapy is modulated according to interocular acuity differences quantified by clinical preferential looking techniques.

Development of grating acuity in children treated for unilateral or bilateral congenital cataract

PURPOSE

To study the development of grating acuity in children treated for dense congenital unilateral or bilateral cataract and to examine how variations in treatment affect grating acuity during early childhood.

METHODS

The authors used optokinetic nystagmus (OKN), preferential looking (PL), or both to measure the grating acuity of children treated for congenital cataract in one eye (n = 63) or both eyes (n = 77) whenever possible from the time of treatment until 3 years of age. At each age, the authors compared patients' monocular acuity to that of children with no history of eye disorders.

RESULTS

The OKN acuity of treated eyes did not improve with age and was abnormal by 12 months of age. In contrast, PL acuity improved with age, and acuity of most treated eyes was not outside normal limits until 24 to 30 months of age. Nonetheless, at 12 months and at 3 years of age, PL acuity correlated significantly with age at treatment in children who had bilateral cataract. In children who had unilateral cataract, PL acuity correlated significantly with the number of hours per day the good eye had been patched since treatment. Children whose good eye was patched fewer than 3 hours per day did significantly worse than children treated at a comparable age for bilateral congenital cataract. However, children whose good eye was patched at least 3 hours per day had PL acuities similar to those of children treated at a comparable age for bilateral congenital cataract.

CONCLUSIONS

Children treated for congenital cataract show deficits in grating acuity, with the deficit apparent earlier in OKN acuity than in PL acuity. At least by 1 year of age, visual development has begun to be influenced by the age at treatment and, in children treated for unilateral cataract, by patching of the good eye.

A linkage between hereditary hyperferritinaemia not related to iron overload and autosomal dominant congenital cataract

The only genetic disorder with elevated serum ferritin levels so far described is hereditary HLA-related haemochromatosis. On the other hand, hereditary cataract is both genotypically as well as phenotypically heterogenous, and no specific locus or any useful marker has been yet identified. We studied two Italian families in whom a combination of elevated serum ferritin not related to iron overload and congenital nuclear cataract is transmitted as an autosomal dominant trait. Affected individuals have normal serum iron and transferrin saturation, but high serum ferritin. Red cell counts are normal and venesection therapy rapidly produces iron-deficiency anaemia. This genetic disorder, which is characterized by hyperferritinaemia, differs from hereditary HLA-related haemochromatosis mostly for the absence of iron overload. A gene responsible for the congenital nuclear cataract likely maps on chromosome 19q close to the ferritin L-subunit gene. Within families with autosomal dominant congenital cataract, serum ferritin might be an early marker of disease.

Autosomal dominant typical coloboma associated with unilateral pseudoptosis, myopia and cataract

Ocular coloboma is considered to be hereditary ocular malformation which can manifest itself in various conditions ranging from iris defect to rudimentary cystic eye globe. We describe a three generation family affected by autosomal dominant typical coloboma, unilateral pseudoptosis, myopia and cataract. Correction of refractive errors improved their visual performance and prevented amblyopia. Genetic consultation was given in order to prevent blindness. We recommend a multidisciplinary approach regarding management of colobomatous patients.

[Sandwich intraocular lens implant: a concept for aphakia correction in children]

BACKGROUND

In the management of congenital cataracts the correction of aphakia is still an unsatisfactorily solved problem. As far as surgical techniques and materials are concerned, the implantation of an IOL seems to be justified even in younger children; but choosing the refractive power of the lens is somewhat difficult regarding the expected growth of the eye.

MATERIALS AND METHODS

A new type of IOL is presented as a solution for this problem. Being composed of a PMMA-fashioned optic and haptic it bears a silicone lens which is fastened on top of it. The supporting lens is made of PMMA (polymethylmethacrylate) with a biconvex surface with modified J-loops. The diameter of the optic is 6 mm, the overall diameter is 11 mm. The supplementary lens is made of the same silicone material as used for foldable intraocular lenses. Its diameter is 4.5 mm. This additional component can be removed from the implanted lens so that the needed reduction of refractive power after completed growth of the eye can be performed. The PMMA-fashioned basic component remains in situ just like a conventional posterior chamber lens. The lens was examined using scanning-electron microscopy. Im- and explantation was performed in isolated porcine eyes.

RESULTS

The high quality of the lens could be demonstrated using scanning-electron microscopy. The technical feasibility of this concept could be demonstrated on isolated porcine eyes.

DISCUSSION

Currently the sandwich lens is being tested in animal experiments. Our special interest is focussed on biocompatibility, formation of secondary cataract, biological reactions in the interface and the possibility of atraumatic explantation of the silicone lens.

Cloning of the galactokinase cDNA and identification of mutations in two families with cataracts

Galactokinase is an essential enzyme for the metabolism of galactose and its deficiency causes congenital cataracts during infancy and presenile cataracts in the adult population. We have cloned the human galactokinase cDNA, which maps to chromosome 17q24, and show that the isolated cDNA expresses galactokinase activity in bacteria and mammalian cells. We also describe two different mutations in this gene in unrelated families with galactokinase deficiency and cataracts. The availability of the cloned galactokinase gene provides an important reference to identify mutations in patients with galactokinase deficiency and cataracts.

[A case of hereditary motor and sensory neuropathy with congenital cataract and mental retardation]

A 6-year-old boy with hereditary motor and sensory neuropathy (HMSN), congenital cataract and mental retardation was reported. The condition commenced with distal weakness and wasting of lower limbs. Subsequently marked right pes cavus and equinovarus deformity appeared. Motor and sensory conduction velocities in the limbs were slowed. Pathological examination of biopsied sural nerve showed significant loss of large myelinated fibers. Neither demyelination nor onion bulbs were observed. For clinical and neuropathological findings, the present case did not fit in with previously reported cases of HMSN. The case was classified as a new variant of HMSN type II.

Atypical methylmalonic aciduria with progressive encephalopathy, microcephaly and cataract in two siblings--a new recessive syndrome?

Two siblings with atypical methylmalonic aciduria and progressive encephalopathy are reported. Initial symptoms were failure to thrive and growth retardation from the first year of life, progressing to severe mental retardation, microcephaly, dystonia, spasticity and cataracts. The amount of methylmalonic acid excreted in the urine was substantially lower than in classical methylmalonic acidemia and was not reduced by vitamin B12 therapy. The activity of methylmalonyl-CoA mutase and the overall assay of propionic acid metabolism in cultured fibroblasts were normal. The primary defect in this probably new autosomal recessive disorder associated with methylmalonic aciduria is currently not known.

Cataract surgery and intraocular lens implantation in children

PURPOSE

To evaluate visual outcome and complications after extracapsular cataract extraction with posterior chamber intraocular lens implantation in children.

METHODS

Extracapsular cataract extraction with posterior chamber intraocular lens implantation was performed on 20 eyes of 19 patients with traumatic cataract, ten eyes with unilateral congenital or developmental cataract, and 15 eyes (eight patients) with bilateral developmental cataract. Nd:YAG posterior capsulotomy was performed in the early postoperative period as indicated.

RESULTS

Fourteen (70%) of 20 eyes with traumatic cataract had best-corrected pseudophakic visual acuity of 20/40 or better. When we excluded four eyes with macular injuries from analysis, 14 (87%) of 16 eyes had visual acuity of 20/40 or better. In patients with bilateral cataract in whom vision was quantified by Snellen acuity (nine eyes of five patients), nine of nine eyes had best-corrected pseudophakic visual acuity of 20/40 or better. In the remaining three patients, six of six eyes had central steady and maintained fixation. Visual outcome was poorest in patients with unilateral cataract (ten eyes); one eye had best-corrected pseudophakic visual acuity of 20/40; two eyes, 20/60; two eyes, 20/70; one eye, 20/100; and two eyes, 20/200. One additional eye had central steady maintained fixation and noncentral fixation. Five of ten eyes had four or more lines improvement in visual acuity. Postoperative complications occurred in five eyes, each of which had traumatic cataract. Three eyes developed iris capture, one eye had a postoperative intraocular hemorrhage, and another developed a dense secondary membrane. In 45 postoperative postoperative eyes, 27 (60%) received one Nd:YAG laser posterior capsulotomy. A second Nd:YAG laser posterior capsulotomy was performed in 11 (41%) of these 27 eyes.

CONCLUSIONS

Extracapsular cataract extraction with posterior chamber intraocular lens implantation in children can be accomplished in selected patients, with generally favorable results. However, many of the patients in this series remain potentially amblyogenic, and long-term follow-up may temper our present visual results.

[Spectral filters as a method of therapeutic correction]

Spectral filters were used for additional correction of vision in 67 patients: in 15 adults with initial cataracts (intensive yellow filter), 26 children with albinism (yellow-brown filter), 14 children with macular hypoplasia (orange filter), and 12 children with aphakia after removal of congenital cataracts (yellow filter). Selection of the filter density is carried out using a special method including visocontrastometry, examination of sensitivity to lateral light, and study of color perception thresholds. Use of filters resulted in improvement of the vision acuity by 43.5% in patients with initial cataracts, by 10% in those with albinism, by 20% in those with macular hypoplasia, and by 22% in those with aphakia; moreover, an improvement of the frequency-contrast characteristics was observed, as well as a reduction of photophobia, and a reduction of vision amplitude in patients with nystagmus. The possible applications of spectral correction are discussed.

Assignment of congenital cataract Volkmann type (CCV) to chromosome 1p36

Congenital cataract, type Volkmann (McKusick no 115665, gene symbol CCV) is an autosomal dominant eye disease. The disease is characterized by a progressive, central and zonular cataract, with opacities both in the embryonic, fetal and juvenile nucleus and around the anterior and posterior Y-suture. We examined blood samples from 91 members of a Danish pedigree comprising 426 members, by using highly informative short tandem repeat polymorphisms and found the closest linkage of the disease gene (CCV) to a (CA)n dinucleotide repeat polymorphism at locus D1S243 (Zmax = 14.04 at theta M = 0.025 theta F = 0.000), at a penetrance of 0.90. Using two additional chromosome 1 markers, we were able to map the CCV gene in the sequence 1pter-(CCV, D1S243)-D1S468-D1S214. The (enolase 1) gene has been mapped to this area; however, a mutation described in this gene did not give eye disease.

[Rubella pigmentary pseudoretinopathy]

Two cases of rubeolic pigmentary retinopathy with multiples anomalies at congener eye are presented. Both two cases present at congener eye microphthalmos and congenital cataract with uveitis in the first case and convergent strabismus and retard psychomotor in the second case. The retinal lesions are disseminated in all retinal surface in one observation, and only in the temporal retinal area in the second one. These retinal lesions associated with other ocular anomalies are characteristic for rubeolic etiology.

Posterior chamber intraocular lenses: long-term results in pediatric cataract patients

Major problems in pediatric cataract patients include noncompliance with contact lenses resulting in amblyopia. Advances in intraocular cataract surgery have provided a better environment to perform intraocular lens (IOL) implantation in children. We prospectively analyzed the results of 34 consecutive pediatric patients who underwent cataract removal and insertion of an IOL. Operative technique performed was posterior scleral beveled or frown incision and IOL endocapsular fixation. Subgroups included 10 eyes with traumatic cataract, and 24 eyes with developmental cataracts. Six patients had bilateral IOLs. Data presented in each subgroup included initial and final visual acuity, age, sex, type of cataract, A and B scan biometry, early and late postoperative complications, time of YAG capsulotomy, postoperative refractive correction, and state of binocular vision. Preoperative visual acuity ranged from 20/70 to light perception. The success rate for postoperative visual acuity of 20/40 or better occurred in 29 of 34 eyes, or 85.3%. In the traumatic cataracts, 8 of 10 eyes (80%) obtained 20/40 vision or better. In developmental cataracts, 21 of 24 eyes (88%) achieved visual acuity of 20/40 or better. Amblyopia (three patients) or macular scar (two patients) accounted for reduced visual acuity in the five eyes with vision less than 20/40. Early complications included posterior synechiae and lens deposits. The primary late complication was opacification of the posterior capsule in 18 of 34 eyes. The average time for YAG capsulotomy post-cataract removal was 17 months. None of the 28 patients (34 eyes) developed glaucoma, IOL dislocation, or other significant postoperative problems related to IOL insertion.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired posterior lentiglobus

PURPOSE/METHODS

An infant examined by three ophthalmologists was found to have unilateral posterior lentiglobus, which subsequently developed bilaterally by 15 weeks of age.

RESULTS/CONCLUSIONS

The onset of posterior lentiglobus may be congenital or acquired. Infants with unilateral cataracts whose family history indicates early-onset lens opacities require careful and frequent examinations of the fellow eye.

Familial acanthosis nigricans with madarosis

We report familial acanthosis nigricans affecting a 35-year-old woman, her 7-year-old son and 5-year-old daughter. Absence of the eyebrows and eyelashes was noted in this family. The mother had no axillary hair and her pubic hair was sparse. The boy also suffered from congenital heart disease and a congenital cataract in the left eye. The combination of acanthosis nigricans and ectodermal defects in this family may represent a distinct nosological entity.

[Condition of the posterior capsule in pseudophakia in children]

PURPOSE

Evaluation of the posterior capsule transparency in children after congenital cataract surgery with posterior intraocular lens implantation.

MATERIAL AND METHODS

Examination comprised 41 eyes of 29 patients with posterior IOLS, aged 5-17 years (mean 10.3). In all cases, posterior capsule was unimpaired during surgery.

RESULTS

During follow-up, (mean 27 months), 36.6% the eyes showed posterior capsule opacity of various degree. Neodymium YAG laser capsulotomy was performed in 13 cases and instrumental capsulotomy in 2. Opacity of the posterior capsule caused a decrease of visual acuity below 0.4. It improved after capsulotomy in all cases. No serious complications were observed.

Glaucoma after congenital cataract surgery

OBJECTIVES

To study eyes that manifested glaucoma after congenital cataract surgery and to identify factors that might lead to better diagnosis and treatment of such glaucoma.

DESIGN

A retrospective review of patients treated for glaucoma that developed after congenital cataract surgery.

RESULTS

Sixty-four eyes of 38 patients were studied. Open-angle glaucoma was the more frequent type of glaucoma (51 eyes, 79.7%). Glaucoma was diagnosed a mean interval of 12.2 years after cataract surgery, but it could occur at any time from months to decades after the cataract surgery. Medications alone were successful in intraocular pressure control in 21 (63.6%) of 33 eyes, and additional surgical procedures resulted in successful intraocular pressure control in 11 of 14 eyes in which they were performed.

CONCLUSION

The authors cannot predict in which eyes glaucoma will develop after surgery for congenital cataracts. Once detected, the glaucoma can be treated successfully in the majority of cases. Careful follow-up, including examinations with the patient sedated or anesthetized as needed, is required.

[A new surgical technique in congenital cataracts for prevention of regenerated cataract. Controlled central excision of capsular leaves with endodiathermy coagulation of the capsular sac periphery]

Inherent in all operative methods of congenital cataract surgery with the aim of preserving the posterior leaf of the capsule is the risk of recurrence. Even after phakectomy of the pars plicata, secondary cataract can occur in the peripheral remains of the capsule, and this method also entails the risk of retinal detachment and loss of the capsule diaphragm, which would otherwise allow subsequent IOL implantation. We developed a new surgical technique to preserve the peripheral capsular sac and to avoid secondary cataract within the optical axis. Unipolar diathermy coagulation was applied to the anterior peripheral leaf of the capsule, provided that both leaves of the capsule were touching when slight pressure was applied to the probe. In preliminary studies of autopsy eyes, fusion of the capsular leaves was clearly apparent, even if the lens epithelium was not morphologically destroyed by diathermy coagulation. These were 42 eyes with congenital cataract (12 children with bilateral cataract, 9 eyes with mild anterior PHPV syndrome). Their ages were between 4 weeks and 8.5 years and the period from April 1988 to December 1992; follow-up was 1 to 4.5 years: 36 eyes, 6 eyes with PHPV. The following operation was undertaken in the children. After central anterior capsulectomy and aspiration of the lens, the anterior and posterior leaves of the capsular sac were fused circularly at the periphery by unipolar endodiathermy coagulation. The posterior chamber was deepened by viscoelastic substance allowing diathermy application at the anterior capsule with risk.(ABSTRACT TRUNCATED AT 250 WORDS)

Cloudy lenses and issues: a pedigree of unoperated congenital cataracts

1. Although there are many strong recommendations regarding congenital cataracts in the literature, little has been written about the initial decision of whether to operate. 2. Because this condition does not often occur and a large number of patients is necessary to determine the predictive value, a large, collaborative study is required to make significant headway in this area. 3. If we can identify the factors that have strong predictive value for good vision after cataract surgery, we may start to define the profile of children who will have good vision, with or without surgery.

Lens sorbitol dehydrogenase deficiency in a patient with congenital cataract

Lens sorbitol dehydrogenase activity was assayed in patients with congenital cataracts, senile cataracts, without cataracts and in one fetal lens. In patients with congenital cataracts we did not observe any abnormality of galactose and sorbitol metabolising enzymes in erythrocytes. In one of these patients with inexplicable congenital cataracts lens sorbitol dehydrogenase deficiency was found.

CONCLUSION

Determination of galactose metabolising enzymes, sorbitol dehydrogenase and polyols in lenses may help in understanding the mechanism of formation of inexplicable congenital cataracts.