|Year : 1968 | Volume
| Issue : 3 | Page : 142-145
Combined central membranous and anterior suture cataract in a family
K Sundaresan, GS Madhavarao
Minto Ophthalmic Hospital, Bangalore, India
|Date of Web Publication||24-Dec-2007|
Minto Ophthalmic Hospital, Bangalore
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sundaresan K, Madhavarao G S. Combined central membranous and anterior suture cataract in a family. Indian J Ophthalmol 1968;16:142-5
|How to cite this URL:|
Sundaresan K, Madhavarao G S. Combined central membranous and anterior suture cataract in a family. Indian J Ophthalmol [serial online] 1968 [cited 2020 Jul 5];16:142-5. Available from: http://www.ijo.in/text.asp?1968/16/3/142/37538
Three children aged 20, 14 and 12 respectively were referred to our hospital with defective vision in September 1965. On examination it was seen that there was evidence of central and anterior Y-suture cataract in all of them in the right eye [Figure - 1]. The left eye which had been operated upon elsewhere about a year ago, showed lumps, tags and flaps of capsular and/or cortical matter in the pupillary region. Most probably they had similar central and suture cataracts in the left eye also.
On enquiring it was learnt that the grand-father of the children had visual defect. He had five issues of whom two males and a female had "visual defects". The present three children were born to the eldest male member of the second generation. It is not known whether they underwent any treatment. It was not possible to elicit whether such visual defects occurred further backwards in the family tree nor could the cause of dimness of vision in the grandfather and father of these children be elicited. Assuming that all the above were similar cataracts, which is most likely, three successive generations have shown cataracts, in both male and female issues. Furthermore, whilst in the second generation three out of five had the defects, in the third generation all the children presented practically identical lental opacities.
| Case reports|| |
Case 1 and Case 2:
Miss L. and Miss V. Development, hearing and speech were normal. They were rather apathetic and had photophobia [Figure - 1]. The left eyes, operated elsewhere showed secondary after-cataracts. The fundus could not be seen. Slit-lamp showed a thin after-cataract. The right eyes, under atropine, showed a peripheral clear area, a central membranous cataract and anterior linear Y-suture cataract overlying the lamella [Figure - 2]a. The Y-suture was thin and regular with pencil point outlines and at the apices had button-shaped opacities : the whole of it producing a pretty picture. The visual acuity was handmovements only with good perception and projection of light. It was decided not to operate on the right eyes but needling was done on the after-cataracts in the left eyes. At the time of discharge all the three had 6/36 vision with suitable glasses. After wearing glasses, with vision enabling them to see and move about freely, all the three children became livelier and went home quite happy.
S: The eldest son, 20 years of age is fairly intelligent, speaks and hears normally. In the operated eye (L.E.) he counts finger from ½ foot. In the unoperated right eye there is perception and projection of light and sees hand movements, but he cannot count fingers even at 6 inches.
Under atropine mydriasis it was noticed that there was a translucent central membranous cataract with a superimposed Y-suture cataract. The peripheral part of the lens was clear without any riders from the membranous opacity. The Y-suture was thick and white, with conglomerated coalescing rounded and knobby masses all along the Y. The anterior-Y was affected exclusively [Figure - 2]b. The central membranous opacity was responsible for the decrease in visual acuity. Another curious finding was that at the apices of the Y there were beautifully defined round opacities, which looked as if buttons were sewn to the ends of the linear opacities.
Case 3 was the only one that was operated upon for the congenital cataract in the right eye. A linear extraction was done. The Y-sutural knobs and flaps came out in masses. The central lamella to which it appeared that the Y-suture was adherent, was removed with an iris forceps with difficulty. The next day the cortical matter had become opaque due to imbibition of water.
All of them had been asked to come in 1966 to reassess the conditions and further treatment, but have not vet reported.
| Discussion|| |
As the lamella with the attached Y-Suture came out in a mass, it was surmised that these are instances of central membranous cataracts rather than the typical lamellar cataracts. MANN describes central cataract as "not allied to lamellar cataract, but probably merely a dense lamella, involving the central fibres exclusively." Suture cataract has been described by her as a deposition of some abnormal substance along the Y-sutures of the foetal nucleus. It is possible that a minute amount of some cement substance is normally present between the lens fibres in the sutures and that in suture cataract this substance is in excess and is abnormal in consistency, refractive index, and chemical composition. The condition occurs by about the third month of intra uterine life. It is also said to be mostly familial and hereditary.
In the present series the points to be noted are:
1. This peculiar type of cataract has been traced to three generations -the grand-father most probably had the same type of cataract; 3 of his five children two males and one female had cataracts. In the third generation all the children of the eldest member (male) are having it. It was not possible to get for examination the other members of the family nor to get any history related to this form of cataract. It is thus suspected that the present series is of hereditary and familial character.
2. In the eldest (male), the suture cataract was characterised by a thick white suture, with flakey and knobby projections along the suture, but otherwise the lamella and button shaped opacities were of the usual appearance. In the other two cases (girls) the anterior suture had thin pencil point outlines producing a pretty picture; with the lamella posterior and the sewed on buttons in the plane of the suture. [Figure - 2]a,b.
3. The central membranous cataract associated with Y-suture cataract surmounted by a button-shaped opacity at the apices has not been described in literature. The membranous part was grey in colour and was a thickish membrane and not annular with central clear lens matter as described in lamellar-cataracts. That it was a thick flat structure was trade out on the operation table in case 1, when it was pulled out with forceps. The fact that on examination the Y-suture base was attached to the lamella made us infer that all these episodes occured during the 3rd month of intra uterine life. It will be interesting to find out why and how they formed, although one is aware that stationary cataracts are protean in manifestations and there is no particular reason why such regular opacities should not form.
4. In all the three the anterior-Y was affected exclusively which is a common enough condition in such cataracts.
5. In suture cataracts, if simple, the vision is not affected to any considerable extent as the sutural opacities do not obstruct rays of light. But in our series, the presence of the central semi-opaque membrane caused considerable visual incapacity. The operator elsewhere had taken decision and operated on the left eyes of all the three, which one can concede was justifiable. But the trouble arose as there was no proper follow up. As described already the girls had to have needling of an after cataract and later had more or less comfortable vision of 6/36 with suitable glasses. Next time they come, the cases will be reassessed and if found necessary the cataracts in right eyes will be operated and glasses given.
| Summary|| |
Three cases of congenital familial hereditary central cum suture cataracts are described, all the three are of the third generation, the persons of the prior two generations may have had similar cataracts.
The cataract consisted of a central compact membranous mass and an opacity in anterior Y-suture, the ends of which were mounted with button-like opacities.
Only partial though satisfactory improvement could be obtained by linear extraction.
[Figure - 1], [Figure - 2]