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ARTICLE
Year : 1968  |  Volume : 16  |  Issue : 3  |  Page : 142-145

Combined central membranous and anterior suture cataract in a family


Minto Ophthalmic Hospital, Bangalore, India

Date of Web Publication24-Dec-2007

Correspondence Address:
K Sundaresan
Minto Ophthalmic Hospital, Bangalore
India
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Source of Support: None, Conflict of Interest: None


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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.

History:

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 Top


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.

Case 3

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 Top


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 Top


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.


    Figures

  [Figure - 1], [Figure - 2]



 

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