Delhi Journal of Ophthalmology

A minute for anterior polar cataract

Prateek Jain, Anshuman Pattnaik
Department of Ophthalmology, Global Hospital Institute of Ophthalmology, Abu Road, Sirohi, Rajasthan, India

Corresponding Author:

Prateek Jain (MS, DNB)
Consultant, Global Hospital Institute of Ophthalmology, Abu Road, Sirohi, Rajasthan, India.
Email: docprateekjain@gmail.com

Received: 25-NOV-2020

Accepted: 21-DEC-2020

Published Online: 12-MAR-2021

DOI:http://dx.doi.org/10.7869/djo 644

Abstract
Anterior polar cataracts(APC) are congenital lenticular opacities involving the anterior layers of Lens, often appearing as white dots in the anterior lens capsule. They are non-progressive, however require regular follow-up to prevent long term visual complications, especially in childhood . This photoessay consists of a 27 year old male presenting with APC to a tertiary eye care institute in Southern Rajasthan.

Keywords :Anterior Polar Cataract, Congenital Cataract, Central Lenticular Opacity

Anterior polar cataracts(APC) are congenital opacities involving the anterior capsule and subcapsular cortex. They consist of hyperplastic lens epithelium in a collagenous matrix.1 They are usually less than 3 mm in diameter, appearing as small white dots in the centre of the anterior lens capsule. They are congenital, and can be bilateral or unilateral. Inheritance pattern is usually sporadic, however autosomal dominant pattern has also been found.2 Eight different loci have been mapped for the AD type of cataract on chromosome 16 and 17 along with overexpression of gamma crystallin pseudogene.3,4

APC can be an isolated disorder but also have been found associated with other ocular abnormalities, including microphthalmos, persistent pupillary membrane, and anterior lenticonus. Even though they are non-progressive and not visually significant, anisometropia is a common occurrence. It is important to differentiate anterior polar cataract from anterior pyramidal cataract as the latter is usually larger, elevated, conical opacities which project into anterior chamber from the anterior capsule of lens, and are more likely to progress to visual significance.5

We present photograph of a 27 year old man presenting with complains of blurring of vision, who on slit lamp examination was found to have anterior polar cataract in the right eye (Figure 1,2,3). The cataract was visually insignificant for him. His UCVA in was 6/9 and was prescribed glasses for simple myopic astigmatism. His left eye revealed visually insignificant focal pulverulent lenticular opacities in pupillary area. (Figure 4) No other ocular abnormalities were found in either of his eyes. There was no positive family history either.


 Figure 1: Right eye slit lamp photograph at 10x magnification showing central lenticular opacity on anterior capsule.


Figure 2: Right eye slit lamp photograph at 25x magnification showing two concentric rings around a central flat plaque.


Figure 3: Right eye slit lamp photograph at 10x magnification showing dilated pupil with absolutely clear lens around the anterior polar cataract.


 Figure 4: Left eye slit lamp photograph at 10x magnification showing focal pulverulent lenticular opacities in pupillary area.

Even though anterior polar cataracts usually do not require treatment one study found that over one-third of the patients have strabismus, refractive anisometropia, or some form of amblyopia.6 Hence, rigorous follow-up of such patients is necessary to avoid vision threatening complications.

References
  1. Wheeler DT, Mullaney PB, Awad A, Zwaan J. Pyramidal anterior polar cataracts. Ophthalmology. 1999 Dec;106(12):2362-7
  2. Jick SL, Beardsley TL et al.Congenital Cataract.Basic Clincal and Science Course, 2019-2020;11(4):54
  3. Ionides A, Berry V, Mackay D, Shiels A, Bhattacharya S, Moore A. Anterior polar cataract: clinical spectrum and genetic linkage in a single family. Eye (Lond). 1998;12 ( Pt 2):224-6.
  4. Brackenhoff RH, Henskens HAM, van Rossum MWPC, Lubsen NH, Schoenmakers JGG. Activation of the –y crystallin pseudogene in the human hereditary Coppock-like cataract. Hum Mol Genet 1994;3:279-83.
  5. Wilson ME.Pediatric Cataracts: Overview.[Internet] American Academy of Ophthalmology-ONE Network.2015.Available from: https://www.aao.org/disease-review/pediatric-cataracts-overview
  6. 6. Jaafar MS, Robb RM. Congenital anterior polar cataract: a review of 63 cases. Ophthalmology. 1984 Mar;91(3):249-54.

Search PubMed for

CITE THIS ARTICLE

Jain P, Pattnaik AA minute for anterior polar cataract.DJO 2021;31:108-109

CITE THIS URL

Jain P, Pattnaik AA minute for anterior polar cataract.DJO [serial online] 2021[cited 2021 Jul 28];31:108-109. Available from: https://www.djo.org.in/articles/31/3/A-minute-for-anterior-polar-cataract.html