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Posterior Subcapsular Cataract

Psc Posterior Subcapsular Cataract

Posterior subcapsular cataract is a relatively common type of cataract which develops in the posterior capsule of the lens and causes visual impairment, especially while reading. It is reported to happen rapidly in individuals on steroids, or amongst patients with diabetes, high-grade myopia or retinitis pigmentosa. It can occur alone or may be associated with other lens opacities. An ophthalmic examination and slit-lamp evaluation are required to diagnose its presence.


Presentation

Posterior subcapsular cataract (PSC) is a type of lenticular opacity. It can occasionally be associated with other lens opacities like a nuclear or cortical cataract. The incidence of isolated PSC is low and has been reported to be 1-2% in patients between the fifth and eighth decades of life [1] while it is 7% in the pediatric population [2]. Although PSC can be idiopathic, it reported to be associated with several medical conditions [3] such as myopia [4], diabetes [5], dermatological diseases [6], long-term steroid use [7] [8] [9], retinitis pigmentosa [10], ocular injury [11], smoking [12] and vitamin D deficiency [13]. It starts as a small opacity on the posterior aspect of the lens and in the path of light.

A majority of the PSC in pediatric patients are unilateral but can be bilateral in adults [2]. Patients present with difficulty in reading, halos or a glare around lights at night and clouding of vision in the presence of illumination which improves in presence of low light. However, visual acuity is maintained until a nuclear cataract develops. Based on the signs and symptoms, PSC is classified as:

  • imminent dehiscence of the posterior capsule
  • existing dehiscence of the posterior capsule
  • spontaneous lens dislocation

PSCs can be of two types: progressive or stationary [14]. Progressive PSC is associated with radiating opacities in the posterior cortex with symptoms worsening gradually as the extensions expand peripherally. The stationary variant is a central opacity surrounded by concentric rings and resembles a bull's eye. It is located in the posterior capsule and is associated with good visual acuity.

Receding Chin
  • His disease was further characterized by physical underdevelopment and distinct features of hypertelorism, a wide-based nose, long philtrum, relatively large mouth with thick lower lip, enlarged forehead, small, receding chin, short neck, and rounded[ncbi.nlm.nih.gov]
Arcus Senilis
  • Slitlamp biomicroscopy showed symmetric arcus senilis-like deposits, a polygonal appearance resembling crocodile shagreen, an unusual endothelial appearance, and posterior subcapsular cataract.[ncbi.nlm.nih.gov]
Blepharoptosis
  • CONCLUSION: Posterior subcapsular cataract may be associated with Degos disease in addition to previously reported findings, including visual field defects, third cranial nerve palsies, blepharoptosis, and optic atrophy.[ncbi.nlm.nih.gov]
Alopecia
  • Abstract Monilethrix is a rare developmental hair shaft defect characterized by small elliptical node-like deformities with increased hair fragility resulting in partial or diffuse alopecia.[ncbi.nlm.nih.gov]
Short Neck
  • His disease was further characterized by physical underdevelopment and distinct features of hypertelorism, a wide-based nose, long philtrum, relatively large mouth with thick lower lip, enlarged forehead, small, receding chin, short neck, and rounded[ncbi.nlm.nih.gov]
Hypertelorism
  • His disease was further characterized by physical underdevelopment and distinct features of hypertelorism, a wide-based nose, long philtrum, relatively large mouth with thick lower lip, enlarged forehead, small, receding chin, short neck, and rounded[ncbi.nlm.nih.gov]

Workup

The workup in PSC consists of a thorough history, specifically for pre-existing medical comorbidities and a detailed ophthalmological examination. Visual acuity testing is followed by a slit-lamp exam to evaluate the opacity and exclude anterior vitreous involvement or adherence of the anterior capsule. Slit-lamp images and retro-illumination are used according to the 'Lens Opacities Classification System (LOCS)' to grade cataracts while A-scan ultrasound, keratometry, and intra-ocular pressures are routinely calculated prior to cataract surgery.

A complete blood count, a plain X-ray chest and other tests depending upon associated comorbidities are also required prior to surgery. An electrocardiogram may be indicated to rule out cardiac diseases.

An anterior segment optical coherence tomography (OCT) performed preoperatively helps to grade cataracts, identify patients with PSC who are at risk of posterior capsular rupture; to plan the surgery and counsel the patients [15] [16].

Hypertriglyceridemia
  • These results suggest that the association of hypertriglyceridemia, hyperglycemia and obesity favors the formation of a specific morphologic type of lens opacity, posterior subcapsular cataract, occurring at an early age.[ncbi.nlm.nih.gov]

Treatment

  • There were 57 phakic eyes in the treatment group and 54 phakic eyes in the control group. One eye per patient was studied. INTERVENTION: Four milligrams of intravitreal triamcinolone or 1 ml subconjunctival saline.[ncbi.nlm.nih.gov]
  • Treatmente of pemphigus with corticosteroids: results obteined in 46 patients over a period of 11 years. Arch Dermatol. 1963; 87:52-66. [ Links ] 2. Haim S, Shafrir A. Remarks on the treatment of pemphigus vulgaris.[scielo.br]
  • Treatment Treatment Options: Surgical cataract removal may be indicated. Amblyopia is a risk and requires rehabilitation.[disorders.eyes.arizona.edu]
  • The material is in no way intended to replace professional medical care by a qualified specialist and should not be used as a basis for diagnosis or treatment.[orpha.net]

Prognosis

  • If recognized and treated early, the visual prognosis is excellent and full recovery may be possible. However, if left untreated, ocular syphilis can progress to glaucoma, optic atrophy, and retinal necrosis.[webeye.ophth.uiowa.edu]
  • These particular cataracts are often more difficult to treat and have a worse prognosis because of the other associated eye abnormalities. A traumatic cataract results from either a blunt or penetrating force that damages the lens.[aapos.org]
  • Noting the integrity of the posterior capsule could help explain the prognosis to the patient.[eyeworld.org]
  • The first steps are to assess the patient’s Lotmar potential visual acuity and to discuss in detail with her and her family the questionable cataract surgical prognosis based on her history of retinal disease and the probability of a tear in the posterior[crstoday.com]
  • What is the prognosis of cataracts? The rate of progression of cataracts is usually predictable and surgery is successful in restoring vision in a large majority of cases.[medicinenet.com]

Etiology

  • CONCLUSIONS: Most PSCs were of unknown etiology; a significant number of eyes had more than 1 etiology. Vacuolar PSC was the most common type, with more eyes in this group having significantly reduced visual acuity and contrast sensitivity.[ncbi.nlm.nih.gov]
  • Etiology: The lens is composed largely of crystallins which aggregate in cataract formation.[images.missionforvisionusa.org]
  • Faical Akaichi 2 1 The Eye Center, Fayetteville, AR, USA; 2 Scotland’s Rural College, Edinburgh, UK Purpose: To evaluate risk factors associated with posterior subcapsular cataract (PSC) development and the relationship between vitamin D deficiency and etiology[dovepress.com]
  • The Framingham Eye Study did not specifically address the incidence of posterior polar cataracts as a separate group. [7] Other studies focused on incidence and etiology and nutrition. [8, 9] Etiology A posterior subcapsular cataract is a distinctive,[emedicine.medscape.com]

Epidemiology

  • METHODS: The Melton Eye Study is an English community-based epidemiological study of the natural history of eye disease in people aged 55 to 74 years.[ncbi.nlm.nih.gov]
  • BMJ. 2006;333(7559):128-32 Links: management of cataracts clinical features epidemiology complications of cataract cataract senile cataract[gpnotebook.co.uk]
  • Risk factor analysis in a cataract epidemiological survey in West Sumatra, Indonesia. Dev. Ophthalmol. 1991;21:78–86. PubMed Google Scholar 12. Harding JJ, Egerton M, Van Heyningen R, Harding RS.[link.springer.com]
  • "Future studies on the pathogenesis and epidemiology of cataracts must distinguish between the three types of lens opacities, as they clearly show different patterns." By Ingrid Grasmo[medwirenews.com]
Sex distribution
Age distribution

Pathophysiology

  • DISCUSSION Pathophysiology: Posterior polar cataract is a congenital condition that can be sporadic or familial.[eyerounds.org]
  • Pathophysiology A posterior polar cataract has an autosomal dominant inheritance pattern.[emedicine.medscape.com]

Prevention

  • They imply the possibility of effective modes of preventive therapy for a subgroup of patients with 'senile' cataract.[ncbi.nlm.nih.gov]
  • Writing in the journal Acta Ophthalmologica , the researchers conclude: "Whether prevention and improved control of diabetes would reduce the burden of cataract remains to be demonstrated.[medwirenews.com]
  • Enhancing p53 activity in the lens during therapies that are known to increase the risk of PSCs might therefore be a useful preventative strategy. Page 484 Written by editorial staff. 2011. Published by The Company of Biologists Ltd.[dmm.biologists.org]
  • Several factors may prevent the formation of cataracts.[pdfs.journals.lww.com]
  • Tipperman Yearbook of Ophthalmology. 2007; 2007: 14 5 Posterior capsule opacification in Pseudophakie eyes - Etiopathogenesis, clinical picture, possibilities of prevention and therapy [Zmȩtnienie torebki tylnej soczewki w oczach pseudofakijnych - Etiopatogeneza[ijo.in]

References

Article

  1. Sperduto BD, Hiller R. The prevalence of nuclear, cortical, and posterior subcapsular lens opacities in a general population sample. Ophthalmology 1984;91:815-8.
  2. Mistr SK, Trivedi RH, Wilson ME. Preoperative considerations and outcomes of primary intraocular lens implantation in children with posterior polar and posterior lentiglobus cataract. J AAPOS. 2008;12:58–61.
  3. Eshagian J. Human posterior subcapsular cataracts. Trans Ophthalmol Soc UK 1982;102:364-8.
  4. Brown NA, Hill AR. Cataract: the relation between myopia and cataract morphology. Br J Ophthalmol. 1987;71(6):405-414.
  5. Bron AJ, Sparrow J, Brown NA, et al. The lens in diabetes. Eye (Lond) 1993;7(2):260–275.
  6. Sasaki K, Kojima M, Nakaizumi H, et al. Early lens changes seen in patients with atopic dermatitis applying image analysis processing of Scheimpflug and specular microscopic images. Ophthalmologica. 1998;212(2):88–94.
  7. Jick SS, Vasilakis-Scaramozza C, Maier WC. The risk of cataract among users of inhaled steroids. Epidemiology. 2001;12(2):229–234.
  8. Praveen MR, Shah GD, Vasavada AR, et al. Posterior capsule opacification in eyes with steroid-induced cataracts: comparison of early results. J Cataract Refract Surg. 2011;37(1):88–96.
  9. Urban RC, Jr, Cotlier E. Corticosteroid-induced cataracts. Surv Ophthalmol. 1986;31(2):102–110.
  10. Dilley KJ, Bron AJ, Habgood JO. Anterior polar and posterior subcapsular cataract in a patient with retinitis pigmentosa: a light microscopic and ultrastructural study. Exp Eye Res. 1976;22(2):155–167.
  11. Hooper PL, Rao NA, Smith RE. Cataract extraction in uveitis patients. Surv Ophthalmol. 1990;35(2):120–144.
  12. Hiller R, Sperduto RD, Podgor MJ, et al. Cigarette smoking and the risk of development of lens opacities. The Framingham studies. Arch Ophthalmol. 1997;115(9):1113–1118.
  13. Brown CJ, Akaichi F. Vitamin D deficiency, and posterior subcapsular cataract.Clin Ophthalmol. 2015;9:1093–1098
  14. Duke-Elder S. Posterior polar cataract. In: Duke-Elder S (ed). System of Ophthalmology 3, Pt 2 Normal and Abnormal Development, Congenital Deformities. CV Mosby: St Louis, MO, 1964;723–726.
  15. Chan TC, Li EY, Yau JC. Application of anterior segment optical coherence tomography to identify eyes with posterior polar cataract at high risk for posterior capsule rupture. J Cataract Refract Surg. 2014 Dec;40(12):2076-81.
  16. Kymionis GD, Diakonis VF, Liakopoulos DA, et al. Anterior segment optical coherence tomography for demonstrating posterior capsular rent in posterior polar cataract. Clin Ophthalmol. 2014;8:215-7

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Last updated: 2018-06-21 18:56