Partial Lens Opacities

The evaluation of partial lens opacities is related to the location of the cataract. Anterior cataracts include anterior lenticonus, polar cataracts, persistent pupillary membrane opacities, and those occurring with anterior segment dys-genesis. Posterior cataracts include posterior polar, posterior lenticonus, persistent hyperplastic primary vitreous, and posterior subcapsular lens opacities. Posterior subcapsular cataracts are typically associated with corticosteroid use, atopic dermatitis, or inflammatory diseases and are generally bilateral.

Traumatic and Posterior Lenticonus

Traumatic cataract, the most common cause of unilateral cataract in children, is caused by penetrating or blunt trauma. Posterior lenticonus cataracts are the second most common cause of unilateral acquired cataract in children. Posterior lenticonus is a circumscribed oval or round bulge in the infant's or child's posterior lens capsule and cortex, restricted generally to a 2 x 7-mm axial diameter. The bulge increases progressively, and cataractous changes occur in the cortex surrounding the posterior lenticonus. Generally, there is a reduced red reflex initially with posterior lenticonus, and cataractous changes occur in the surrounding cortex. In 21 patients with posterior lenticonus, only two had bilateral posterior lenticonus. The interval between the "oil droplet" posterior lenticonus and cataract development is variable. The eyes are normal in size, and visual results are good with surgery. Posterior lenticonus cataracts occur as early as 3 months of age or as late as 15 years. If the vision becomes worse than 20/70, the cataract should be removed by specialized instrumentation, followed by contact lens fitting or an intraocular lens.

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