Cataract classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Rohan Bir Singh, M.B.B.S.[2]

Overview

Classification

The classification of cataracts is based on four different criteria.

  1. Morphology,
  2. Age of Onset
  3. Maturity
  4. Etiology
  5. Location of opacity
Morphology
  • Capsular
  • Subcapsular
  • Nuclear
  • Cortical
  • Lamellar
  • Sutural
  • Congenital capsular thickening may be associated with posterior or anterior polar cataracts and pyramidal cataract. The posterior form may be associated with a hylaoid remnant.
  • Acquired capsular opacities can occur with pseudoexfoliation, Infra-red radiation (Glass blower’s cataract) or Secondary to blunt trauma when a Vossius’ ring may be formed.
  • Nuclear - Congenital : Cataract is that secondary to Rubella - Age related : Nuclear sclerosis cataract.
Maturity
  • Immature Senile Cataract (IMSC) - partially opaque lens, disc view hazy
  • Mature Senile Cataract (MSC) - Completely opaque lens, no disc view
  • Hypermature Senile Cataract (HMSC) - Liquefied cortical matter: Morgagnian Cataract
  • Congenital cataract
Location of opacity
  • Anterior cortical cataract
  • Anterior polar cataract
  • Anterior subcapsular cataract
  • Nuclear cataract
  • Posterior cortical cataract
  • Posterior polar cataract (importance lies in higher risk of complication - posterior capsular tears during surgery)
  • Posterior subcapsular cataract (PSC) (clinically common)
  • Anterior subcapsular lens changes may be associated with Wilson’s disease (sunflower cataract) or with drugs e.g., amiodarone
  • Posterior subcapsular cataract changes may associated with secondary or complicated cataracts, drugs e.g., steroids, or be an age related cataract.
Etiological
  • Congenital 
  • Degenerative or “age related” (senile) 
  • Traumatic 
  • Secondary to other conditions (including metabolic causes) 
  • Toxic 
  • Hereditary 
  • Congenital cataract can be a result of heredity (often autosomal dominant), pre-natal infections such as rubella or metabolic disorders. 

- Intrauterine infections e.g. rubella and toxoplasmosis. 

- Maternal drug ingestion e.g. thalidomide and corticosteroids. 

- Genetically transmitted syndromes 

- Microphthalmos is often associated with cataract. 

- Ocular conditions with associated anomalies e.g. retinopathy of

prematurity & some types of retinitis pigmentosa. 

- Secondary to metabolic disorders  e.g. Galactosemia & Wilson’s disease  

  • Congenital cataract
  • Sutural cataract
  • Lamellar cataract
  • Zonular cataract
  • Total cataract
  • Secondary cataract
  • Drug-induced cataract (e.g. Corticosteroids)
  • Traumatic cataract
  • Blunt trauma (capsule usually intact)
  • Penetrating trauma (capsular rupture & leakage of lens material - calls for an emergency surgery for extraction of lens and leaked material to minimize further damage)
  • Nuclear cataract - Grading correlates with hardness & difficulty of surgical removal
  • 1 - Grey
  • 2 - Yellow
  • 3 - Amber
  • 4 - Brown/Black (Note: "Black cataract" translated in some languages (like Hindi) refers to Glaucoma, not the color of the lens nucleus)
  • After-cataract - posterior capsular opacification subsequent to a successful extracapsular cataract surgery (usually within 3 months - 2 years) with or without IOL implantation. Requires a quick & painless office procedure with Nd:YAG laser capsulotomy to restore optical clarity.

References

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