sutural cataract

Cataracts, Congenital Sutural with Punctate and Cerulean Opacities

Clinical Characteristics
Ocular Features: 

The anterior and posterior Y sutures have prominent, dense white opacities.  The embryonal and fetal nuclei are clear but the cortex contains gray-bluish, sharply defined and elongated as well as punctate opacities.  These are denser near the posterior pole and the posterior Y suture is also more heavily involved.  The cortical opacities may be arranged in concentric lamellae.  Considerable variation in density of opacities has been noted among patients.

Systemic Features: 

None reported.

Genetics

A large Indian family consisting of 5 generations containing 33 affected individuals has been described.  This is an autosomal dominant disorder in which a mutation has been found in exon 6 of the CRYBB2 gene (22q11.2-q12/22q11.23).  This region contains four crystallin genes as well as the CRYBP1 pseudogene.  It has been suggested that gene conversion between exon 6 of the CRYBB2 gene and CRYBR1 may be responsible for the phenotype.  Three additional families with identical mutations in the same CRYBB2 exon have been reported and, since each family seems to have a unique phenotype, it is likely that more than a simple bp mutation is responsible for the cataracts.  

Some Coppock-like cataracts (604307) also result from mutations in CRYBB2 at the same location but others have  mutations in the CRYGC gene.  Type 2 congenital cerulean cataracts (601547) have also been associated with mutations in the CRYBB2 gene. 

Another autosomal dominant congenital cataract with sutural opacities (600881) has a slightly different phenotype and results from a mutation on chromosome 17.  

Pedigree: 
Autosomal dominant
Treatment
Treatment Options: 

Visually significant cataracts may need to be removed.

References
Article Title: 

Cataracts, Congenital, Volkmann Type

Clinical Characteristics
Ocular Features: 

The nature of lens opacities is highly variable, ranging from dense opacification to barely detectable opacities.  The opacities may be located in the embryonic, fetal and juvenile nuclei as well as around the Y sutures.  They are congenital in origin and progressive.   Minimal opacities can be asymptomatic early but all eventually require removal, usually by the first or second decades of life.  Most cases have been reported from Denmark. 

Systemic Features: 

No systemic disease is present. 

Genetics

This type of cataract is inherited in an autosomal dominant pattern.  The causative mutation is unknown but a presumed locus has been identified at 1pter-p36.13.  This type of cataract may be allelic to congenital posterior polar cataract (116600).

Other forms of autosomal dominantly inherited, congenital, progressive lens opacities include congenital cerulean (115660, 601547, 608983, 610202), Coppock-like (604307), and lamellar (116800), cataracts. Due to clinical heterogeneity, it is not always possible to classify specific families based on the appearance and natural history of the lens opacities alone.

Pedigree: 
Autosomal dominant
Treatment
Treatment Options: 

Visually significant cataracts may require removal. 

References
Article Title: 
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