Contributor: Gordon K. Klintworth
The cerulean cataract (coronary cataract) is a congenital autosomal dominant cataract characterized by the presence of tiny dot-like or flake-like opacities within the lens organized in concentric layers with some central radially arranged lesions contributing to a crown configuration. The cataract, which was first described by Vogt in 1922, appears to have predominantly bluish-green or white opacifications when viewed by slit lamp biomicroscopy using direct illumination. The designation cerulean cataract stems from the dull blue color. The position of the opacities varies with the age of the individual. During infancy and childhood they are situated beneath the lens capsule and in the superficial layers of the fetal nucleus near the lens equator. The opacification occurs deeper in the lens in adults and occupies the adult lens nucleus.The cerulean cataract is usually bilateral. It does not significantly affect visual acuity and hence does not need treatment. Wart-like, laminar excrescences that stain positively with the Periodic acid-Schiff reaction are present beneath the anterior lens capsule. Granular material is present in the affected lens and become displaced deeper into the lens over time. The cerulean cataract is one of many types of autosomal dominant cataract [cataract - autosomal dominant]. Two genetically different types of congenital cerulean cataract have been identified (cerulean cataract type I [cataract - cerulean type I] and cerulean cataract type II [cataract - cerulean type II]. Also, a cerulean cataract sometimes occurs in individuals with Down syndrome. Some cases are associated with a specific mutation in the CRYGD gene (P23T).