Cerulean Cataract

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Cerulean cataracts, also known as blue dot cataracts, are developmental cataracts characterized by blue and white opacifications scattered in the nucleus and cortex of the lens. Patients with cerulean cataracts are usually asymptomatic until 18-24 months of age and often do not need them removed before adulthood. Treatment is with surgical cataract removal and artificial lens placement.

Cerulean Cataract

Cerulean Cataract

Disease

Etiology/Pathophysiology

Cerulean cataracts are inherited as an autosomal dominant trait. At least four loci for the cerulean cataract phenotype have been mapped – congenital cataract-1 (CCA1;17q24), CCA2 (22q11.2-q12.2), CCA3 (2q33-q35), and CC4 (16q22-q23)1. Multiple causative mutations have been identified, including mutations in the beta-B2-crystallin gene (CRYBB2)2, gamma-D-crystallin gene (CRYGD)3, V-MAF avian musculoaponeurotic fibrosarcoma oncogene homolog gene (MAF)4, and the major intrinsic protein of lens fiber gene (MIP)1.

Cerulean Cataract

Diagnosis

Presentation

Patients with cerulean cataracts usually have preserved visual acuity and rarely need cataract extraction before adult age5. Because many newborns are asymptomatic until 18-24 months of age, cerulean cataracts are considered to be a form of developmental cataract rather than a true congenital cataract. Progression of cerulean cataracts is slow and may not become significant until the third or fourth decade of life, when patients begin to notice a gradual decrease in vision in both eyes6. However, children who develop signs of visually significant cataracts such as nystagmus and amblyopia may require cataract surgery earlier7.

Physical examination

Cerulean cataracts usually present as bilateral, blue-white opacities that begin to form in the fetal nucleus after birth5. Patients can be diagnosed via slit lamp examination at ages as early as 18 months, which would reveal tiny blue and/or white opacities in the superficial layer of the lens nucleus8.

Differential diagnosis

The differential diagnosis for cerulean cataracts includes other congenital, developmental and traumatic cataracts. These can be distinguished by physical examination, family history, and laboratory tests.

Cerulean Cataract


Management

Serial evaluations and surgery

There are no known treatments to prevent the formation and progression of cerulean cataracts. Serial eye evaluations and eventual cataract surgery are the standard of care9.


References

1. Xiao X, Li W, Wang P, et al. Cerulean cataract mapped to 12q13 and associated with a novel initiation codon mutation in MIP. Mol Vis. 2011;17:2049-2055.

2. Litt M, Carrero-Valenzuela R, LaMorticella DM, et al. Autosomal Dominant Cerulean Cataract Is Associated with a Chain Termination Mutation in the Human β-Crystallin Gene CRYBB2. Human Molecular Genetics. 1997;6(5):665-668. doi:10.1093/hmg/6.5.665

3. Nandrot E, Slingsby C, Basak A, et al. Gamma-D crystallin gene (CRYGD) mutation causes autosomal dominant congenital cerulean cataracts. Journal of Medical Genetics. 2003;40(4):262-267. doi:10.1136/jmg.40.4.262

4. Vanita V, Singh D, Robinson PN, Sperling K, Singh JR. A novel mutation in the DNA-binding domain of MAF at 16q23.1 associated with autosomal dominant “cerulean cataract” in an Indian family. American Journal of Medical Genetics Part A. 2006;140A(6):558-566. doi:10.1002/ajmg.a.31126

5. Ram J, Singh A. Cerulean cataract. QJM: An International Journal of Medicine. 2019;112(9):699-699. doi:10.1093/qjmed/hcz038

6. Kumawat D, Jayaraman N, Sahay P, Chandra P. Multicoloured lenticular opacities in a case of cerulean cataract. BMJ Case Reports CP. 2019;12(4):e230167. doi:10.1136/bcr-2019-230167

7. Pediatric Cataracts: Overview. American Academy of Ophthalmology. Published November 11, 2015. Accessed September 19, 2021. https://www.aao.org/disease-review/pediatric-cataracts-overview

8. Armitage MM, Kivlin JD, Ferrell RE. A progressive early onset cataract gene maps to human chromosome 17q24. Nat Genet. 1995;9(1):37-40. doi:10.1038/ng0195-37

9. Cerulean cataract | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program. Accessed September 19, 2021. https://rarediseases.info.nih.gov/diseases/9508/cerulean-cataract/cases/30241#ref_3241

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