Clinical Image

Christmas tree cataract: A shimmering cataract

Sefrioui Meryem1
,  
Taouri Narjisse2
,  
Ed-Darraz Imane3
,  
Cherkaoui Ouafae4

1 Ophthalmology Resident, Department A of Ophthalmology, Mohammed V University Souissi, Rabat, Morocco

2 Ophthalmology Resident, Department A of Ophthalmology, Mohammed V University Souissi, Rabat, Morocco

3 Ophthalmology Resident, Department A of Ophthalmology, Mohammed V University Souissi, Rabat, Morocco

4 Department Head, Department A of Ophthalmology, Mohammed V University Souissi, Rabat, Morocco

Address correspondence to:

Sefrioui Meryem

Hospital des Spécialités, Avenue Abderrahim Bouabid, Rabat,

Morocco

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Article ID: 100024Z17SM2022

doi: 10.5348/100024Z17SM2022CI

How to cite this article

Sefrioui M, Taouri N, Ed-Darraz I, Cherkaoui LO. Christmas tree cataract: A shimmering cataract. J Case Rep Images Opthalmol 2022;5:100024Z17SM2022.

ABSTRACT

No Abstract

Keywords: Cataract, Christmas tree, Lens

Case Report

This study reports the case of a 92-year-old female patient with a history of hypertension presenting for progressive bilateral blurred vision. The neurological examination was normal.

Her best corrected visual acuity is 2/10th Snellen chart in both eyes. Slit lamp examination after pupillary dilatation reveals needle-shaped polychromatic crystals in the anterior cortex and the nucleus of the lens.

Under direct focal lighting, the crystals display a palette of sparkling colors varying with the angle of light incidence reminiscent of an illuminated Christmas tree (Figure 1 and Figure 2).

In retroillumination, only a faint outline of the cataract is seen suggesting that it is a diffractive phenomenon. This aspect was associated with a cortical, nuclear, and dense subcapsular cataract in both eyes explaining the decline in visual acuity.

Figure 1: : Slit lamp examination of the left eye showing needle-shaped sparkling opacities in the anterior cortex of the lens.
Figure 2: : Slit lamp examination of the right eye showing the Christmas tree cataract as a double arch in the anterior cortex and nucleus of the lens.

Discussion

Christmas tree cataract is a rare form of lens opacification. It can be unilateral or asymmetrically bilateral. It is often seen in clear lenses and its presence is often associated with a visual acuity of 10/10th. The presence of other cataracts seems to be accidental [1]. The association with myotonic dystrophy was found in 16.7% of patients with this type of cataract [2].

Several authors have attempted to explain the mechanism of crystal formation. According to Anders and Wollensak, the crystals are cholesterol in nature and result from the lens metabolism [3],[4]. According to Shun-Shin, they are probably of cystine due to age-related aberrant lens degradation induced by elevated Ca++ levels [1].

Conclusion

The Christmas tree cataract is a rare type of polychromatic cataract. Although it is not often responsible of significant visual loss, it can progress and impair vision, it can also be associated with other types of lens opacities. A cataract surgery is often performed. The crystals are highly ringent and change significantly the viewing of the procedure by the surgeon, it must be known not to surprise during the surgical procedure avoiding an increased time of surgery.

REFERENCES

1.

Shun-Shin GA, Vrensen GF, Brown NP, Willekens B, Smeets MH, Bron AJ. Morphologic characteristics and chemical composition of Christmas tree cataract. Invest Ophthalmol Vis Sci 1993;34(13):3489–96. [Pubmed] Back to citation no. 1  

2.

Reiter C, Gramer E. Anticipation in patients with iridescent multicoloured posterior capsular lens opacities (“Christmas tree cataract”): The role in the diagnosis of myotonic dystrophy. [Article in German]. Ophthalmologe 2009;106(12):1116–20. [CrossRef] [Pubmed] Back to citation no. 1  

3.

Anders N, Wollensak J. Christmas tree ornament cataract – An indication for disordered lipid metabolism? [Article in German]. Klin Monbl Augenheilkd 1992;201(1):30–3. [CrossRef] [Pubmed] Back to citation no. 1  

4.

Stival LRS, Lago AM, de Figueiredo MNFC, Bittar RHG, Machado ML, Nassaralla Junior JJ. Efficacy and safety of subconjunctival bevacizumab for recurrent pterygium. Arq Bras Oftalmol 2014;77(1):4–7. [CrossRef] [Pubmed] Back to citation no. 1  

SUPPORTING INFORMATION

Author Contributions

Sefrioui Meryem - Substantial contributions to conception and design, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Taouri Narjisse - Acquisition of data, Drafting the article, Final approval of the version to be published

Ed-Darraz Imane - Analysis of data, Revising it critically for important intellectual content, Final approval of the version to be published

Cherkaoui Ouafae - Revising it critically for important intellectual content, Final approval of the version to be published

Data Availability Statement

The corresponding author is the guarantor of submission.

Consent For Publication

Written informed consent was obtained from the patient for publication of this article.

Data Availability

All relevant data are within the paper and its Supporting Information files.

Competing Interests

Authors declare no conflict of interest

Copyright

© 2022 Sefrioui Meryem et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.