Congenital Cataract in Triplet Pregnancy after IVF with Frozen Embryos: Prenatal Diagnosis and Management

Abstract

Unilateral congenital cataract was diagnosed at the 2nd trimester ultrasonography in a triplet pregnancy following in vitro fertilization (with frozen embryos). Congenital cataract could be hereditary or related to metabolic and infectious disorders. To our knowledge this is the first antenatal diagnosis of the disorder in triplets after IVF with frozen embryos.

Early sonographic detection of recurrent fetal eye anomalies

“…In our review of the literature7–25, 30 it became obvious that a history of fetal eye anomalies leads to a diagnosis in the first half of the pregnancy. However, the absence of risk factors should not preclude the possibility of this occurrence, although we observed that in families with no family history of fetal eye anomalies, the diagnosis was made only late in the third trimester, usually during second‐opinion sonography.…”

“…Charts for normal intra‐orbital and interorbital diameters have been made available to help the clinician identify hypertelorism and hypotelorism1–5, in addition to charts for normal lens development throughout pregnancy6. The prenatal diagnosis of fetal orbital or eye anomalies, such as cyclopia, microphthalmia, cataract and anophthalmia, has been described7–20. Some of these abnormalities may be part of congenital syndromes, such as trisomy 13, trisomy 21, Walker–Warburg syndrome, Fraser‐cryptophthalmos syndrome, or a brain anomaly, such as holoprosencephaly12, 15, 17, 21–25.…”

Isolated Congenital Hereditary Cataract in a Dizygotic Twin: Prenatal Ultrasonographic Diagnosis

“…Our case demonstrated congenital hereditary cataracts in a dizygotic twin pregnancy with discrepancy in body weight and affected status between two fetuses; one twin, the smaller female, was affected, and the other, the larger male, was unaffected. The principal finding was relatively echogenic areas around ocular lenses rather than advanced opacification of crystalline lens in previously reported cases of congenital hereditary cataracts with no other associated abnormalities (Cengiz & Baxi, 2001;Drysdale et al, 1997;Monteagudo et al, 1996). Congenital cataracts were mostly presented as homogeneous opacity of the lens and loss of hypoechoic center of the lens within a hyperechoic ring of the normal fetal lens (Bronshtein et al, 1991;Cengiz & Baxi, 2001;Drysdale et al, 1997;Graw, 2004;Monteagudo et al, 1996;Pedreira et al, 1999;Reches et al, 2007;Romain et al, 1999).…”

“…The principal finding was relatively echogenic areas around ocular lenses rather than advanced opacification of crystalline lens in previously reported cases of congenital hereditary cataracts with no other associated abnormalities (Cengiz & Baxi, 2001;Drysdale et al, 1997;Monteagudo et al, 1996). Congenital cataracts were mostly presented as homogeneous opacity of the lens and loss of hypoechoic center of the lens within a hyperechoic ring of the normal fetal lens (Bronshtein et al, 1991;Cengiz & Baxi, 2001;Drysdale et al, 1997;Graw, 2004;Monteagudo et al, 1996;Pedreira et al, 1999;Reches et al, 2007;Romain et al, 1999). However, there are various sonographic features of cataracts in echogenicity and affected location that hinders the diagnosis of congenital cataracts before birth (Monteagudo et al, 1996).…”

“…Although congenital cataracts are usually associated with intrauterine infections (i.e., rubella), metabolic disorders, trauma, medication and chromosomal abnormalities, and congenital cataracts may also be inherited as an isolated ocular abnormality (Cengiz & Baxi, 2001; Drysdale et al, 1997; Monteagudo et al, 1996). Unfortunately, in this study, genetic analysis of distinct gene mutations was not performed.…”