Congenital cataract

Introduction to congenital cataract Any cause such as aging, genetics, local dystrophies, immune and metabolic abnormalities, trauma, poisoning, radiation, etc., can cause lens metabolism disorders, resulting in lens protein denaturation and turbidity, known as cataract. At this time, the light is blocked by the opaque lens and cannot be projected on the retina, so that the object cannot be seen. From the perspective of group blindness prevention and blindness prevention, the World Health Organization degenerates and turbids the lens, becomes opaque, and even affects vision. Those with corrected visual acuity of 0.7 or less are classified into the cataract diagnosis range. basic knowledge The proportion of illness: 0.005% Susceptible people: infants and young children Mode of infection: non-infectious Complications: strabismus, nystagmus, retinopathy

Causes of congenital cataract

Genetic (35%):

In the past 50 years, there has been more in-depth study on the inheritance of congenital cataract. About one-third of congenital cataracts are hereditary, among which autosomal dominant inheritance is the most common. China's statistics show that dominant inheritance accounts for 73. %, recessive inheritance accounted for 23%, and no reports of sexual inheritance have been reported. In areas or countries with high blood marriage ratios, recessive inheritance is not uncommon.

Environmental factors (30%):

In addition to heredity, the influence of environmental factors is another important cause of congenital cataract, accounting for about one-third of congenital cataracts. In particular, nutrition and infection during pregnancy have a great impact on the disease, so it is necessary to emphasize perinatal care to reduce the incidence of congenital cataract.

Other factors (30%):

About 1/3 of the congenital cataracts are unclear, that is, sporadic, no obvious environmental factors, some of the cases may be hereditary, new autosomal dominant gene mutations, cataract in the first generation However, there is no family history, so it is difficult to determine that hereditary, recessive hereditary single cases are also difficult to diagnose as hereditary.

The most basic method for determining the cause of congenital cataract is to first identify whether the cataract is an isolated condition in a healthy child or part of a systemic or ocular lesion. In some cases, by understanding the family history and personal history, combined with the whole body and eye Departmental examination can generally find the cause and make a correct diagnosis. Pre-polar cataract, posterior lens cone is generally not associated with systemic abnormalities; children with bilateral permanent vitreous hyperplasia should be differentiated from Norrie disease, 13-trisomy. The history of the first 3 months of maternal pregnancy, medication history, X-ray exposure history, etc. have important reference value.

When a newborn has a cataract in one eye or both eyes, the cause should be clarified. If there is a positive family history, it is related to the remains. In addition, the influence of environmental factors is also the cause of the disease, and some are the common diseases of the whole body, even after the disease. After family analysis or laboratory examination, there are still 1/3 cases that cannot be found. The cataracts with unknown causes are called idiopathic cataracts. The patients have no other eye abnormalities and no systemic sorrow. Factors cause turbidity in the body. It is speculated that one-fourth of this group of patients is caused by a new autosomal dominant gene mutation, some of which are related to systemic diseases, but are neglected or unrecognizable due to the mild manifestation of systemic diseases.

Pathogenesis

1. Genetics: Although the genetic research of congenital cataract has been more than a hundred years old, it has brought certain difficulties to the research because of different types, different genetic loci and genetic heterogeneity. Since the 1950s, the genetic loci of congenital cataract have been studied. At least 12 pathogenic genes are located at different sites on different chromosomes. At present, at least 3 autosomal dominant congenital cataracts are found. Different sites On two chromosomes, one type of cataract (post-polar type) causative gene is located on chromosome 16 linked to haptoglobin; and one type of embryonic cataract is located on chromosome 2 Another type of embryonic nucleus, the causative gene of fetal nuclear cataract is located on chromosome 1, and the dominant hereditary cataract is characterized by irregular dominant inheritance, which is characterized by irregular hereditary inheritance. It is possible to think of recessive hereditary or congenital cataracts of unknown cause.

Autosomal recessive cataracts are rare, and are more related to the marriage of close relatives. The incidence of close relatives is more than 10 times higher than that of random maternal offspring. The more common is nuclear cataract, recessive. Genetic cataracts can also be classified incorrectly, because in a family with random marriage, if the parent has a normal phenotype, but is a carrier of the cataract-causing gene, if a child with a congenital cataract is mistaken, it will be mistaken. It is considered to be a cataract of unknown cause.

Since there is no method for detecting recessive gene carriers, prohibiting close relatives is an important measure to reduce recessive genetic cataract. It is known that such cataracts have 2 to 3 pathogenic genes.

X-linked recessive cataracts are rare, and there is a disease-causing gene. Male patients are mostly nuclear cataracts, which are static or gradually develop into mature cataracts. Female carriers have Y-slot opacity and no visual impairment.

Animal experiments have observed hereditary congenital cataracts, such as the autosomal dominant nuclear cataract in the hamster, and the recessive hereditary rabbit y-seal cataract, which can gradually develop into a complete cataract.

A sporadic cataract with no family history may be a mutation in an autosomal dominant gene. The patient is the first generation of cataracts in the family, and their children will have a 50% chance of getting sick.

In the molecular genetic study of congenital cataract, the results were found to be inconsistent. This is due to the fact that the disease has different genetic loci and is polymorphic. In the study of DNA recombination technology, the gene defect of the lens was found. It can cause hereditary congenital cataract. Other scholars believe that the occurrence of cataract is related to chromosome 21, gene defect of crystal protein and defect of MIP protein gene of chromosome 12 crystal. It is found in the study of hereditary cataract by laser Raman spectroscopy. When the cataract begins to form, it exhibits a change in the crystalline tyrosine residue, and the thiol group is converted into a disulfide bond, which is crosslinked into a macromolecular polymer, so that the turbid crystal protein polymer is in a stable state.

2, environmental factors: should be proposed is the mother's infection in the first 2 months of pregnancy, is a non-negligible factor leading to cataract, pregnancy infection (rubella, chickenpox, simple pityriasis, measles, banded pityriasis and Influenza and other viruses can cause fetal lens turbidity. During this period, the crystal capsule is not fully developed and can not resist the invasion of the virus. At this time, the crystal protein synthesis is active and sensitive to viral infection, thus affecting the growth and development of crystal epithelial cells. At the same time, there are changes in nutrition and biochemistry, and the metabolism of the crystals is disordered, causing turbidity. In the late stage of pregnancy, the crystal capsule of the fetus has gradually developed and improved, and the crystal is protected from the virus.

Among the cataracts caused by various viral infections, rubella virus infection is the most common. There was a rubella epidemic in the United States from 1964 to 1965, and 20,000 children suffered from rubella syndrome, and 50% of them had congenital cataract. There is crystal turbidity at birth or within one year after birth. The degree of turbidity is related to the time or extent of the virus invading the crystal. In addition, with the increase in the incidence of various sexually transmitted diseases, cataract caused by herpes simplex virus type II infection Attention should also be given to the fact that newborns can be infected with the virus from the mother's birth canal. It has been reported that a simple herpesvirus type II is cultured in the patient's crystal cortex, and the neonatal crystals can be transparent, but cataracts soon occur.

Malnutrition during pregnancy, pelvic radiation, taking certain drugs (such as high-dose tetracycline, hormones, salicylic acid preparations, anticoagulants, etc.), systemic diseases during pregnancy (heart disease, nephritis, diabetes, anemia, hyperthyroidism, Hand and foot twitching, calcium metabolism disorders, and vitamin D deficiency can cause fetal opacity.

Another common cause of congenital cataract is the developmental disorder of the fetus in the last 3 months. The typical manifestations are premature birth weight and hypoxia, central nervous system damage. Animal experiments have confirmed that intrauterine hypoxia can cause congenital cataract. .

About 2.7% of premature babies have cataracts after birth. There are clear bubbles under the anterior and posterior capsules. The eyes are symmetrical. The bubbles can subside or gradually develop into diffuse opacity under the posterior capsule. In addition, premature infants with immature development often need to inhale. High concentration of oxygen, mostly retinopathy of prematurity, crystal turbidity after several months.

In short, in non-hereditary congenital cataracts, the influence of environmental factors is an important cause of cataract, so it is necessary to emphasize perinatal care to reduce the incidence of congenital cataract.

Congenital cataract prevention

Congenital cataract is a common childhood eye disease, but in the past there is no statistics on the prevalence rate in China. In recent years, through the screening of blinding eye diseases and hereditary eye diseases, it is concluded that the population of congenital cataract in China is 0.05% (1:1918), lower than the foreign (Francois, 0.4%) thinking rate.

Because this disease is an important cause of blindness and amblyopia in children, it is necessary to reduce the prevalence of congenital cataract from the perspective of prenatal and postnatal care and prevention of blindness. In the investigation of blinding causes of blind children in Tianjin, Shanghai and Beijing, 22% were found. 30% of blind children are blinded by congenital cataracts, accounting for the second cause of blindness. In addition, many children suffer from irreversible amblyopia due to this disease. Francois recalls previous data that congenital cataracts account for blindness in children. 10.0% to 38.0%.

Since there is no method for detecting recessive gene carriers, it is an important measure to reduce the hereditary cataract, and it is necessary to emphasize perinatal care to prevent viral infections 3 months before pregnancy to reduce congenitality. The occurrence of cataract should be standardized for oxygen inhalation measures in premature infants to prevent excessive oxygen inhalation and excessive concentration.

Congenital cataract complications Complications squint nystagmus retinopathy

Many congenital cataract patients often have other eye diseases or abnormalities. The presence of these comorbidities exacerbates visual impairment. Therefore, in the diagnosis and treatment of congenital cataracts, attention should be paid to the existence of these comorbidities in order to take corrective measures.

1, strabismus: about 1/2 of the patients with monocular cataract and less than 1/2 of the two eyes cataract with strabismus, due to monocular crystal opacity or refractive power changes, resulting in decreased vision; or binocular crystal opacity caused by different eyes Unbalanced vision disrupts the fusion mechanism and gradually causes strabismus. In addition, congenital cataracts may have certain anatomical abnormalities (such as small eyeballs) and certain intraocular diseases, which may also cause strabismus to occur and gradually worsen. Some systemic disorders can be congenital cataracts with strabismus, such as Lowe syndrome, Stickler syndrome, neonatal hemolysis and some chromosomal abnormalities.

2, nystagmus: due to congenital cataract vision is affected, can not watch and swing or search for nystagmus, that is, secondary nystagmus, can be reduced or disappeared after cataract surgery, if postoperative nystagmus can not be eliminated, It is bound to affect the recovery of vision. Congenital cataract combined with nystagmus can also be seen in some systemic diseases. One of the following is a skull dysplasia syndrome, the long arm of chromosome 21 is missing, and the Marinesco-Sjögren syndrome.

3, congenital small eyeball: congenital cataract with congenital small eyeballs, vision recovery is impossible, even after cataract surgery, vision recovery is limited, congenital small eyeball presence and congenital cataract The type is irrelevant. It may change the size of the eyeball when crystal turbidity occurs during the abnormal development of the crystal. It is related to heredity. In addition to small eyeballs, some intraocular tissues (such as iris and choroid) may be combined. Congenital cataracts with small eyeballs can also be found in certain systemic diseases such as Norrie's disease, Gruber's disease, and certain chromosomal aberration syndromes.

4, retinal and choroidal lesions: a small number of congenital cataracts can be combined with myopic chorioretinopathy, blanket retinal degeneration, Leber congenital black sputum, and macular dystrophy.

5, iris pupil dilated muscle dysplasia: the pupil is not easy to expand after the dilatation of the sputum, so it brings certain difficulties to the examination and surgery of cataract patients.

6, other: In addition to the above common complications, may also be combined with crystal dislocation, crystal defects, congenital aniridia, congenital iris and / or choroidal defects, pupillary residual membrane, large cornea, keratoconus, water storage vitreous Arteries, etc.

About 6% of congenital cataracts with other abnormalities in the eye, such as primitive vitreous hyperplasia, no iris, choroidal defects, etc., congenital cataracts occur within 1 year of age, mostly accompanied by metabolic or systemic diseases, a small number of children can Combined with myopic retinal choroidal lesions, retinal degeneration, and macular dystrophy, may also be associated with lens dislocation, lens defect, iris and choroidal defect, pupillary residual membrane, keratoconus and other abnormal conditions.

Congenital cataract symptoms Common symptoms Photophobic vitreous through the pupil... Visual acuity uvitis lens opacity nystagmus dysfunction color loss small eye deprivation amblyopia

1. White sputum sign: Adult cataract patients often see their doctors because of their obvious loss of vision. Infants and young children, especially monocular patients, are generally asymptomatic and therefore often delayed in diagnosis. Only when there is white reflection in the pupil area, the so-called When leukokoria is caused by the parents or doctors, the white sign is not unique to congenital cataracts and should be differentiated clinically from other conditions.

2. Ocular tremor: Children with dense opaque cataract in both eyes are mostly accompanied by nystagmus. The tremor is mostly wanderring and searching. This type of nystagmus often reminds visual acuity. Extremely low, generally does not exceed 0.1.

3. strabismus: due to low vision or imbalance of binocular vision, hindering the formation of the fusion mechanism, can quickly cause eye position deflection.

4. Photophobia: In some cases, light scattering caused by opacity of the lens can cause photophobia in children, which is more likely to occur in children with nuclear cataract.

5. Other ocular abnormalities combined: congenital cataract with congenital small eyeball is not uncommon clinically. The presence of congenital small eyeball is not related to cataract type, and often combined with other ocular tissue dysplasia, such as choroidal defect, poor visual prognosis. Even the surgery can not achieve satisfactory vision results.

The most common cause of neonatal leucorrhea is congenital cataract. Clinical diagnosis is not difficult. However, many other congenital abnormalities in the eye can also be manifested as white sputum. The clinical manifestations, treatment principles and prognosis are different. It is very important to make accurate diagnosis and differential diagnosis in time.

There are many types of congenital cataracts, including complete and incomplete cataracts, and can be divided into nuclear, cortical and membranous cataracts. Because of the location, degree and degree of opacity, visual impairment is different. There are several types of cataracts.

1, total cataract (total cataract) crystals all or nearly all turbidity, can also be gradually developed after birth, all turbid in 1 year old, this is because the crystal fiber is damaged in the middle or late stage of development, clinical manifestations The crystals in the pupil area are white turbid, sometimes the capsule is thickened, the calcification or cortex is concentrated or even dislocated, the visual impairment is obvious, mostly bilateral, and it is most common in autosomal dominant inheritance, which can be inherited continuously for several generations in one family. A few are recessive, and very few are sexually linked recessive.

2. Membrane cataract: When the crystal fibers of congenital complete cataract undergo degeneration in the uterus, the cortex gradually absorbs and forms a membranous cataract. When the cortex is swollen or the vitreous artery is pulled, the capsule is It can cause rupture of the posterior capsule and accelerate the absorption of the cortex, which is characterized by congenital aphakic, clinical manifestations of grayish white dura mater, how many different colored spots, irregular surfaces, sometimes visible on the surface of the membrane. To the ciliary process and blood vessels, the latter may come from the vascular membrane of the embryo, and also the fibrous tissue extends to the surface of the membrane, so it is also called vascular cataract or fibrous cataract, single or double eyes, severe visual impairment, a few cases combined Intrauterine iridocyclitis.

3, nuclear cataract (nuclear cataract): This disease is more common, accounting for about 1/4 of congenital cataract, embryonic nucleus and fetal nucleus are involved, showing a dense white turbidity, turbidity range of 4 ~ 5mm, completely obstructing the pupil area Therefore, visual impairment is obvious, mostly suffering from both eyes, usually autosomal dominant inheritance, a few are recessive inheritance, but also sporadic.

4, central puffer cataract (centralpuiverulent cataract): in the first 3 months of the embryonic period due to embryonic nucleus damage, the fetal nucleus is not affected, the clinical manifestations of the embryonic nucleus between the two Y-slots are dusty or granules It is also called slab dusty cataract. If the fetal nucleus is also damaged, it will appear as a nuclear cataract or lamellar cataract in the clinic. There are many small white spots in the turbid area under the slit lamp. The range of turbidity About 1 ~ 2.5mm, mostly bilateral symmetry, static and unchanged, has little effect on vision.

5, perinuclear cataract (perinuclear cataract): this type of cataract is very common, accounting for 40% of congenital cataract, because turbidity is located in the layer around the nucleus, it is also known as lamellar cataract (1amellar cataract), usually stationary Development, bilateral, clinical manifestations of nuclear turbidity around the fetal nucleus, these turbidity is composed of many small white spots, the cortex and embryonic nucleus are transparent, in the outer periphery of the turbid area, there is a "V" shaped turbid ride across the turbidity Before and after the belt, called the "riding child", because the central part of the nucleus is transparent, the influence of vision is not very serious. The disease occurs because the crystal has a turbidity in the metabolic disorder of the embryo at a certain period, and it can also be accompanied by the whole body. Other systemic diseases, autosomal dominant inheritance, have been reported in the literature for up to 11 generations in a vertical lineage, and 132 out of 542 people are patients with nuclear cataract.

6, anterior axil embryonic cataract (this type of cataract is also a more common congenital cataract, accounting for about 25%, after the first Y-slot there are many white shards or white crystal turbidity, these Turbidity is formed in the first 4 months of the embryonic period. Due to the limitation of turbidity, there is no significant influence on vision, so generally no treatment is needed.

7, anterior polar cataract (anterior polar cataract): This disease is characterized by limited turbidity in the center of the anterior capsule of the lens, the range of turbidity is different, there is no more than 0.1mm small white point turbid; can also be large, and account for The area covered by the pupils is mostly round and can protrude into the crystal cortex or protrude into the anterior chamber. Even the prominent front part touches the cornea, called the pyramidal cataract, which corresponds to the center of the cornea. White localized turbidity, part of the iris residual membrane, the crystal nucleus of the anterior cataract is transparent, indicating that the capsule of the late embryo is damaged, the capsule membrane reacts abnormally to form a white mass, and the turbid mass can be pulled out with a needle. Maintain the integrity of the crystal capsule, bilateral disease, static development, no obvious impact on vision, can not be treated.

8, posterior po1arcataract (posterior po1arcataract): This disease is characterized by localized opacity of the central region of the posterior capsule, irregular edges, different shapes, disc-shaped, nucleus or flower-like, often accompanied by permanent vitreous artery The central part of the opacity is the termination area of the vitreous artery. A few lesions are progressive, most of them are static and there is little serious vision loss. In adolescence, the turbidity of the posterior pole develops into the cortical area, forming radial turbidity. Vision has a certain impact.

9. Sutural cataract: The clinical manifestation of this disease is abnormal calcium deposition along the Y-slot of the fetal nucleus. It is three radial white lines, so it is also called tri-radiate catarct. ), a linear, nodular or branch-like opacity point constitutes a y-shaped cataract, greenish white or blue, the edges are not neat, generally limited, not developed, has little effect on vision, generally does not require treatment There are often family history, and there are reports of serial passages: autosomal dominant inheritance, combined with coronary cataract or azure cataract.

10, coral cataract (coralliform cataract): coral cataract is rare, in the central region of the crystal has a rounded rectangular gray or white turbidity, radiating outward to the capsule, shaped like a cluster of forward-grown coral, central The nucleus is also turbid, which has a certain influence on vision. Generally, it does not develop at rest, and has a family history. It is an autosomal dominant recessive inheritance.

11, punctate cataract (punctate cataract): the body cortex or nucleus has white, blue-green or light brown point turbidity, occurs in postnatal or adolescence, turbidity does not develop, general vision has no effect, or only in light Vision loss, sometimes combined with other types of turbidity.

12, discoid cataract (disciform cataract): This disease was discovered by Nettleship et al in the Coppock family of congenital cataracts, hence the name Coppock cataract, which is characterized by a clear disc-shaped opacity between the nucleus and the posterior pole The clear cortex separates the turbid area from the posterior pole. Because the range of turbidity does not affect vision, the opacity of the crystal occurs in the fourth month of the embryonic stage, which may be related to the local metabolic abnormality of the crystal.

13, disc-shaped cataract (disc-shaped cataract): disc-shaped cataract is relatively rare, the pupil area of the crystal has a dense turbidity, central calcification, and thin, flat plate, hence the name disc-shaped cataract, due to crystal no The nucleus, the central part becomes thinner, and when it is transversely cut, it has a distinct genetic tendency.

14. Hard liquefied cataract: Hard liquefied cataract is rare. Due to the liquefaction of the peripheral crystal fiber layer, there is a translucent milky liquid in the crystal capsule. The brown embryonic nucleus floats in the liquefied cortex, sometimes the nucleus also liquefies. When the cortex is liquefied, the capsule may be damaged to reduce permeability, the crystal protein may be stimulated to stimulate the ciliary body, or the nuclear floating stimulates the ciliary body, so that uveitis or glaucoma may occur.

Examination of congenital cataract

Congenital cataracts have different causes and different clinical manifestations. The following laboratory tests should be completed for a clear diagnosis.

1. Congenital cataract combined with malformations of other systems. These patients may be chromosomal diseases, so karyotype analysis and zoning examination should be completed.

2, diabetes, neonatal hypoglycemia should check blood sugar, urine sugar and ketone body.

3, nephropathy combined with congenital cataract should check urine routine and urine amino acid to confirm the diagnosis of Lowe syndrome, AIport syndrome.

4, phenylketonuria phenylpyruvic acid (phenylpyruvic acid) test positive, urine ferric chloride test positive.

5, hypoparathyroidism: serum calcium decreased, serum phosphorus increased, serum calcium below 1.92mmoI have low calcium cataract.

6, galactosemia: In addition to screening for galactose urine, galactose-phosphate-diuretic transferase and galactose kinase should be investigated.

7, homotypic urinary urinary tract: should be done qualitative test of homotypic urinary urine, positive sodium borohydride test can confirm the disease.

8. Determination of amino acids: The determination of blood amino acid levels by using an automatic amino acid analyzer can diagnose certain metabolic diseases with congenital cataracts, such as tyrosineuria and arginine.

9. Rubella syndrome: After the mother is infected with rubella virus, the serum of the acute phase or recovery period is taken, and the serum antibody titer is measured. If it is 4 times higher than normal, it is a positive result.

Because congenital cataract may also be combined with other eye diseases, in addition to the above necessary laboratory tests, B-ultrasound, electroretinogram, visual evoked potential and other items should be examined, not only can other ocular lesions and functional conditions be examined, but also Predicting visual recovery after cataract surgery.

Diagnosis and diagnosis of congenital cataract

Differential diagnosis

Newborns have a white reflex in the pupil area called white sputum (1eukocoria), the most common of which is congenital cataract, and other eye diseases can also be caused by their clinical manifestations, treatment and prognosis, timely and correct identification Diagnosis is very necessary.

1, retinopathy of prematurity (post-crystal fibroplasia) This disease occurs in premature infants with low body weight, inhalation of high concentrations of oxygen may be the cause of the disease, the incidence of both eyes, the main lesion is the formation of fibrous vascular tissue behind the lens, and Cardiac traction of the ciliary body, cataract and retinal detachment can occur at the same time, retinal vasodilation is distorted, neovascularization and edema in the peripheral retina, fibrous vascular tissue behind the crystal, pulling the ciliary body toward the central part, resulting in cataract Detach from the retina.

2, permanent survival of the original vitreous: children with full-term delivery, mostly single-eyed thinking, thinking eyeball is small, anterior chamber shallow, crystal is relatively small, ciliary process is very long, can reach the posterior pole of the crystal, after the crystal The vascular fiber membrane is rich in blood vessels, and the crystals in the posterior pole are turbid, and the iris-crystal compartment moves forward.

3, inflammatory pseudoglioma: mostly for the incidence of both eyes, a few for a single eye, there are white plaques behind the crystal, the eyeball becomes smaller, the intraocular pressure is reduced, the cause of the disease is in the last 3 months of embryonic development, in the uterus It is caused by mother's infection or by intraocular neonatal endophthalmitis.

4, retinoblastoma: is the most common intraocular malignant tumor in childhood, although most occur before the age of 2 to 3 years old, but it can also occur very early, can see white pupils within a few days after birth, because the tumor is milky white or Yellow-white, when it grows to a certain size, the light entering the eye is reflected as yellow-white, the tumor continues to grow and cause retinal detachment, the surface has calcification, the intraocular pressure rises, and finally the glaucoma and extraocular transfer.

5, outer exudative retinitis (Coats disease): the retina has white-yellow lesions, mild uplift, the surface of new blood vessels and microangioma, telangiectasia, severe cases of retinal detachment, white pupil reflex, late iris Neovascularization, secondary glaucoma and iridocyclitis, typical changes to retinal vascular abnormalities and retinal oozing lesions, lesions can be located in any quadrant of the fundus, but the most common side of the temporal side, single or multiple lesions visible in the fundus, lesions The retina has a yellow-white bulge, interstitial or lipid-like exudation, and retinal arteries and veins are involved, especially in the arteries. The blood vessels are dilated, distorted, and the diameter of the tube is uneven. The cystic, fusiform expansion can be arranged in a bead-like manner. There are neovascular and hemangiomas.

6, retinal dysplasia: the child is a full-term delivery, the eyeball is small, the anterior chamber is very shallow, there are white tissue mass after the crystal and white pupil, often combined with brain dysplasia, congenital heart disease, cleft palate and multi-finger malformation .

7. Congenital Toxoplasmosis: This disease has been reported in China in recent years. It is characterized by recurrent intraocular inflammation, and finally the pigmented scar of the chorioretinal remnant. The lesion is more common in the macula, and thus has the performance of white pupil. There may be hepatosplenomegaly, jaundice, hydrocephalus and brain calcification, Toxoplasma gondii indirect blood agglutination test positive, Toxoplasma gondii indirect immunofluorescence antibody test positive, can make a diagnosis.

8, toxocariasis (toxocariasis): the child's fundus has granuloma formation, clinically divided into two types, one is the posterior pole of the active inflammatory choroidal retinal granuloma, one is the obvious inflammation of the vitreous Turbidity, both can cause white pupil reflex, ask history, and have a history of contact with animals (cats and dogs).

Other rare cases of white diarrhea include Nonie's disease, defect in the posterior pole of the fundus, vitreous hemorrhage, and severe retinal gliosis.

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