Atlas of Ophthalmology

Christmas Tree Cataract (Colour Photography)

Lens -> Senile Cataract -> Mixed Cataract
Patient: 68 years old, male, BCVA 1.0 at OD, 0.5 at OS, IOP 14/14 mmHg. Ocular medical history: slow decrease of vision in OS. General medical history: stenosis of ispilateral internal carotid artery, stroke in 2005. Main complaint: glare and decrease of vision at OS. Methods: colour photography. Findings: Colour photography showed highly refractile multicolored "needles" crisscrossing the lens fibers. Discussion: Christmas tree cataract consists of highly refractile multicolored "needles" crisscrossing the lens fibers of the deep cortex. The fact that the colors vary according to the angle of the incident light, and that in retroillumination only a dim outline of the cataract is seen, would suggest that Christmas tree cataract is a diffractive phenomenon. In a study 8 lenses with Christmas tree cataract were investigated by scanning and transmission electron microscopy (1). They found that the needles are smooth, rectangular, plate-like elements bordered by membranes and amorphous material and running crisscross through the lens. The needles proved to be largely dissolved, but the remains showed regular spacings of approximately 5 nm. The needles have a high sulfur content and pronounced S-S, CS-SC, and C-S vibrations. The cytoplasm adjacent to the needles and reticular meshwork had an elevated Ca++ content. They concluded that cystine is the most likely candidate for the Christmas tree needles and that the needles probably are formed as the result of an age-related aberrant breakdown of crystallins induced by elevated Ca++ levels. Literature: (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 Dec;34(13):3489-96.

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