An 82-year-old woman was referred for surgical repair of a full thickness retinal macular hole associated with profound vision loss in the right eye. She was otherwise healthy, and had no history or family history of muscle weakness. Slit-lamp examination revealed needle-like polychromatic crystals within the deep cortex of the crystalline lens (A). With retroillumination, in which the angle of light is perpendicular to the cataract, only an outline of the crystals are seen (B). At others angles of incident light, these refractile lenticular inclusions demonstrated a variety of colors, including pink, green, blue, red and gold, reminiscent of Christmas tree tinsel (C,D). Known as a “Christmas tree cataract,” this form of media opacity is most commonly related to age-related degeneration of crystallin proteins associated with elevated calcium levels in the lens, as in our patient. In a subset of patients, Christmas tree cataracts have an important systemic association: autosomal-dominant myotonic dystrophy. While these cataracts are often not visually significant, they can progress and impair vision. In this case, vision loss was secondary to the macular hole, but the patient deferred vitreoretinal surgery.
Slit-lamp examination (A,C,D) and retroillumination (B) of a Christmas tree cataract showing polychromatic crystals of gold, green, blue, red and and gold within the substance of the crystalline lens.
Acknowledgments
R.C.R. is supported by NIH/NEI K12EY022299. This sponsor had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.
Footnotes
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Contributor Information
Rajesh C. Rao, Department of Ophthalmology & Visual Sciences, Department of Pathology, University of Michigan, Ann Arbor, MI 48105 USA.
Netan Choudhry, Director, Vitreoretinal Surgery, Toronto, Ontario, Canada.