Cataract

most common ophthalmic disorder seen in all over world. in India 2015 incidence of cataract patient was 62.6 % (9 million). so the awareness and the management is very important for this disease condition. i hope this presentation is very helpful to all the student and people to understanding the cataract refractive ophthalmic disease

2. The lens
It’s crystalline.
Cross section:
1.Capsule
2.Cortex
3.nucleus

3. Ciliary muscle
•Function:
•Constricts ciliary body
•Relaxes tension on lens
•Lens become spherical,
which increase the
refractive power
Ciliary process
•Attaches to the lenses by
suspensory ligament (zonular
fibers)
•Secrete the Aqueous humor
into the post. chamber

4. DEFINITION
•A cataract is a clouding or capacity that
develops in the crystalline lens of the eye or
in its envelope, varying in degree from slight
to capacity and obstructing the passage of
light.
•The term cataract is derived from the Greek
word cataractos, which describes rapidly
running water or falling water.

7. Epidemiology
1.Cataracts remain the
leading cause of blindness.
2.Age-related cataract is
responsible for 48% of
world blindness, which
represents about 18
million people.
3.Cataracts are also an
important cause of low
vision in both developed
and developing countries.

8. Causes of cataract
•Old age (commonest)>65 Year
•Ocular & systemic diseases
–DM
–Uveitis
–Previous ocular surgery
•Systemic medication
–Steroids
–Phenothiazines
•Trauma & intraocular foreign
bodies
•Ionizing radiation
–X-ray
–UV
•Congenital
–Part of a syndrome
–Abnormal galactose
metabolism
–Hypoglycemia
•Inherited abnormality
–Myotonic dystrophy
–Marfan’s syndrom
–Rubella
–High myopia
8

9. Any physical or chemical cause
↓
Disturbs the intracellular and extracellular equilbrium of water and
electrolytes
↓
Deranges the colloid system in lens fibres
↓
Aberrant fibres are formed from germinal epithelium of lens
↓
Epithelial cell necrosis
↓
Focal opacification of lens epithelium
(glaucomflecken)
↓
Opacification of lens

PATHOMECHANISM

10. Opacification of lens takeplace by 3 biochemical changes.
1.Hydration 2.Denaturation of 3.Slow

lens protein sclerosis

Abnormalities of lens proteins
&
Disorganisation of lens fibres
Loss of transparency of lens

Cataract

11. CLASSIFICATION :
BASED ON :
•MORPHOLOGY
•AGE OF ONSET
•MATURITY
•ETIOLOGY

12. Cataract
Divided to :
•Acquired cataract
Age - related cataract
Metabolic cataract
Radiation or electric cataract
Traumatic cataract
Toxic cataract
Secondary cataract

13. AGE OF ONSET:
1.CONGENITAL
2.INFANTILE
3.JUVINILE
4.PRE-SENILE
5.SENILE

14. CONGENITAL CATARACT

15. INFANTILE AND JUVINILE CATARACT

16. Age -related cataract
It is the Most commonly occurred.
Classified according to:
Morphological Classification
•Capsular cataract
•Sub capsular cataract
•Cortical cataract
•Supra nuclear cataract
•Nuclear cataract
•Polar cataract

17. Nuclear cataract
•Most common typeMost common type
•Age-relatedAge-related
•Occur in the Occur in the centercenter of of
the lens.the lens.
•It involves the nucleus It involves the nucleus
of the crystalline lens. of the crystalline lens.
The nucleus becomes The nucleus becomes
diffusely cloudy and diffusely cloudy and
obstructs the light rays.obstructs the light rays.

18. Cortical cataract
•Occur on the outer edge of the lens (cortex).
•Begins as whitish, wedge-shaped opacities.
•The lens fibers of the cortex are mainly affected. There is
hydration due to accumulation of water droplets in between the
fibers and the protein are first denaturated and then are
coagulated forming opacity.

20. Subcapsular cataract
•It involves superficial part of the cortex(just
below the capsule) and includes anterior sub
capsule or posterior sub capsule.
capsular cataract
•It involves the capsule and may be
anterior capsule or posterior capsule.

22. MATURITY:
1.IMMATURE CATARCT
2.MATURE CATARACT
3.HYPERMATURE CATARACT

23. MATURE AND IMMATURE CATARACT

24. Mature Cataract
•Lens is completely opaque.
•Vision reduced to just perception of light
•Iris shadow is not seen
•Lens appears pearly white
Right eye mature cataract, with obvious
white opacity at the centre of pupil

25. IMMATURE CATARACT

26. Hypermature Cataract
•Shrunken and wrinkled anterior capsule due to leakage of water
out of the lense.
•This may take any of two forms:
1.Liquefactive/Morgagnian Type
2.Sclerotic Cataract

27. Liquefactive/Morgagnian Type
•Cortex undergoes auto-lytic liquefaction and turns uniformly
milky white.
•The nucleus loses support and settles to the bottom.

28. Sclerotic Cataract
•The fluid from the cortex gets absorbed
and the lens becomes shrunken.
•There may be deposition of calcific
material on the lens capsule.
•Iridodonesis: Anterior chamber
deepens and iris becomes tremulous.
•The zonules become weak, increasing
the risk of subluxation / dislocation of
lens.

29. SUBJECTIVE
CLASSIFICATION:
•GRADE 0: CLEAR LENS
•GRADE 1: SWOLLEN FIBRES AND SUB
CAPSULAR OPACITIES
•GRADE 2: NUCLEAR CATARACT AND
VISIBLE LENS FIBRES
•GRADE 3: STRONG NUCLEAR CATARACT
WITH PERINUCLEAR AREA OPACITY
•GRADE 4: TOTAL OPACITY

30. SUBJECTIVE CLASSIFICATION

31. Clinical Manifestations
•Gradual painless
burning
•Loss of vision due to
lens opacity
•Increased glare in
bright light
•Decreased color
perception
•Decreased visual
acuity
•Poor vision at night
•Photophobia(light Photophobia(light
sensitivity)sensitivity)
•Blurred or distorted imagesBlurred or distorted images
•Light scatteringLight scattering
•Leukokoria or white pupilLeukokoria or white pupil
•Reduced light transmissionReduced light transmission
•Contrast sensitivity is also Contrast sensitivity is also
lostlost

32. BLURRED VISION DUE TO SCATTERING
OF LIGHT ON THE RETINA

34. GLARED VIEW(TROUBLE DRIVING AT
NIGHT)

35. CHANGE IN COLOUR VISION(DIMNESS)

36. 1.History collection
2.Visual acuity test
3.Dilated eye exam
4.Tonometry

37. Treatment
•Glasses: Cataract alters the refractive power of the natural lens
so glasses may allow good vision to be maintained.
•Surgical removal: when visual acuity can't be improved with
glasses.
•Surgical techniques
–Phacoemulsification method.
–Extracapsular cataract extraction.
–Intra capsular cataract extraction.
–Intraocular lens implantation
–cryosurgery

38. Phacoemulsification in cataract surgery
involves insertion of a tiny, hollowed tip that
uses high frequency (ultrasonic) vibrations to
"break up" the eye's cloudy lens (cataract). The
same tip is used to suction out the lens
.

41. Intra-capsular Cataract Extraction
Intracapsular Cataract Extraction. From the late 1800s
until the 1970s, the technique of choice for cataract
extraction was intracapsular cataract extraction
(ICCE). The entire lens (ie, nucleus, cortex, and
capsule) is removed, and fine sutures close the
incision. ICCE is infrequently performed today;
however, it is indicated when there is a need to
remove the entire lens, such as with a subluxated
cataract (ie, partially or completely dislocated lens).

42. Extra-capsular Cataract Extraction
(ECCE)
•Extracapsular Surgery. Extracapsular cataract
extraction (ECCE) achieves the intactness of
smaller incisional wounds (less trauma to the
eye) and maintenance of the posterior capsule
of the lens, reducing postoperative
complications, particularly aphakic retinal
detachment and cystoid macular edema.

43. Postoperative care after cataract
surgery
•Steroid drops (inflammation)
•Antibiotic drops (infection)
•Avoid
•Very strenuous exertion (rise the pressure in the eyeball)
•Ocular trauma.

44. Complications of cataract surgery
•Infective endophthalmitis
–Rare but can cause permanent severe reduction of vision.
–Most cases within two weeks of surgery.
–Typically patients present with a short history of a
reduction in their vision and a red painful eye.
–This is an ophthalmic emergency.
–Low grade infection with pathogen such as
Propionibacterium species can lead patients to present
several weeks after initial surgery with a refractory uveitis
•Suprachoroidal haemorrhage.
–Severe intraoperative bleeding can
lead to serious and permanent
reduction in vision.

45. •Uveitis
•Ocular perforation.
•Postoperative refractive error
•Posterior capsular rupture and
•vitreous loss

46. Retinal detachment.
Cystoid macular oedema
Glaucoma
Posterior capsular opacification

47. Nursing diagnosis
•Anxiety related to lack of knowledge about
post operative care.
•Risk for infection related to surgical incision
and self care after surgery.
•Risk for injury related to sensory deficit while
operated eye is patched.