Cataract

cataract

1. CATARACT

2. INTRODUCTION Cataract is a vision-impairing disease characterized by thickening of lens. The amount of incoming light is reduced due to cloudiness of lens that affects vision which is often being similar looking through a waterfall or waxed paper. Cataract is age related disorder which is the most ancient disease to man

3. DEFINITION A cataract is an opacification of the lens of the eye which leads to a decrease in vision. Cataracts often develop slowly and can affect one or both eyes. Symptoms may include faded colors, blurry or double vision, halos around light, trouble with bright lights, and trouble seeing at night.

4. CAUSES An overproduction of oxidants, which are oxygen molecules that have been chemically altered due to normal daily life Smoking Ultraviolet radiation The long-term use of steroids and other medications Certain diseases, such as diabetes Trauma Radiation therapy

5. RISK FACTORS Older age Heavy alcohol use Smoking Obesity High blood pressure Previous eye injuries A family history of cataracts Too much sun exposure Diabetes Exposure to radiation from X-rays and cancer treatments

6. TYPES Nuclear Cataracts Cortical Cataracts Posterior Subcapsular Cataracts Anterior Subcapsular Cataracts Congenital Cataracts Traumatic Cataracts Secondary Cataracts Radiation Cataracts Lamellar or Zonular Cataracts Posterior Polar Cataracts Anterior Polar Cataracts Post-Vitrectomy Cataract Diabetic Snowflake Cataracts Christmas Tree Cataracts Brunescent Cataracts

7. TYPES Nuclear Cataracts Also called a nuclear sclerotic cataract. They form in the center of the lens, known as the nucleus. As they get worse, your reading  vision  may actually get better at first. It's called second sight, but it's short lived.  the lens hardens and turns yellow or even brown. You have a hard time seeing small details, colors get less rich, and you see  halos  around bright objects at night.

8. 2.Cortical Cataracts . These take shape on the outside edge of your lens, called the cortex. They start as white wedges, like triangles that point toward the center of your  eye . As they grw , they scatter light. These  cataracts , the main symptom is glare. may find it hard to drive at night. They can also make your vision hazy, like you're looking through a fog. may find it hard to tell similar colors apart or to judge how far away an object is. Since they can spell trouble for both near and distance  vision , typically get them removed early on. .

9. 3.Posterior Subcapsular Cataracts cataracts  form just inside the back of the lens capsule -- the part of the eye  that surrounds the lens and holds it in place. They're directly in the path of light as it passes through the lens. They're quicker to come on than other cataracts, and you may get symptoms within months. They affect your close-up vision and make it harder to see in bright lighting.

10. 4.Anterior Subcapsular Cataracts This type forms just inside the front of your lens capsule. An injury or welling in your eye can lead to one. So can type of eczema called atopic dermatitis.

11. 5.Congenital Cataracts Congenital cataracts  refers to a  lens opacity   present at birth.   Congenital   cataracts   cover broad spectrum of severity: whereas some lens opacities do not progress and are visually insignificant, others can produce profound visual impairmentCongenital cataracts may be   unilateral  

12. 6.Traumatic Cataracts Many kinds of injuries can lead to a cataract. You can get one if you're hit inthe eye a ball or get hurt from a  burn , chemical, or splinter byThe cataract could come on soon after the injury or not show up until years later.

13. 7.Secondary Cataracts When another condition or a medical treatment leads to a cataract, doctors call it secondary.  Diabetes , taking  steroids  like  prednisone , and even cataract surgery are possible causes.

14. 8.Radiation Cataracts From the sun's ultraviolet (UV) radiation, but it can take a toll on your eyes, too. You can sometimes get cataracts if you spend too much time in the sun without eye protection. People who work outdoors, like fishermen and farmers, are more likely to get this kind of cataract. To prevent it, wear  sunglasses  with 100% UVA and UVB protection. Cataracts are also a possible side effect from radiation therapy for cancer .

15. 9.Lamellar or Zonular Cataracts This type typically shows up in younger children and in both  eyes . The genes that cause them are passed from parent to child. These cataracts form fine white dots in the middle of the lens and may take on a Y shape. Over time, the whole center of the lens may turn white.

16. 10 . Posterior Polar Cataracts These on the back center of the lens, and they're often due to genes that are pased down through your family. Posterior polar cataracts often don't cause, which is a big plus since they're hard to remove.

17. 11.Anterior Polar Cataracts They form on the front and center of your lens, and look like small white dots.

18. 12.Post-Vitrectomy Cataracts Vitrectomy is surgery to remove the vitreous, the clear gel at the center of your eye. The operation can help with certain  eye problems  but may lead to a cataract.

19. 13.Diabetic Snowflake Cataracts This is a rare type of cataract that can happen if you have diabetes. It gets worse quickly and forms a gray-white pattern that looks like a snowflake.

20. 14.Christmas Tree Cataracts A Christmas tree cataract is a rare age-related change resulting from accelerated breakdown of membrane-associated denatured proteins induced by elevated calcium levels. The peptides and amino acids accumulate in the lumen of the reticular meshwork, and cysteine is concentrated beyond the level of crystallization causing the formation of needles, that impart the fascinating appearance of a Christmas tree in the eye. Christmas tree cataracts have also been seen in patients with myotonic dystrophy

21. 15.Brunescent Cataracts If don't treat a nuclear cataract, it turns very hard and brown. When that happens, it's called brunescent This kind of cataract makes it hard for you to tell colors apart, especially blues and purples. Surgery to remove it is harder, longer, and riskier than when treated earlier on.

22. SIGNS AND SYMPTOMPS OF CATARACT Clouded, blurred or dim vision Increasing difficulty with vision at night Sensitivity to light and glare Need for brighter light for reading and other activities Seeing "halos" around lights Frequent changes in eyeglass or contact lens prescription Fading or yellowing of colors Double vision in a single eye

23. MANAGEMENT counseling the patient about cataract symptoms and how it may affect daily activities advising the patients about minimizing their exposure to risk factors e.g. - cessation of smoking, control of diabetes, alternate medications for people on oral or inhaled corticosteroids. prescribing spectacles or contact lenses to improve vision using brimmed hats or sunglasses to minimize glare

24. SURGICAL MANAGEMENT Phacoemulsification  ( phaco ) is the most common technique used in developed countries. It involves the use of a machine with an ultrasonic handpiece equipped with a titanium or steel tip. The tip vibrates at ultrasonic frequency (40,000 Hz) and the lens material is  emulsified . A second fine instrument (sometimes called a "cracker" or "chopper") may be used from a side port to facilitate cracking or chopping of the nucleus into smaller pieces. Fragmentation into smaller pieces makes emulsification easier, as well as the aspiration of cortical material (soft part of the lens around the nucleus). After phacoemulsification of the lens nucleus and cortical material is completed, a dual irrigation-aspiration (I-A) probe or a bimanual I-A system is used to aspirate out the remaining peripheral cortical material.

25. 2.Extracapsular cataract extraction ( ECCE): Extracapsular cataract extraction involves the removal of almost the entire natural lens while the elastic lens capsule (posterior capsule) is left intact to allow implantation of an intraocular lens ]  It involves manual expression of the lens through a large (usually 10–12 mm) incision made in the  cornea  or  sclera . Although it requires a larger incision and the use of stitches, the conventional method may be indicated for patients with very hard cataracts or other situations in which phacoemulsification is problematic 3.Manual small incision cataract surgery (MSICS): This technique is an evolution of ECCE (see below) where the entire lens is expressed out of the eye through a self-sealing  scleral  tunnel wound. An appropriately constructed scleral tunnel is watertight and does not require suturing. The "small" in the title refers to the wound being relatively smaller than an ECCE, although it is still markedly larger than a phaco wound. Head-to-head trials of MSICS vs phaco in dense cataracts have found no difference in outcomes, but shorter operating time and significantly lower costs with MSICS .

26. 4 .Intracapsular cataract extraction[ICCE] involves the removal of the lens and the surrounding lens capsule in one piece. The procedure has a relatively high rate of complications due to the large incision required and pressure placed on the  vitreous body . It has therefore been largely superseded and is rarely performed in countries where  operating microscopes  and high-technology equipment are readily available. After lens removal, an artificial  plastic  lens (an  intraocular lens  implant) can be placed in either the anterior chamber or sutured into the  sulcus . 5.Femtosecond  laser-assisted cataract surgery has been shown to have no visual, refractive or safety benefit over manual phacoemulsification. 6.Cryoextraction  is a form of ICCE that freezes the lens with a cryogenic substance such as  liquid nitrogen . In this technique, the cataract is extracted through use of a  cryoextractor  — a  cryoprobe  whose refrigerated tip adheres to and freezes tissue of the lens, permitting its removal. Although it is now used primarily for the removal of  subluxated  lenses, it was the favored form of cataract extraction from the late 1960s to the early 1980

27. Intraocular lenses come in three basic forms : monofocal , astigmatic ( toric ), and multifocal lenses . 1. Monofocal lenses   are the most commonly implanted lenses. They have the same power in all areas of the lens. They can have a fixed focus or allow for changes in focus. Fixed Focus Monofocal IOLs  can provide excellent distance vision. However, since these lenses have a fixed focus set for distance vision, you may need to use reading glasses for good near vision. Accommodating Monofocal IOLs  are a relatively new lens option that can be used for patients who want both good distance and near vision without the use of eyeglasses or contact lenses. These lenses also have a single focusing power. However, they can shift from focusing on distance objects to focusing on near ones by physically moving inside the eye in response to the focusing action of the eye muscles. Like with all things new, there can be a learning curve to working with specialty implants. 2.Astigmatic ( toric ) IOLs   have astigmatism correction in them. They can be used for patients who have a lot of astigmatism and want to reduce it. 3.Multifocal lenses   are like bifocal eyeglasses. Several areas of the lens have different powers, which allow individuals to see clearly at far, intermediate and near distances. However, these multifocal lenses are not suitable for everyone. For some individuals, they may cause more problems with night vision and glare than monofocal IOL lenses.

28. one week before cataract surgery, you will have an appointment with your eye doctor to perform a few tests. These tests are painless and allow the doctor to determine which lens implant to use during your surgery . How to prepare for surgery eye care provider may give you eye drops or medication to take the evening before the surgery. Make certain you follow those instructions precisely. You will also need to abstain from alcohol the night before your cataract surgery. Make sure your eye care provider knows if you take other medications regularly as certain medications may need to be taken differently. Do not eat or drink past midnight (unless otherwise instructed by your doctor), and try to get a good night’s rest. If you are stressed or worried about the procedure, talk to your eye care provider and primary care physician about options available to help you relax this night. . Eye Drops: You will be using 3 eye drops; use is detailed below starting the day before surgery. • Ofloxacin OR Zymar (beige cap) this is an antibiotic eye drop to help prevent infection. • Cyclopentolate dilating drop (red cap) this drop helps ready your eye for surgery. • Prednisolone Acetate 1%. This reduces inflammation after surgery.

29. may feel slightly gritty or scratchy for the first 24-48 hours after cataract surgery. Your vision may be blurry due to dilation and antibiotic ointment that is sometimes instilled directly after the operation. You will be given a few different eye drops to use for the next couple of weeks after surgery.  These eye drops are used to prevent infection and to manage inflammation. After care of surgery should avoid touching and rubbing the eye. to sleep with a protective eye patch at night to avoid an accidental finger in your eye. For the first few days after surgery, it is okay to use your eyes to read, write or watch television. You should avoid bending over and lifting heavy objects for the first week or two following surgery.

30.   Complications of cataract surgery? Infection  Inflammation   Swelling Retinal detachment  Posterior capsular haze  The capsule behind the new lens implant can thicken and become hazy following cataract surgery. A simple  laser procedure  known as " Yag capsulotomy " can be performed to remove this hazy capsule.

31. CATARACT SURGERY VEDIO

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