Cataract

CATARACT OF LENS BY DNYANESHWAR BHAGWAN POTFODE
OPHTHALMIC OFFICER

1. Cataract DNYANESHWAR B. POTFODE OPHTHALMIC OFFICER

2. Normal lens structure The lens is a transparent, biconvex, crystalline structure placed between iris and the vitreous in a saucer shaped depression the patellar fossa . It has got two surfaces: the anterior surface is less convex than the posterior . These two surfaces meet at the equator. Its refractive index is 1.39 and total power is 15-16 D

3. Crystalline lens structure

4. Cataract Definition :- The crystalline lens is a transparent structure. Its transparency may be disturbed due to degenerative process leading to opacification of lens fibers. Development of an opacity in the lens is known as cataract .

5. cataract

6. Etiology of ctaract I. Congenital and developmental cataract II. Acquired cataract 1 . Senile cataract 2 . Traumatic cataract 3 . Complicated cataract 4 . Metabolic cataract 5 . Electric cataract 6 . Radiation cataract

7. Etiology of ctaract 7. Toxic cataract e.g., i Corticosteroid-induced cataract ii. Miotics -induced cataract iii. Copper and iron 8. Cataract associated with skin diseases 9. Cataract associated with osseous diseases.

8. Etiology of ctaract 10. Cataract with miscellaneous syndromes i . Dystrophica myotonica ii. Down's syndrome. iii. Lowe's syndrome iv. Treacher - Collin's syndrome

9. Traumatic cataract

10. Rediational cataract

11. Morphologically classification

12. Congenital and developmental cataract 1. Anterior capsular cataracts are nonaxial , stationary and visually insignificant . 2. Posterior capsular cataracts are rare and can be associated with persistent hyaloid artery remnants

13. Congenital cataract

14. Etiology of congenital cataract I. Heredity . II. Maternal factors 1. Malnutrition 2. Infections 3. Drugs ingestion . 4. Radiation III. Foetal or infantile factors 1. Deficient oxygenation 2. Metabolic disorders 3. Cataracts associated with other congenital Anomalie 4. Birth trauma 5. Malnutrition IV . Idiopathic

15. Management of congenital and developmental cataract 1. Ocular examination Density and morphology of cataract Assessment of visual function Associated ocular defects 2. Laboratory investigations Intrauterine infections Galactosemia Lowe's syndrome Hyperglycemia Hypocalcemia

16. Surgical procedures Childhood cataracts , ( congenital, developmental as well as acquired) can be dealt with anterior capsulotomy and irrigation aspiration of the lens matter or lensectomy .

17. 1. Senile cataract Also called as ‘age-related cataract’, this is the commonest type of acquired cataract affecting equally persons of either sex usually above the age of 50 years . By the age of 70 years, over 90% of the individuals develop senile cataract. The condition is usually bilateral, but almost always one eye is affected earlier than the other.

18. Senile cataract

19. Etiology of senile cataract Senile cataract is essentially an ageing process. Though its precise etiopathogenesis is not clear,

20. Factors affecting age of onset, type and maturation of senile cataract. Heredity Ultraviolet ray Dietary factor Dehydration Smoking

21. Causes of presenile cataract. The term presenile cataract is used when the cataractous changes similar to senile cataract occur before 50 years of age. Heredity DM Myotonic dystrophy Atopic dermatitis

22. Clinical feature S ymptomes Glare Uniocular polyopia Colour haloes Black spot Distorsion of vision Loss of vision

23. Clinical feature Sign :- 1 . Visual acuity testing. 2 . Oblique illumination examination . 3. Test for iris shadow 4. Distant direct ophthalmoscopic examination 5. Slit-lamp examination

24. Stages of cataract ISC Imature senile cataract NMSC - Near mature senile cataract MSC - Mature senile cataract HMSC - Hypermature senile cataract

25. Early nuclear senile cataract.

26. Signs of senile cataract

27. Grading of nucleus hardness

28. Differences between mature senile cataract and leukocoria

29. Complication of cataract 1. Phacoanaphylactic uveitis 2. Lens-induced glaucoma 3. Subluxation or dislocation of lens.

30. METABOLIC CATARACTS These cataracts occur due to endocrine disorders and biochemical abnormalities Diabetic cataract Galactosaemic cataract Hypocalcaemic cataract Cataract due to error of copper metabolism Cataract in Lowe's syndrome Lowe’s syndrome is a rare inborn error of amino acid metabolism

31. COMPLICATED CATARACT Etiology 1. Inflammatory conditions 2. Degenerative conditions 3. Retinal detachment 4. Glaucoma (primary or secondary ) 5. Intraocular tumours

32. RADIATIONAL CATARACT Exposure to almost all types of radiant energy is known to produce cataract by causing damage to the lens epithelium 1. Infrared (heat) cataract 2. Irradiation cataract 3. Ultraviolet radiation cataract

33. ELECTRIC CATARACT It is known to occur after passage of powerful electric current through the body. The cataract usually starts as punctate subcapsular opacities which mature rapidly . The source of current can be a live electricity wire or a flash of lightning

34. Corticosteroid-induced cataract Posterior subcapsular opacities are associated with the use of topical as well as systemic steroids

35. MANAGEMENT OF CATARACT IN ADULTS Surgical management Preoperative evaluation I. General medical examination of the patient diabetes mellitus hypertension cardiac problems obstructive lung disorders

36. II. Ocular examination Light perception (PL ). A test for Marcus-Gunn pupillary Projection of rays (PR ). Two-light discrimination test Search for local source of infection Anterior segment evaluation by slit-lamp examination . Intraocular pressure (IOP) measurement

37. Slit lamp examination

38. IOP test

39. Preoperative medications and preparations 1. Topical antibiotics 2. Preparation of the eye to be operated 3. An informed and detailed consent 4. Scrub bath and care of hair . 5. To lower IOP 6. To sustain dilated pupil

40. Antibiotics drop

41. Anaesthesia Cataract extraction can be performed under general or local anaesthesia Zylocaine 2%

42. Peribulbar injection

43. Cataract surgery I. Intracapsular cataract extraction (ICCE ) II. Extracapsular cataract extraction (ECCE ). Manual small incision cataract surgery (SICS), Phacoemulsification

44. Surgical step

45. Postoperative complication Dislocation of lens Infection Corneal oedema SBH

46. Displacements of lens

47. Anterior dislocation

48. Posterior dislocation

49. Diabetes retinopathy