Diseases of the lens and their types and their clinical manifestationpdf

this pdf contains information about various diseases of lens

1. 广西医科大学
第一临床医学院
第一附属医院
Diseases of the lens
Department of Ophthalmology, Affiliated
First Hospital of Guangxi Medical University
QQ:1053297962
Dr. HUANG LI

2. 广西医科大学
第一临床医学院
第一附属医院
Ready go!

3. Anatomy of the lens
Position: The lens connected with the ciliary
body by the zonule that fixes it behind the iris,
in front of the vitreous.

4. Anatomy of the lens
Anatomy : lens capsule + lens fiber

5. Anatomy of the lens
Physiology :
 transparent and non-blood vessel tissue.

 It is an important part of refractive media of
the globe.

The lens’ nourishment are offered by
aqueous humor.

6. The disorder of the lens
loss of its
transparency
(cataract )
The disorder of the lens

abnormality
of its position
(Ectopia and
dislocation)

7. cataract

8. cataract

 Cataract is the first
cause of blindness in
many country.


There are three million
of cataract sufferer who
are in need of operation
to restore their visions
in china.

9. Classification
According to the age of occurring:

Congenital cataract
Infantile cataract
Juvenile cataract
Adult cataract
Age-related cataract (senile)

10. Classification
According to etiology:
Traumatic cataract : blunt or penetrating
injury
Complicated cataract: uveitis
Metabolic cataract: diabetes
Drug-induced or toxic cataract
After-cataract
Radioactive cataract

11. cataract
Age-related cataract
Congenital cataract
Traumatic cataract
Complicated cataract
Drug-induced or toxic
cataract

12. aged related cataract

It is the most common cataract, often seen
in the olds with age more than 50 years old.
The incidence of the disease is 100% when
the patient exceed 80 years old.

13. aged related cataract
The disease is related with several
factor:(complex)
Oxidative damage
Environment factor,
Lens nourishment and metabolic
condition
hereditary factor
Systemic disease such as diabetes,
hypertension.
Ultraviolet ray, smoking, drinking…

14. Clinical manifestation:
Bilateral disease
Fixed black spot
Visual decrease
without pain
Refraction change
aged related cataract

15. aged related cataract
cortical
Anterior
capsule
Posterior
capsule
subcapsular
Age-related cataract
nuclear
Classification：
（according to the site where cataract begins to form）

16. aged related cataract
cortical
cortical nuclear subcapsular

17. cortical cataract： 4 stages
Incipient stage:
To begin opacity appears at the periphery of
anterior and posterior cortex
The center lens is almost clear, the pupillary
area isn’t affected, commonly without
influencing vision.
To be diagnose after mydriatic under slit-
lamp examination.
develop slowly

18. Incipient stage
cortical cataract： 4 stages

19. Immature stage(intumescent stage)
The opacity gradually becomes obvious
Vision has obviously decreased
The fundus can’t be observed in
Some patient may induce acute angel-closure
glaucoma due to shallow anterior chamber
Iris projection: the characteristic of this stage
cortical cataract： 4 stages

20. Iris projection

cortical cataract： 4 stages

21. Mature stage
All of the lens protein is opaque, pupil
may be white
The iris projection disappeared
The fundus can’t be looked in
Vision decreases to light perception(LP)
or hand motion(HM)，But the light
seeking and color
sensation are in normal.
cortical cataract： 4 stages

22. Hypermature stage
lens diminishes, the capsule shrinks, the
anterior chamber deepens, iridodonesis
Vision may increase suddenly
Morgagnian cataract

cortical cataract： 4 stages

23. When the lens capsule ruptured

Phacolytic uveitis

Phacolytic glaucoma


cortical cataract： 4 stages

24. nuclear cataract
It generally begins at the age of 40
It slowly progress
Opacity starts at the embryonic or adult
nucleus

25. Nuclear opacity is grayish-yellow at first,
then gradually becomes thick in
yellowish-gray brown or brownish-black.
In that time, the fundus can’t be seen.

The nuclear changes often continue
unchanged for a long period(20~30
years), uneasy to be matured.
nuclear cataract

26. deep yellow canary
brown black
nuclear cataract

27. Subcapsular cataract
According to the site where cataract
begins to form
Posterior subcapsular cataract: common
Anterior subcapsular cataract: rare

28. The opacity often occur to the
posterior capsular center, so vision
decreases in early stage.

The cataract may develop to
cortical opaque, then total cataract.
Subcapsular cataract

29. Anterior subcapsular
cataract
Subcapsular cataract

30. Treatment
There isn’t any effective drug to the
age-related cataract.
 operation.
treatment

31. Operative time
At the immature or mature stage
The vision is lower than 0.3 to
influence with patient’s work and
life

32. Preoperative examination
Systemic
Ocular part:
 visual acuity
Slit-lamp microscope
Corneal curvature
 ultrasonography ……

33. Operating method——PHACO
Phacoemulsification
Characteristic:
•transparent corneal incision(<3.2mm)

•To crush the hard lens nucleus to be chyloid with
ultraemulsifier and extracted

•To implant the foldable intraocular lens in the
lens capsular bag

34. Phaco+foldable IOL implantation

35. 爱剪辑-phaco-我的视频 .mp4
Operating method——PHACO

36. strongpoint:
•Self-healing wound ,safe,
•The corneal astigmatism after operation is
fine
•Visual restoration is soon
Shortcoming:
•The apparatus is expensive
•Too hard lens nucleus may not adopt this
method
Operating method——PHACO

37. Extracapsular cataract extraction(ECCE)
and posterior chamber intraocular
lens(IOL) implantation
The corneoscleral tunnel incision(6mm)
The IOL is hard(unfoldable)
The patient can get good vision soon after
operation
The corneal astigmatism after operation is
less than ICCE.
Operating method——ECCE

38. Two methods to extract the lens nuclear
in ECCE
Operating method——ECCE

39. Operating method

40. Unfoldable IOL implantation
IOL implantation

41. Intracapsular cataract extraction
The incision is bigger than ECCE, so
the corneal astigmatism is high.
The complications are more than that
of ECCE
Extraction cloudy lens completely
Operating method——ICCE

42. Visual correction after cataract
operation
After cataract surgery, the aphakia
is in a state of high hyperopia
(+10~ +12 diopters)
By IOL:
By contact lens:
By glasses:

43. congenital cataract
Definition: congenital cataract is a
result of lens growing and
developing disturbance in the
process of fetal development.
Causes:
Endogenous: chromosome with
heredity. 25%
Exogenous: by mother’s or fetal
systemic disorder.

44. Clinical findings：
It commonly is bilateral, static.
A few develop continuously after birth.
It may be classified according to the site
and the shape of lens opacity, we can
divided the disease into the next classes:
congenital cataract

45. Anterior polar cataract
congenital cataract

46. Perinuclear cataract
congenital cataract

47. Nuclear cataract
congenital cataract

48. Total cataract
congenital cataract

49. Whether or not affect with the vision
not
Observed
affect
Surgery in time
treatment
congenital cataract

50. Opportunity of operation: the
earlier the operation is done, the
greater the chance to get good
vision becomes.
The surgery may be done some weeks
after birth.
It should be done generally in baby
with age of 3~6 months.
But the IOL implantation must do after
2 years old.
congenital cataract

51. Treatment purpose:
Reserve vision
Prevent amblyopia
Promote development of fusion
function
Surgery method
Extracapsular cataract extraction
Cataract suction
IOL implantation after the suction’s
patient is 2 years old
congenital cataract

52. The correction:
By glasses
By contact lens
By IOL
Amblyopia should be treated actively
and timely.
congenital cataract

53. Traumatic cataract
contusion penetrating injury
penetrating injury electric injury
definition：due to contusion, 、penetrating injury、radiation injury and
electric injury.

54. complicated cataract
definition：intraocular disease caused the lens’s nutrition
and metabolism abnormal.

55. Drug-induced cataract

56. Toxic cataract
Drug-induced cataract

57. Ectopia and dislocation of lens

58. Ectopia and dislocation of lens
lens’ positional abnormality has
two causes:
Rupture of suspensory ligament induced
after injury ----dislocation (acquired)

Congenital aplasia or weakness and
laxation of the ligament----ectopia

59. Ectopia lens (dislocate into the anterior
chamber, vitreous cavity or incarcerated at the
pupillary area)
Ectopia

60. The lens
dislocates into
the anterior
chamber
dislocation

61. Subluxation of the lens
dislocation

62. dislocation to the temporal top Dislocation to the vitreous chamber
B ultra-dislocation to the
viterous chamber
dislocation to the anterior chamber
dislocation

63. hemidislocation lens is often occurs in
Marfan’s syndrome patient
dislocation

64. Subluxation of the lens is often
occurs in Marfan’s syndrome patient
（palm）

65. Treatment
The lens is extracted when the vision
is affected or the complications
occurred.

66. Prevention and treatment of blindness
Blindness also indicates that both eyes
lose the ability to distinguish
surroundings, the patient isn’t able to
be competent at some occupations,
even to take care of himself.

67. Blindness:
the best corrected visual acuity <0.05,
or visual field<10 degrees

The low vision:
0.05<the best corrected vision<0.3

68. criterion of classification
Best corrected vision
Best vision
lower than
Lowest vision equal to
or lower
1 0.3 0.1 Low
vision 2 0.1 0.05(FC/3m)
3 0.05 0.02(FC/1m)
4 0.02 Light perception
Blindn
ess
5 No light perception


WHO----1973

69. best corrected visual acuity，BCVA----
1973，WHO
presenting visual acuity ，PVA---Vision in
daily refractive status----2006，WHO

70. status
Blind man：0.7%
cataract
trochoma
Children blindness

developed developing
0.3% ＞0.6%
AMD cataract
DRP infection

71. status
80% ---can avoiable and therapy
cataract：>50%
cataract---surgery

72. target



Three A Priciple




High quality
Appropriate
Affordable
Accessible

74. Cornea disease
Infection
Cornea implantation
Challenge！

75. Trochoma
Underdeveloped countries
Poor sanitation
Preventable



SAFE Principle：
Surgery
Antibiotic
Facial cleanliness
Environmental Improvement

76. Glaucoma
Most important Irreversible Blinding eye
disease
Can not prevent
Early detection and early treatment
Save eye sight

77. Prevalence and clinical characteristics of glaucoma in adult
Chinese: a population-based study in Liwan District,
Guangzhou.
Invest Ophthalmol Vis Sci. 2006 Jul;47(7):2782-8.

all glaucoma of 3.8% (95% confidence interval
[CI], 2.8%-4.8%).
Primary open-angle glaucoma (POAG) was found
in 2.1% (95% CI, 1.4%-2.8%)
Primary angle-closure glaucoma (PACG) in 1.5%
(95% CI, 0.8%-2.1%).

78. Avoidable eye diseases
Retinopathy of prematurity (ROP)，
Ametropia，
Amblyopia after cataract surgery
Active treatment can improve vision

79. VISION2020,THE RIGHT TO SIGHT
Vision 2020，everyone has the right to see

key point：Cataract
Trochoma
River blindness
Children blindness
Ametropia and low vision

VISION2020

80. Rehabilitation of blindness and low vision
Blindness and low vision patients can
live as normal people!
TARGET

81. Psychological change characteristics
Blindness at birth, Gradual blindness,
old people：easy accessible
Adults: huge impact

82. Typoscope

83. Typoscope

84. Artificial vision----Vision prosthesis

85. Summary
Cataract classification,
clinical manifestation

Cortial cataract clinical manifestation: 4

Blindless and low vision: definition

86. 广西医科大学
第一临床医学院
第一附属医院