Investigation and management of senile cataract

investigation and management of senile cataract

1. NISHITA AFRIN B.OPTOM, 3 RD BATCH INSTITUTE OF COMMUNITY OPHTHALMOLOGY INVESTIGATION AND MANAGEMENT OF SENILE CATARACT

2. Senile cataract

3. INVESTIGATION

4. INVESTIGATION OF SENILE CATARACT PREOPERATIVE EVALUATION OF SENILE CATARACT HISTORY General health of the patient - Diabetes mellitus, Hypertension, ischemic heart disease , chronic obstructive pulmonary disease , bleeding disorders , parathyroid tetany , myotonic dystrophy, galactosaemia , down syndrome, atopic dermatitis, neurofibromatosis type 2

5. Cataract in systemic disease Diabetic snowflake cataract advance diabetic catarct stellate posterior subcapsular cataract in myotonic dystrophy Advance left cataract in a patient with myotonic dystrophy bilateral advance cataract in atopic dermatitis shield like anterior sub capsular cataract in atopic dermatitis

6. Continue………. Patient ocular history : Trauma, Inflammation, Amblyopia , glaucoma , optic nerve abnormalities , or retinal disease social history

7. Ocular investigation… MEASUREMENTS OF VISUAL FUNCTION 1. Visual status assessment - visual acuity, perception of light ((PL), perception of rays (PR) 2. Refraction – 3. Brightness acuity 4. Contrast sensitivity 5. Visual field testing

8. Visual acuity test

9. Contrast sensitivity…

10. Pelli-robson contrast sensitivity chart

11. Visual field test

12. Continue….. External examination : a. Extra ocular Motility b. pupils c. cover test

13. Motility…

14. Pupillary reaction test a.Swinging flash light test b.consensual light reflex

15. Cover test…..

16. Continue…… Special Tests : Potential acuity estimation Tests for Macular Function- 1. Two light discrimination test 2. maddox rod test 3. Color perception 4. Entoptic visualisation 5. Blue Light entoptoscopy 6. Purkinje’s entoptic phenomenon

17. Maddox rod test…

18. Entoptic visualisation

19. Blue light entoscopy …

20. Color perception…

21. Continue…. Retinal function test PR – must be present in all 4 quadrants Electro- retinogram Electro- oculogram Visual evoked potential

22. Continue…. Slit-Lamp Examination : Eyelids, Lacrimal apparatus, sclera Conjunctiva , Anterior chamber , Cornea Iris Crystalline Lens

23. Continue……. Fundus Evaluation : - Ophthalmoscopy - Optic nerve - Fundus evaluation with opaque media

24. Ophthalmoscopy …

25. Continue….. Measurement of IOP conjunctival swab for C/S Sac patency test to exclude chronic dacryocystitis Oro-dental check up to exclude septic foci

26. Measurement of iop …

27. Continue…… Preoperative Measurement : Biometry 1.keratometry 2. A- scan ultrasonography

28. Keratometer …..

29. Continue…. B-scan ultrasonography Corneal Topography Corneal phachymetry Specular microscopy

30. B-SCAN ULTRASONOGRAPHY

31. Corneal topography….

32. Systemic investigation…. Clinical : - BP Lab test : - RBS/FBS - Urine - X-Ray chest and ECG – If needed

33. MANAGEMENT

34. Management…… NON-SURGICAL MEASURES ---- 1. Treatment of cause of cataract 2. Measures to delay progression topical preparation containing iodine salts of calcium and potassium, role of vitamin E and aspirin 3. Measures to improve in the presence of incipient and immature cataract----- Refraction, Arrangement of illumination, use of dark goggles, Mydriatics

35. Continue….. SURGICAL MANAGEMENT ----- 1. Visual improvement 2. Medical indication 3. cosmetic indication

36. Preoperative medical and preparations Consent Srcub bath, care of hair, and marking of the eye Preoperative antibiotics and disinfectants IOP lowering Mydriasis

37. Types of surgery Intra capsular cataract (ICCE) Extra capsular cataract (ECCE) Pseudophakia – SICS , Phacoemulsification

38. Counseling after postoperative cataract surgery The post-operative recovery period (the period after cataract extraction is done) is usually short. The patient is usually ambulatory on the day of surgery but is advised to move cautiously and avoid straining or heavy lifting for about a month The eye is usually patched on the day of surgery and at night using an eye shield is often suggested for several days after surgery

39. . Intraocular lenses are usually monofocal , correcting for either distance or near vision, however, multifocal lenses may be implanted to improve near and distance vision simultaneously, but these lenses may increase the chance of unsatisfactory vision

40. Preoperative complications in senile cataract Anxiety Nausea and gastritis Irritative or allergic conjunctivitis Corneal abrasion complications due to local anaesthesia – - Retrobulbar haemorrhage - Oculocardiac reflex - Perforation of globe - Subconjunctival haemorrhage - Spontaneous dislocation of lens

41. Complications of cataract surgery Retinal detachment Endophthalmitis Corneal edema Cystoid macular edema Pseudophakic bullos keratopathy Epithelial keratopathy Fibrous downgrowth

42. LOW VISION MANAGEMENT FOR CATARACT High – add spectacles, magnifiers, CCTV , Telescopeic loupes for reading and close work Direct lighting when reading or performing near work Glare can be reduce by filter,tints , and sunlenses

43. Continue…. Large print reading material Bold line writing paper and Typoscope

44. REFERRANCES……. LENS AND CATARACT – AMERICAN ACADEMY OF OPHTHALMOLOGY COMPREHENSIVE OPHTHALMOLOGY – A. K. KHURANA KANSKI CLINICAL OPHTHALMOLOGY PARSON’S DISEASE OF THE EYE

45. THANK YOU !