senile cataract.pptx

cataract

1. DISEASES OF LENS

2. Senile cataract ‘Age-related cataract’ Opacification is mainly due to degeneration of the already formed normal fibres By the age of 70 years, over 90% of the individuals develop senile cataract Usually bilateral, but almost always asymmetrical

3. Morphological types of senile cataract 1 . Cortical senile cataract (soft cataract) • Cuneiform (M/C) • Cupuliform -posterior subcapsular (PSC) 2. Nuclear cataract (Hard cataract) 3 . M ixed cortical and nuclear Commonly both types co-exist in same eye

4. Risk factors I . Age- usually seen >50 yrs if occurs < 45 years of age it is called pre-senile cataract 2. Sex – affects both sexes, but prevalence is greater in females than males at all ages 3. Heredity-role in onset and maturation 4. Ultraviolet irradiations 5. Dietary factors - Diet deficient in certain proteins, amino acids, vitamins (riboflavin, vitamin A, C and E) 6. Dehydrational crisis - due to diarrhoea, cholera, etc 7. Smoking - A ccumulation of pigmented molecules-3-hydroxykynurenine and chromophores, which lead to yellowing

5. Causes of pre-senile cataract l. Heredity 2. Diabetes mellitus –nuclear cataract is more common and progess rapidly 3. Myotonic dystrophy - posterior subcapsular type of pre-senile cataract , Christmas tree cataract 4. Atopic dermatitis - A topic cataract

6. Mechanism of loss of transparency I. Cortical senile cataract

7. 2.)Nuclear senile cataract Etio - pathogenesis : - Intensification of age related degenerative changes associated with dehydration & compaction of nucleus Features: - Hard cataract is formed Significant increase in water insoluble protein Lens become in elastic & looses power of accomodation Changes begin centrally and slowly spreads to periphery Deposition of pigments gives characteristic colour to nucleus

8. Stages of Maturation a)Cortical type Stage of lamellar separation - E arliest change is demarcation of cortical fibres owing to separation by fluid Demostrated by slit-lamp examination only changes are reversible Characteristic symptom-coloured halos / grey appearance of pupil

9. 2. Stage of incipient cataract -Early detectable opacities with clear areas in b/w them - onle \y seen in dilated pupil -characteristic symptom-polyopia

10. Cuneiform senile cortical cataract Cupuliform senile cortical cataract Wedge shaped opacities with clear areas b/w them Saucer shaped opacity just below the capsule Extends from equator towards centre Gradually extends outwards Opacities present in both anterior & posterior cortex Clear demarcation b/w cataract & surrounding clear cortex Visual disturbances seen at late stages Causes early loss of v/a

11. 3. Immature senile cataract - (ISC) Opacification becomes more diffuse and irregular Lens - Greyish white Cortex - Clear Iris shadow – visible Intumuscent cataract may develop in some and may even persist in next stage of maturation

12. 4. Mature senile cataract (MSC) • Opacification - complete cortex is involved Lens - pearly white Iris shadow is absent DDO- no fundal glow Also labelled as RIPE CATARACT

13. 5.) Hyperm ature senile cataract (HMSC) Morgangian type HMSC Sclerotic type HMSC Cortex is liquified and lens is converted into milky fluid Cortex become disintegrated and lens become shrunken Calcium deposits may be seen on lens capsule AC become deep and iris becomes tremulous ( iridodonesis )

14. B.)Maturation of nuclear senile cataract In it , sclerotic process renders the lens inelastic and hard, decreases its ability to accommodate and obstructs the light rays These changes begin centrally and spread slowly peripherally almost upto the capsule when it becomes mature

15. Grade of hardness Description of hardness Colour of nucleus Grade 1 soft White or greenish yellow Grade 2 Soft-medium yellowish Grade 3 Medium-hard amber Grade 4 hard brownish Grade 5 Ultrahard black

16. A- cataracta brunescens B- cataracta nigra C- cataracta rubra

17. Symptoms Glare Uniocular polyopia Coloured halos Black spots in front of eyes ‘Second sight’ Distortion of images/image blur Gradual, painless progressive loss of vision Discomfort/glare in daylight – nuclear cataract; better vision in daylight – cortical cataract

18. Signs Iris shadow Depth of anterior chamber Pupillary reflex Visual acuity Plain mirror examination under mydriasis

19. D/D-IMSC V/S NS

20. D/D-MSC V/S LEUCOCORIA

21. Complications 1.) P hacoanaphylactic uveitis 2. ) Lens-induced glaucoma i . Phacomorphic glaucoma - by intumescent (swollen and cataractous) lens. T ype of secondary angle closure glaucoma ii. Phacolytic glaucoma- Lens proteins are leaked into the anterior chamber in cases With Morgagnian hypermature cataract iii. Phacotopic glaucoma- Hypermature cataractous lens may subluxate/ di slocate and cause glaucoma by blocking the pupil or angle of AC 3 .) Subluxation or dislocation of lens - d/t degeneration of zonules in hypermature stage

22. Patient workup Retinoscopy and best corrected visual acuity Intraocular pressure Slit lamp examination Fundus evaluation – direct & indirect Macular function tests Ultrasonography IOL power calculation

23. General investigations Blood pressure Blood sugar Complete haemogram HIV, Hepatitis B & C Causes of straining Foci of infection Systemic examination

24. Management An un-operated eye is more comfortable than an operated eye if visual diminution is mild. Early cataract : -Refraction and glasses -Dark glasses or photochromatic glasses for nuclear cataract -Rule out other causes of visual diminution -If BCVA not to patient’s satisfaction, then operate.

25. Surgical techniques Intracapsular cataract extraction (ICCE) Extracapsular cataract extraction (ECCE) Conventional ECCE Small Incision Cataract Surgery Phacoemulsification Lens aspiration in paediatric (soft) cataract

26. Intraocular Lenses Types Anterior chamber IOL Iris supported lens Posterior chamber IOL Rigid Foldable Calculation of IOL power SRK formula IOL power- A-0.9k – 2.5L (A-constant ,K-keratometry , L-axial length

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