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
• Symptomes
• 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

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

37. 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

38. Slit lamp examination

39. IOP test

40. 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

41. Antibiotics drop

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

43. Peribulbar injection

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

45. Surgical step

47. Postoperative complication
• Dislocation of lens
• Infection
• Corneal oedema
• SBH

48. Displacements of lens

49. Anterior dislocation

50. Posterior dislocation

52. Diabetes retinopathy