dr.

Djoko Utomo SpM

Biconvex , avascular , colorless ,

transparent structure
Thick : + 4 mm ; diameter : + 9 mm
It is suspended behind the iris by the
zonula, which connects it with the cilliary
body
The Lens capsule is semi permeable
membrane admit water and electrolytes

The sole fuction : focus light rays upon the

retina
The physiologic interplay of the ciliary body,
zonule, and lens that result in focusing near
object upon the retina is known as
accomodation
As the lens age, its accomodation power is
gradually reduced

Consist about 65% water ; 35% protein and

trace minerals
Pottasium is more concentrated in the lens
Ascorbid acis & glutathione are prsent in
both the oxidized and reduced forms

Cataract formation is characterized

chemically by :
- reduction in oxigen uptake
- lens edema ; calcium & sodium
pottasium, ascorbat acid & protein
damaged lamellar fibers
Risk Factors :

* Individual : age, sex, ethnic, genetic

* Environment : smoking, UV, nutrition,
sosioeconomic, education, alcohol, diabetes,
dehydration, steroid
* Protective : aspirin, hormonal

Cataract-related symptoms are relatively individual

and do not correlate absolutely with vision

cloudy or blurred vision

reduced contrast

increased glare (scattered light)

changes in color perception (usually a yellowish tinge)

Double vision (monocular diplopia)

complain of more severe symptoms in bright light

(sunshine) or when reading

Acquired cataracts (over 99% of cataracts)

Senile cataract (over 90% of cataracts)

Traumatic cataract
Metabolic Cataract
Toxic Cataract
Secondary Cataract

Congenital cataracts
Hereditary cataracts
Cataracts due to early embryonic (transplacental) damage

Frequently preceded by the presence of

radial water clefts in the lens cortex

Morphology :

Nuclear cataract
Cortical cataract
subcapsular cataract
anterior or posterior polar cataract

Severity :

Incipient cataract
Immature cataract
Mature cataract
Hypermature cataract

Nuclear cataract

Nuclear cataract

Cortical cataract

Subcapsularis posterior cataract

Mature
cataract

Hypermature
cataract

The most common cause of unilateral

cataract in young individuals

Types of injury :

Direct penetrating injury

Cincussion vossius ring
Electric shock and lightning
Ionizing irradiation

A. A contusion rosette posterior to the

anterior lens capsule has developed
after severe blunt trauma to the
eyeball
B. Cataract caused by penetrating trauma
C. vossius ring after blunt trauma

Diabetes mellitus
Galactosemia
Renal insufficiency
Mannosidosis
Fabry disease
Lowe syndrome
Wilson disease
Myotonic dystrophy
Tetany
Skin disorders

Diabetic cataract
progresses rapidly

Diabetic cataract
appears as bilateral
white punctate or
snowflake posterior
or anterior
opacities

Occur with chronic

neurodermatitis and
less frequently with
scleroderma,
poikiloderma, and
chromic eczema.
Characteristic signs
include an anterior
crest-shaped
thickening of the
protruding center of
the capsule

Steroid-induced cataract
Chlorpromazine-induced cataract
Miotic drugs-induced cataract
Busulphan-induced cataract
Amiodarone-induced cataract

Prolonged topical or
systemic therapy with
corticosteroids can
result in a posterior
subcapsular opacity.
The exact dose
response relationship is
not known

Chronic anterior uveitis

Hereditary fundus dystrophies

Retinitis pigmentosa
Lebers congenital amaurosis
Gyrate atrophy
Wagners and Sticklers syndrome

High myop
Acute congestive angle-closure glaucoma

The most common cause of

secondary cataract
The earliest finding is a
polychromatic lustre at the
posterior pole of the lens
Anterior and posterior
subcapsular opacities
develop and the lens may
become completely opaque

Associated with the subsequent formation of

glaucomflecken consisting of small, greywhite, anterior, subcapsular or capsular
opacities in the pupillary zone

Indications for cataract surgery

Visual improvement
Medical indications
Cosmetic indications

Surgical techniques
Extracapsular cataract extraction (ECCE)
Small incision cataract surgery (SICS)
Phacoemulsification

Operative complications
Rupture of posterior capsule
Suprachoroidal haemorrhage

Early postoperative complications

Raised intraocular pressure

Iris prolapse
Striate keratopathy
Wound leak
Acute bacterial endophtalmitis

Late postoperative complications

Suture-related problems
Malposition of IOL
Corneal decompensation
Cystoid macular oedema
Opacification of the posterior capsule
Retinal detachment
Epithelial ingrowth
Sunset syndrome