Lens

Congenital & Dev . Cataracts

birth
before Infancy → Adolscence

embryonic / Infantile /
} Affected
•
fetal Nu adult Nu

-
→ most rarigaeted appearance
4 minute opacities

Etiology I
→ Fetal
te ↓ 7 -

Maternal
Idiopathic Hereditary → Def -

oxy 's
#• ( Nainital
"
→ Maluut hemn

Infections rubella Birth trauma

In her cases
[
-
→ .

with Toxoplasmosis '

Sys
met . disorders

↳
. .

disorders Dmgs ingestion [a. + other

-

[
*☐ - chr .
-
Down 's
- skeletal a

www.aag, ,

(
Radiation
.

-
Cars ? with der - cataract

Renal
sys
-
. n

Malnut "
Types

te te ! te
c.
capsular polar
c. c. nuclear c. adult Nu

Sant Sant I & cortex

post ↳ Post .

↓ to / coronary
↳ Blue dot
embryonic fetal whole
cataracts
lamellar
-

pulverulenta ↳ Total
sutural cog .

-
floñbnm
↳ Can .
mem

- corallifonn
 -

spear shape
-

Ant axial
.

-
Dendritic suture

con .

capsular cataracts

→ Ant -

rare , non axial , stationary

1-
visually insignificant

Post
-
.
→ rare Lass -
t
hyaloid artery remnants

¥ads
① Ant.polavcataracts_
↳ central part of Ant .

capsule
for
Due to
delayed der of Ant .
.
chamber

↳ opacity as congenital
Due to corneal perforation
↳ due to neonabwm
after perforation ophthalmia

Morphis
Thickened white
plague → center of ant capsule
1→
.

cataract
→ Ant
pyramidal
.

→ Thickened capsular opacity cone shaped

( (
Reduplicated cataract

§
along with it 1 lens fibers beneath
also become
opaque
buried
opacity ee
imprint
-

Post cataract
2 .
.

polar
ass . -

persistent hyaloid artery remnant

-

post flenticenns
.

Persistent 1° vitreous
-

hyperplastic
 Types stationary

⑥@
↳ onion
Progressive →
what

appears

C- Nuclear cataracts
nucleus
Inv .

embryonic
cataracts centrals's
pulverulent
2)
embryonic Nu cataract

→ due to ⊖ ◦
if lens der at every stage
.

BIL small -
rounded opacity using exactly in center

→
opacity powdery appearance
→

c. nucleus
inv .

fetal
lamellar cataract
der -
cataract

a opacity occupy discrete zone in lens

↳ cataract
type of congenital
Mec

Cfp visual impairment

9h0m
-

genetic → AD
↳ Env suit D
-
→
Hypo
\ mat
car

. rubella

cataract in
CIF
→
none of fetal .

→ clean eenbnopic like

linear
opacities
of
wheel
small )
spokes (RIDERS
→ main mass of lens

int . & ext .

to tone of cataract
is
deaf
2)
mtm%pn&nY¥ogᵗI;¥-• scattered around ant & -

Is static
1 BIL
post . 4 Sutures in
fetal Nu .

Ant axial cataract

embryonic
.

↳ Ant .

Y suture of fetal Nu

↳ chalky bands around 4 sutures

tr BIL
Flori firm cataract
-

petals of flower
CoraWifmn_ fusiform spindle shaped

spear -
shaped → scattered heaps
HI Inv . whole

① Total
congenital cataract

v11 or BIL
4 fetal Nu
- inv
embryonic .
.

-
dense chalky white central opacity -

impairing
vision

-
BIL
-
cause a mat .
rubella

Rubella cataract

- Mat .
Rubella a 1st trimester
[ Rubella cataract white
pearly
µ
as

lens as
soft 1 even lignify
Cantara done nucleus as harbor ring

↳ followed by severe raft mean

.

note prevented by vaccination of %

Rubella
syndrome → con
•calm _
-
-
/
- salt 1 pepper chai retinopathy
wings that mis
ear Heart
I -

%77hpke.FI?isapaptearThn# of lens fibers & transparent lens

capsule

Ca .
inv adult Nut cortex

① Coronary cataract
↳
puberty
ls inv adolescent .
Nu / deeper layer of cortex
↳ hundred in #
↳ many radial dials lens
regular in peripheral
↳ opacities periphery a
 vision a unaffected-

↳
large punctate as tension

2) Blue dot cataract

↳ cataract a puncta ceaemln
-
- -

↳ punctuate opacities as Bluish dot in

peripheral part of adolescent Nudes

Management
Indication
Him a ignored 4 obnnnd
6 ndcs
② BIL → within

① OIL or within days

snrguicd
-

"
↳ Extra cataract
cap exam +
capsnlorherois
Anh.
.

& bed
Irrigation 4 Mph of

lensaspirnh.mn
by manual
-
combined with post
.

capsulotomy
Correction
of peadritic aphakia
Lips 2) by implantation of post
① Child " > -
chants .

IOL
>
2yrs 3
spectacles as can be
prescribed
Paediatric IOL as size / design & power
↳ of child "
use IOL in are
growth of eye
IOL consideration
power
 ↑ vveal roam ,
LT
safety
size a 12 -
12 -75

Devgn 4 fol able IOLS

power
↳ emmetropia >
Signs
underarm 6101 . I -8

4201 22
yrs

"
Corr of amblyopia

ACQUIRED CATARACT

Senile -

Age related

↳ commonest
ls type
>
soyrs BIL

cortical

↳ nuclear
Post .

snbcapsular cataract CPSC)

Etiology
• Risk factors
①
Age
as > 50
④ pre senile
② sex 092

③ Aeridehy ~
⑨ V1 as early onset
⑤ Dietary → A / GE

⑥ dehydration his
]
ass .
Kluth ( diarrhea, )
cholera

⑦ smoking
Causes
1) Heredity
2) DM

3) myotonia dystrophy
9) Atopic dermatitis

mech .

of loss of lens transparency

① cortical
te levels on
crystalline lens of total protein, AA

le ass -
with ↑ conc .
of Na

followed by cog
"
of lens proteins
② Nuclear
=ass . with
dehydn A
compaction of Nu as hard cataract

accompanied by ↑ water soluble proteins

± pigment hw chrome 1 melanin _ AA in lens

stages of maturation

A) math of cortical
lamdlapn a) form " vacuoles & water clefts
& post cortex
↳
in ant . .

demarcation of cortical fibers as

sepm by fluid
inuipentcataractn
wth clear
early detachable opacities areas

→ cortical senile cataract

-
chavac .

by we-dge-skdo-paih.es with clear areas in

btw
- Seen in ant -
t post .
cortex
& apices → toward pupil
white
- radial spoke like pattern of greyish opacities
cuneiform cataract starts at
-
periphery

↳ Post .
sub
capsular senile cataract

saucer -

shaped opacity as just below capsule

usually in central part of post .

cortex
 cataract
btw &
surrounding
"
Diff
dean cortex

3) Immature senile cataract (Imsa )

-
cuneiform / cupulifornr patterns observed till opacity become
-
lens as
greyish white diffuse A irregular
clear cortex as still ✓ in 's shadow visible

SOME lenses swollen due to cast .

hydration
I

4) Mature senile cataract (Msc )

pacification
◦ as
complete
whole cortex -
involved

lens as
pearly white
cataract as
ripe cataract

5) senile C-
Hypermature
mature cataract as left in situ

I
Hgpwmat
I
to
morgainan
sclerotic
cortex → liquidity
to -
Cortex as disintegrated
Bag of mildly blind _ lens -
shrunken due to leakage

settles of water
small brownish Nu
'M
a alt its poh _
Ant -

capsule as wrinkled & thicket

at bottom
in head due to prob 't of ant cells
.

with change
.
 dense white cataract
-
capsular
in pupillary area
-
due to shrinkage of lens

Ant -
chamber → deep
iris → tremulous

b- Math of nuclear senile cataract

nuclear sclerotic
process
progressive
↳ lens inelastic 4 hard
↳ de ability to accommodate &

obstructs light rays

changes centrally
to
peripherally
Nucleus Diffusely cloudy / tinted
due to deposition of
pigment
pigmented nuclear cataract .

- amber
- brown
-
black
- reddish

-
CIF
vishal disturbance
symptoms
1) Glare → direct

2) unilocular diplopia / polyopia

3) colored halos around
light
white colored
light break into
spectrum
u ) Pow color discrimination C blue)

5) Black spots in front of eye

Image blur 4 misty
vision
6)
7) Detention
of vision

-
painters & progressive
 early LOU day blinding
* central opacities eg PSI
-

*
peripheral opacities -
Lor -
delayed
Deteriotcs due to
a nuclear sclerosis -
myopia
diminished
* ◦
pacification progress -
vision

↳ perceptron of light
↳ only
pnojh of light rays
a
gradual prog
. Lou followed by rapid dehiohm

signs
→

0
-
-

✓
✗ -
-
✗
=
= ✗
_
-

=
✗ ✗ ✗

Complicating
① phawanaphylatic uveitis
② lens induced glaucoma

↳ phalomorphic glaucoma ~

Pharo lytic
glaucoma ✓

③ Subluxation / dislocation of lens

 Complicated cataract
lens 20 to Intraocular ds
og o
pacification of some

ʰʰ
lens → nutrition on intraocular fluids

-
'
. ocular birch → disturbed
↳ ohflam toxins → termed
↳ disturb nutrition of
crystalline lens

6
Der
of complicated cataract
-

Inflame conditions
choroiditis
-

ividocyditis ,
retinitis
Degen cmdiwns
pigmentosa
-

↳ Retinal detachment
↳ Glaucoma
ls intraocular tumors

CIF
__
psc
-

opacity
-

irregular , variable in
density
* Breadcrumb
a
Polychromatic luster C Rainbow cataract)
&
Diffuse yellow hare
spread to rest of center
•
Slowly opacity →

Deposition of Ca
& .
P%01.ngm.tn?cATl0#TREAtmEMT
② Scrub bath of
I care hair a
marking of eye
③ prop antibiotics 4 disinfectants
-
Topical antibiotics -
4ᵗʰ gem FQ 3
days before she

PoEo1
"
/ 104) 15min for 2ms
every
-

↳
paint lids 4 facial skin

2-3hr5
( 5% ) a)
drops in cnjuchird
*
eye
sac .

" "

Ioplouering → ECCE_
some
-
SICS
tphnwenrnlh-cah.us

many
-
digital manage
he
drags is mannitol / azetolaraurde

mydriasis
Topical hopicamidely.tpt-2.tt
.
-

[ Topical ↳
every 4-615min times

cyclooxygenase inhibitors
&
day before surgery
18min
3 times a
every
4 times immediately before surgery
↳
mydriasis .

LOCAL AN ATHENA
II
Based on method of fixation
→
Ant chamber IOL

[
.

Inis lens
-

supported
↳ Post .
chamber IOL
" ideal
capsular bag fix
- -

to
ciliary sulcus fix
"

[ scleral fin of PC IOL

[
-

Retro iris
-

tixn

mat
Rigid PMMA
1-
-

-
Foldab1e-
hydrophilic
✗ * &
hydrophobic
C- Based on
focurnng ability
→ mono focal

↳
µ
→
multifocal
extended
as

depth focus
pseudo accomodahhe

Trifocal

D.
sp IOL 's
↳
astigmatism
spherical compact

E- Aphallic
. vs
phatic
add aphakic
"
In to → after lens extractors
special phallic
•
ref . errors

F. specialty's
① Anividia IOLG

② Implantable miniature as for age related macular dege

.

③ Piggyback IOL
 lentic.org
shaped elevation of ant pole
%↓
-

- cone -
'

in
alport 's syndrome
= love's
syndrome
-

Both present as an oil globule lying in center

of red reflex
slit lamp
"
-
exam → confirm diagnoses