Management of Senile and Complicated cataract

Introduction:
*To review management of senile and complicated cataract, highlighting the latest in the field. * Cataract is derived from a Greek word that describes rapidly running water tuning white. *Cataract accounts for around 40% of global blindness representing about 16 million people.

:How we did it
I-Diagnosis: A-Clinical picture: -Symptoms: *Cloudy, fuzzy, foggy, or filmy vision. *Problems with glare from lamps or the sun. *Frequent changes in his/her eyeglass prescription. *Double vision.
Management Diagnosis Treatment C/P Investigation Preoperative Check Surgery PostOperative Visual Rehabilitation

B-:Pre-operative Tests *We must know the type of cataract we are dealing with whether: -Age related -Complicated -So we do these examinations:
*Cover test. *Pupillary responses. *Ocular adnexa. *Cornea *Anterior chamber. * Lens. *Intraocular pressure *Fundus *Snellen visual acuity.

*Newer techniques for evaluating visual dysfunction caused by cataract include contrast sensitivity and glare testing. *Predicting postoperative visual acuity: (Potential Vision Testing ( -Maddox rod test. -laser interferometer -potential acuity meter -critical flicker frequency. A recent study concluded that the potential acuity meter and the laser interferometer showed a limited clinical capability

in predicting postoperative visual acuity, particularly with dense opacities. The critical flicker frequency shows the most promise as a potential vision test; particularly with dense cataract .

II-TREATMENT:
The indications are:

1-Visual improvement

2- Medical indications

*Types:
a- Conventional extracapsular cataract extraction. b- Phacoemulsification. c-Intracapsular Extraction. d-Cryosurgery. N.B. Complicated cataract is managed firstly by

treating the cause.

:Recently
Pulsed electron avalanche knife
a new electrosurgical device, which has recently been introduced for ‘‘cold’’ and traction-free dissection of tissue in liquid medium.

:Complications
*Posterior capsule opacity, treated by YAG laser. *Edema (swelling) of the cornea. *Uveitis *Rupture of the posterior capsule *Malpositioning of the IOL

*Endophthalmitis
Recently, The gatifloxacin (GFLX) concentrations found in aqueous humor samples were sufficient to kill bacteria other than S. epidermidis, P.aeruginosa, and MRSA in vitro.

III-Visual Rehabilitation
The choices are: 1-Cataract eyeglasses 2- Contact lenses 3- Intraocular Lens (IOL): a- Monofocal IOLs.
b-Multifocal IOLs. c-Toric IOLs. d-Accommodative IOLs

:Prevention of Senile cataract*
( Inhibition of Crystallin Ascorbylation by Nucleophilic Compounds in thehSVCT2 Mouse Model of Lenticular Aging).
A title of a recent study that resulted in a pharmacologically blocking protein ascorbylation with absorbable guanidino compounds is feasible and may represent a new strategy for the delay of age-related nuclear sclerosis of the lens .

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