Cataract

Deasy Mirayashi
(I11110003)

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Definition
• A cataract is any opacity in the lens.
Cataract is present when the transparency
of the lens is reduced to the point that the
patient’s vision is impaired.
• The term cataract comes from the Greek
word katarraktes (down-rushing: waterfall)

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• Aging is the most common cause of cataract,
but many other factors can be involved,
including trauma, toxins, systemic disease
(such as diabetes), smoking, and heredity.
• Age-related cataract is a common cause of
visual impairment.

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Pathogenesis
• Cataractous lenses are characterized by
protein aggregates that scatter light rays
and reduce transparency.
• Other protein alterations result in yellow or
brown discoloration.
• Additional findings may include vesicles
between lens fibers or migration and
aberrant enlargement of epithelial cells.
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Patients experience the various symptoms such as • seeing only shades of gray. blurred vision. distorted • vision. glare or star bursts. etc. visual impairment. monocular diplopia. Page 5 .General symptom • Development of the cataract and its symptoms is generally • an occult process. altered color perception.

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Classification • Cataract can be classified according to several different criteria : a. Time of occurance (acquired or congenital) b. Maturity c. Morphology Page 7 .

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Etiology • Long term exposure to ultraviolet light • Exposure to radiation • Secondary effects of diseases – Diabetes. hypertensiion • • • • Age Trauma Genetic Drugs Page 9 .

Classification • Age • Morphology Page 10 .

Age – Congenital cataract – Juvenile cataract – Senile cataract • • • • • Insipien Intumescent Immature Mature Hypermature Page 11 .

chromosomal abnormalities. prenatal infection. skeletal syndrom Page 12 .Congenital cataract • Hereditary Congenital Cataracts • Cataract from Transplacental Infection in the First Trimester of Pregnancy – Without systemic association : isolated hereditary cataracts – Systemic association : metabolic(galactosemia. galaktokinase deficiency).

– Toxoplasmosis 5%.Congenital Cataract • A statistical study by Pau (1986) cites the following incidences of congenital cataract with respect to systemic disease contracted by themother during the first trimester of pregnancy: – Rubella 40–60%. – Mumps 10–22%. Page 13 . – Hepatitis 16%.

nutrisional deficiency). galactosemi.Juvenil Cataract • Cataract that occur in age > 1 years. hipocalsemi. toksik. Page 14 . distrofi miotonik. traumatik. • Cause : metabolic (diabetic. komplikata.

– Angle of anterior chamber may close resulting in glaucoma (Phacomorphic Glaucoma).Cataract Intumescent – Sometime during the course maturation the lens imbibes lot of fluid and becomes swollen. Page 15 . – Anterior chamber becomes shallow.

Page 16 .will obstruct vision more when the pupil is small than when it is dilated. This particular cataract.as shown here. which is congenital.The opacity appears as a dark shadow against the red reflex.Immature Cataract • The nucleus of this lens is opaque(nuclear cataract). while the cortical layers remain clear.

Immature Cataract Page 17 .

the pupil appears white.The radial spokes in this figure reflect variations in density of the radially arranged fibers in the cortical layers of the lens. Light still reaching the retina is totally diffused and will allow the perception of light but not form.Mature Cataract • A cataract is called mature when the lens is totally opacified. A red reflex cannot be obtained. Page 18 .

Mature Cataract Page 19 .

a condition known as an overripe (hypermature) cataract • Mature cataract. which has become smaller and has a wrinkled capsule as a result of leakage of water out of lens. eye pain and headache • A hypermature cataract is extremely rare and needs removal Page 20 . • This can cause inflammation.Hypermature Cataract • A cataract isn't dangerous to the eye unless the cataract becomes completely white.

Hypermature Cataract Page 21 .

Page 22 .Hypermature Cataract • Morgagnian Cataract : A Hyper-mature cataract. in which total liquefaction of cortex allows the nucleus to sink inferiorly.

Morphology • Nuclear cataract develops in the nucleus or centre of the lens. • smoking. sunlight exposure and diabetes increased the risk of nuclear cataract. Page 23 . • As it increases. heavy alcohol consumption. there is an associated yellow or brown discolouration of the lens.

Nuclear Cataract Page 24 .

and a blood factor (fibrinogen) associated with vascular conditions appeared to increase the risk Page 25 .Cortical cataract • Cortical cataract develops in the outer shell of the lens as spokes and wedges and commonly causes increasing glare sensitivity. • A history of diabetes or previous heart attack.

Cortical Cataract Page 26 .

and so affects vision rapidly and severely. often in the visual axis.Posterior subcapsular cataract • Posterior subcapsular cataract develops at the back of the lens. • The majority of people needing cataract surgery have some posterior subcapsular cataract present at that time Page 27 .

Posterior subcapsular cataract Page 28 .

reduces your vision in bright light and causes glare or halos around lights at night Page 29 . right in the path of light on its way to the retina • This type of cataract may occur in both eyes but tends to be more advanced in one eye than the other • Often interferes with reading vision.Subcapsular Cataract • Subcapsular Cataract : Starts as a small. usually at the back of the lens. opaque area just under the capsule shell.

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particularly when driving at night Increased difficulty seeing at night Change in the eye's refractive error Page 32 . or vision Reduced intensity of colors Increased sensitivity to glare from lights.Sign n Symptoms Blurred. hazy.

This will help in prognostic evaluation of visual recovery after cataract surgery. surgery is needed to prevent further complications.Methods of evaluation • Visual acuity : Checking vision of both eyes unaided and aided with glasses and pin-hole vision to know the improvement as well as to get the general idea about the macular function of the eyes. • Direct and indirect ophthalmoscopy : Dense opacity (cataract will prevent retinal evaluation) Page 33 . • Intra ocular pressure : If intra-ocular pressure increases as a secondary to cataract. morphology and etiology or any associated ocular pathology. • Slit-lamp examination : To know the type of cataract along with its opacity.

topical meds. uveitis. or the visual acuity is decreasing gradually and disturb the daily activities) Page 34 . glaukoma. iontophoresis.Treatments been used for Senile Cataract • Iodium liquid tear-drops. • Calcium cysteine • Immunization in purpose to fix the lens metabolic disorder • Lentokalin and cataractolysin made from fish lens and high dose of vitamin • Recent treatment is surgical procedure (with several condition.

Phacoemulsification It utilizes a handheld ultrasonic vibrator to disintegrate the hard nucleus such that the nuclear material and cortex can be aspirated through an incision of approximately 3 mm Page 35 . Intra Capsular Cataract Extraction Surgical procedure where the lens is being pulled out with the capsule c. Extra Capsular Cataract Extraction    Surgical procedure to the cataract lens where the action is to do the incision or tearing the lens in order to pulling out the contain of the lens An opening is formed in the anterior capsule.Surgical Processes Types of surgical processes for cataract: a." supported by the intact posterior capsule b. and the nucleus and cortex of the lens are removed The intraocular lens is then placed in the empty "capsular bag.

THANK YOU Page 36 .

TREATMENT OF CATARACT Page 37 .

or reverse the development of a cataract. Page 38 . the effectiveness of conservative cataract treatment in humans has not been demonstrated. Galactosemic cataracts are the only exception to this rule. delay. • At present there are no available conservative methods to prevent.Medical Treatment • In spite of theoretical approaches in animal research.

Extra Capsular Cataract Extraction(ECCE) Surgical procedure to the cataract lens where the action is to do the incision or tearing the lens in order to pulling out the contain of the lens b. Page 39 . Phacoemulsification (SICE) Offers the surgeon the possibility to break the nucleus into smaller pieces and even into a fine emulsion of material. all of which can be removed through the probe used to achieve the break-up.Intra Capsular Cataract Extraction(ICCE) Surgical procedure where the lens is being pulled out with the capsule c. • Three types of surgical processes for cataract: a.Surgical Treatment • Earlier surgical techniques were dependent upon the maturity of the cataract.

it can be diagnosed from these symptoms: – Leukocoria. or metabolic cataract will not necessarily communicate their visual impairment verbally. – Erratic eye movement is present. – The child cries when the normal eye is covered. – Nystagmus. – Strabismus: the first sign of visual impairment. • However. traumatic.Cataract Surgery in Children • Observe changes in the child’s behavior: Children with congenital. – Oculodigital phenomenon: The child presses his or her finger against the eye or eyes because this can produce light patterns the child finds interesting. – The child has difficulty walking or grasping. Page 40 .

Page 41 .• Operate as early as possible: Retinal fixation and cortical visual responses develop within the first six months of life. This means that children who undergo surgery after the age of one year have significantly poorer chances of developing normal vision.