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LENS

AND
CATARACT

Calumpad, Ann Krizel Zyra T.


Castillo, Grace
LENS

Function:
An essential refractive media
Focuses the light on the retina
total refractive power
Adds 10-20diopters to the corneas
43 diopters RP
LENS
Shape:
Biconvex, transparent
structure
Posterior surface has a radius
of 6mm, with greater
curvature than that of the
anterior surface which has a
LENS
Weight:
An adult lens weighs about
220mg
Approximately 4mm thick
Increases with age to five
times its weight at birth
LENS
Position and suspension
Lies in the posterior
chamber of the eye between
the posterior surface of the
iris and the vitreous body in
a saucer-shaped
depression of the
vitreous body called the
Embryology and growth
Purely an epithelial structure
No nerves and blood vessels
Purely an ectodermal structure
Differentiates from an anterior
layer of epithelial cells into central
geometric lens fibers and an
acellular hyaline capsule
LENS
Direction of growth is cetrifugal
Younger cells are always on the surface
and the oldest ones are in the center of
the lens
Metabolism and aging of the lens
Nourished by the diffusion from the aqueous
humour
Epithelium maintains and permit ion
equilibrium for transportation of nutrients,
mineral s and water for preservation of
integrity, transparency and optical function of
Lens
LENS
Water content of the lens decreases with
age
Protein increases.
Lens becomes harder, less elastic and
less transparent
Unavoidable over the age of 65
Central portion of the lens becomes
sclerosed and slightly yellowish with age
CATARACT
Opacity in the lens
Age-related cataract
65-74 y/o
PATHOGENESIS
yellow or brown discoloration

Additional findings may


include vesicles between lens
fibers or migration and
enlargement of epithelial cells
FACTORS

oxidative damage (from free


radical reactions)
ultraviolet light damage
malnutrition
SYMPTOMS

1. Blurring of vision

2. Glare (Photophobia)

3.Image blur

4. Distortion
CLASSIFICATION
IMMATURE CATARACT
has some transparent regions

MATURE CATARACT
is one in which all of the lens substance is opaque

HYPERMATURE CATARACT
cortical proteins become liquid. This liquid may escape
through the intact capsule, leaving a shrunken lens with a
wrinkled capsule
morgagnian cataract
AGE RELATED CATARACT

NUCLEAR

CORTICAL

POSTERIOR SUBSCAPULAR
NUCLEAR CATARACT
The normal condensation process in
the lens nucleus: nuclear sclerosis.

The earliest symptom may be


improved near vision without glasses
(second sight).

Most nuclear cataracts are bilateral


CORTICAL CATARACTS
opacities in the lens cortex. Changes in the
hydration of lens fibers create clefts in a radial
pattern around the equatorial region. They also
tend to be bilateral, but they are often
asymmetric.

Visual function is variably affected, depending


on how near the opacities are to the visual axis.
POSTERIOR SUBCAPSULAR CATARACTS
Common symptoms include glare
and reduced vision under bright
lighting conditions

This lens opacity can also result


from trauma, corticosteroid use
(topical or systemic),
inflammation, or exposure to
ionizing radiation
CHILDHOOD CATARACT
congenital (infantile) cataracts, which are
present at birth or appear shortly
thereafter

acquired cataracts, which occur later and


are usually related to a specific cause.
Either type may be unilateral or bilateral.
Results from prenatal exposure to
radiation (1st trimester)
Drugs taken by the mother prenatally
(corticosteroids, sulfonamides)
Maternal malnutrition
Intrauterine infection (rubella, herpes,
mumps, toxoplasmosis)
TRAUMATIC CATARACT

Most commonly d/t foreign


body injury to the lens or blunt
trauma to the eyeball
CATARACT SECONDARY TO INTRAOCULAR
DISEASE (COMPLICATED CATARACT)

begins: posterior subcapsular area-


entire lens structure.

chronic or recurrent uveitis,


glaucoma, retinitis pigmentosa,
and retinal detachment.
CATARACT ASSOCIATED WITH SYSTEMIC
DISEASE

Bilateral cataracts occur in many


systemic disorders including diabetes
mellitus, hypocalcemia (of any
cause), myotonic dystrophy, atopic
dermatitis, galactosemia, and Down,
Lowe (oculo-cerebro-renal), and
Werner syndromes
DRUG-INDUCED CATARACT
Corticosteroids administered over a long
period of time, either systemically or in
drop form, can cause lens opacities.
Other drugs associated with cataract
include phenothiazines, amiodarone,
and strong miotic drops such as
phospholine iodide.
Cataract Surgery
CATARACT SURGERY

No medical treatment for


cataract
Surgery is the definitive
treatment
INDICATIONS
Visual improvement
Medical indications
Phacolytic glaucoma
Hypermature cataract leading to
leakage of proteins leading to
inflammatory reaction and open
angle glaucoma from increased
IOP due to blockage of trabecular
pores
INDICATIONS
Phacomorphic glaucoma
Swelling of the lens (intumescent
lens) leads to angle closure
glaucoma (secondary)
Diabetic nephropathy
Cosmetic indications
To restore black pupil in a mature
cataract with no light perception
Cataract Surgery
Extracapsular Cataract Extraction
Preserves the posterior portion of the lens
capsule
Incision is made at the limbus either superiorly
or temporally
An opening is formed in the anterior capsule and
the nucleus and cortex of the lens are removed
An intraocular lens can then be placed in the
empty capsular bag supported by the intact
posterior capsule
CATARACT SURGERY
Phacoemulsification
Now the most common form of
extracapsular cataract extraction in
developed countries
Utilizes a handheld ultrasonic vibrator to
disintegrate the hard nucleus that the
nuclear material and cortex can be
aspirated through a 3mm small incision.
This incision will also be the site of
insertion of foldable intraocular lenses
CATARACT SURGERY
Manual Sutureless Small Incision
Cataract Surgery
Traditional nuclear expression form
of extracapsular cataract extraction

The nucleus is removed intact but


utilizing a small incision
Cortex is removed by manual
aspiration
ADVANTAGE: SMALL INCISION
SURGERY
More controlled operating
conditions
Avoidance of suturing
Rapid wound healing with lesser
degrees of corneal distortion
Reduced postoperative
intraocular inflammation
More rapid visual rehabilitation
COMPLICATION
Posterior capsular tear
Rf: previous trauma
Dense cataract
Unstable lens
Small pupil
Post-operative complications:
Secondary opacification of the
posterior capsule
PARS PLANA LENSECTOMY
OR PHACOFRAGMENTATION
Lens is removed via the pars plana in
conjuction with posterior vitrectomy
using automated lens and vitreous
cutters
May be performed to facilitate vitero-
retinal surgery or to remove
completely dislocated lens or a
partially dislocated lens that is not
amenable to phacoemulsification
Depends on severity of cataract
INTRAOCULAR LENSES
Newest posterior chamber lenses are
made of flexible materials such as
silicone and acrylic polymers
Allows implant to be folded, decreasing
the required incision size
There are lens designes that incorporate
multifocal optics or partially restore
accomodation
Goal: to provide patients with good
vision for both near and distance
without glasses
POST-OPERATIVE CARE
Small incision
Shortened postoperative recovery
period
Patient is ambulatory on the day of
surgery but is advised to move
cautiously and avoid straining or heavy
lifting for about a month
May be patched on the day of surgery,
metal shield is often suggested for
several days after surgery
Temporary glasses can be used for few
days
COMPLICATIONS OF ADULT
CATARACT SURGERY
Has a very low 2-5% rate of
complication that results in permanent
impairment of vision
Most serious complication:
Intraocular infection
(endophthalmitis, 0.1%
Intraocular hemorrhage (<0.5%)
COMPLICATIONS OF ADULT
CATARACT SURGERY
Other complications:
Retinal detachment
Cystoid macular edema
Glaucoma
Corneal edema
Ptosis
Most common: posterior capsule
opacification
POSTERIOR CAPSULE
OPACIFICATION
after cataract posterior capsule
opacification after an
extracapsular cataract extraction
But due to more advance
surgeries, this complication is now
not a common complication
POSTERIOR CAPSULE OPACIFICATION

This may be due to a proliferating


epithelium following cataract
surgery which leads to frank
opacification.
These cells may contract which may
lead to wrinkling of the posterior
capsule resulting in visual distortion
and decreased visual acuity
CATARACT SURGERY IN THE
YOUNG
Less dense cataracts than in adults
and may usually be removed by
irrigation-aspiration technique
without the need for
phacoemulsification
Correction consists of spectacles but
most childhood operations are
followed by contact lens correction
PROGNOSIS
Cataract in children requiring surgery is
not as good as that with age-related
vcataract surgery.
Associated amblyopia and occasional
anomalies of the optic nerve or retina
limit the degree of useful vision
Prognosis for improvement of visual
acuity is worst following surgery for
unilateral congenital cataracts and best
for incomplete bilateral congenital
cataracts that are slowly progressive
THANK YOU