SENILE

CATARACT
Dr Syed Akhter
 Definition of Cataract
The term “Cataract” refers to the
development of any opacity in the lens
or its capsule.
This leads to decrease vision.
 SENILE CATARACT

 It is the most common form of cataract

affecting people of either gender above
50 years of age.
 Usually one eye is affected earlier
followed by the other eye.
 Morphologically it is of two types:

 Cortical (soft) Cataract.

 Nuclear (hard) Cataract
The cortical type starts as cuneiform or
cupuliform cataract.

 Both type may co-exist in the same lens.

Cuneiform is predominantly seen, 70%.

ETIOLOGY :
Etiopathogenesis is unclear, but cataract
is essentially an ageing process.
 CORTICAL SENILE CATRACT

 It is the result of decreased levels of total

proteins, amino acids and potassium of
the lens.

 There is increased concentration of

sodium and hydration of the lens.

 this ultimately leads to denaturation of

lens proteins.
 Stages of maturation of
cortical type.
 1. Stage of lamellar separation: This can
be seen under slit lamp examination
only, there is demarcation of cortical
fibers, where they start to separate by
fluid
 2. Stage of incipient cataract: In this stage
two different forms can be seen.
a. Cuneiform senile cataract . Seen as
wedge shaped opacity with clear
areas in between.
 These extend from equator towards

and can be seen when pupils are

center

dilated.
First seen in the nasal quadrant.

 These opacities are present both in

 anterior and posterior cortex and their
apices slowly progres towards the pupil.
 On oblique illumination, these present as
radical spokes.

On distant direct ophthalmoscopy, theseopacities

appear as dark lines agaisntred fungal glow.

Visual disturbances are seen in later stages.

b. Cupuliform senile cataract.
 it has a saucer shaped opacity
(postero- subcapsular) which
gradually extend outwards.
 there is usually definitive
demarcation between cataract
and surrounding clear cortex.
This cataract lies in the visual axis,
causes early loss of vision.
3. Immature Senile cataract .
Opacification further progresses in this
stage.
 both forms can be recognized till the
advanced stage of ISC.
 the lens appears greyish white but
clear cortex is present so iris shadow is
visible.
 in some patients, lens swell up due to
hydration, this is called intumescent
cataract, which may persist in next
stage.
The anterior chamber becomes shallow
due to swollen lens.
4. Mature senile cataract. In this stage
opacification becomes complete.
Whole of the cortex is opaque.
Lens become pearly white in colour
Is Also labelled as ‘ripe cataract’
5. Hypermature senile cataract. It develops when
mature cataract is untreated. It is of two types :
Morganian hypermature cataract. The cortex
liquifies and lens becomes a bag of milky fluid.
Small brownish nucleus settles at the bottom,
altering its position with head posture.
 Sclerotic type. The cortex becomes
disintegrated and the lens shrinks due to
leakage of water. The anterior capsule is
wrinkled and thickened due to proliferation of
anterior cells and dense white capsular
cataract may be formed in the pupillary area.
The anterior chamber becomes deep due to
shrinkage of lens.
Nuclear Senile Cataract
In this type, the usual degenerative
changes are aggravated due to
dehydration and compaction of nucleus
, leading to hard cataract.
There is increase in water insoluble
proteins, but total proteins remain the
same.
It may be associated with deposition of
pigments like urochrome and melanin.
Maturation of Nuclear type
The lens becomes inelastic and hard with
decreased ability to accommodate and
obstructs the light rays.
The changes progress towards the
periphery.
Thin layer of clear cortex is seen when it
matures up to the capsule.
The nucleus becomes cloudy or tinted
due to deposition of pigments.
Clinical Symptoms
GLARE or intolerance of bright light
UNIOCULAR POLYOPIA i.e. doubling or
trebling or visions due to irregular
refraction by the lens.
COLOURED HALOS owing to the splitting
of light by water droplets in lens.
BLACK SPOTS in front of eyes.
DISTORTION OF IMAGES and blurring.
LOSS OF VISION is painless and gradually
progressive.
Incupuliform, there is early loss of vision and
Vision is improved when pupils are dilated.

 In cuneiform, there is delayed loss and vision is improved when

pupils are dilated.
Vision diminishes
with increased opacification
until only perception of light and projection of
rays remains in the stage of mature cataract.
 PREOPERATIVE EVALUATION OF SENILE CATARACT HISTORY
general health of the patient diabetes mellitus,
hypertension,
ischemic heart disease ,
chronic obstructive pulmonary disease ,
bleeding disorders ,
parathyroid tetany,
myotonic dystrophy,
galactosaemia
down syndrome,
CONTINUE……….

patient
ocular history : Trauma,
Inflammation, Amblyopia ,
glaucoma , optic nerve
abnormalities , or retinal disease
 social history
OCULAR INVESTIGATION…
MEASUREMENTS OF VISUAL
FUNCTION
1. Visual status assessment visual acuity,
perception of light ((PL), perception of rays (PR)
2. Refraction –
3.Brightness acuity
4 Contrast sensitivity
5 Visual field testing
Examination

Slit-Lamp Examination :

Eyelids,
Lacrimal apparatus,
sclera Conjunctiva ,
Anterior chamber ,
Cornea
Iris
Crystalline Lens
CONTINUE…….
 Fundus Evaluation;

Ophthalmoscopy –

Optic nerve –

Fundus evaluation with

opaque media
 Preoperative Measuremen;

: Biometry

1.Keratometry

2. A- scan ultrasonography
MANAGEMENT
 NON-SURGICAL MEASURES ---
1. Treatment of cause of cataract
2. 2. Measures to delay progression topical
preparation containing iodine salts of
calcium and potassium, role of vitamin E
and aspirin
3. Measures to improve in the presence of
incipient and immature cataract----
Refraction, Arrangement of
illumination, use of dark goggles,
Mydriatics
 Surgical Treatment:
Options :
 I. Intracapsular lens extraction (ICCE):
 Method of intracapsular cataract extraction (ICCE),
now becoming obsolete, by which the entire lens
including the capsule is removed by rupturing zonular
ligaments.
2. Extracapsular Cataract Extraction (ECCE):
Methods –
1. Conventional ECCE
2. ECCE by small incision cataract surgery (SICS)
(SICS)
3. Lensectomy
4. Phacoemulsificatio
COUNSELING AFTER POSTOPERATIVE CATARACT
SURGERY
The post-operative recovery period (the period
after cataract extraction is done) is usually short.
The patient is usually ambulatory on the day of
surgery but is advised to move cautiously and
avoid straining or heavy lifting for about a month.
The eye is usually patched on the day of surgery
and at night using an eye shield is often suggested
for several days after surgery.
PREOPERATIVE COMPLICATIONS IN SENILE
CATARACT
 Anxiety
 Nausea and gastritis
 Irritative or allergic conjunctivitis
 Corneal abrasion
 Complications due to local anaesthesia:
1 Retrobulbar haemorrhage
2 Oculocardiac reflex –
3 Perforation of globe –
4 Subconjunctival haemorrhage –
5 Spontaneous dislocation of lens
COMPLICATION OF CATARACT
SURGERY:
 Retinal detachment
 Endophthalmitis
 Corneal edema
 Cystoid macular edema
 Pseudophakic bullos keratopathy
 Epithelial keratopathy
 Fibrous downgrowth
THANK
S