CATARACT

THE LENS

The lens is a transparent, biconvex, crystalline structure

placed between iris and the vitreous.
Lens capsule is a thin, transparent, hyaline membrane
surrounding the lens which is thicker over the anterior
than the posterior surface
Anterior epithelium in the equatorial region these cells
become columnar. Its actively dividing and elongating to
form new lens fibres.
THE LENS

Lens fibres. Mature lens fibres are cells which have lost
their nuclei. As the lens fibres are formed throughout
the life, these are arranged compactly as nucleus and
cortex of the lens
Nucleus is the central part containing the oldest fibres
Cortex is the peripheral part which comprises the
youngest lens fibres.
Suspensory ligaments of lens (Zonules of Zinn)
consist of a series of fibres passing from ciliary body to
the lens. These hold the lens in position and enable the
ciliary muscle to act on it.
CATARACT
DEFINITION

A cataract is present when the transparency of the lens is reduced to the point that the
patients vision is impaired.
The term cataract comes from the Greek word katarraktes (downrushing; waterfall)
because earlier it was thought that the cataract was a congealed fluid from the brain that
had flowed in front of the lens.
ETIOLOGY

Aging is the most common cause of cataract,

trauma,
toxins,
systemic disease (such as diabetes),
smoking,
and heredity.
Age-related cataract is a common cause of visual impairment. Cross-sectional studies place the
prevalence of cataracts at 50% in individuals aged 65-74; the prevalence increases to about 70% for those
over 75.
GENERAL SYMPTOMS

seeing only shades of gray, glare or star bursts,

visual impairment, monocular diplopia,
blurred vision, altered color perception
distorted to varying degrees, and these symptoms
vision, will vary with the specific type ofcataract
ACQUIRED CATARACT

1. Age Related Cataract

2. Cataract in systemic disease
3. Secondary Cataract
4. Traumatic Cataract
5. Congenital Cataract
AGE RELATED CATARACT

Clinical findings
Symptom: Progressively blurred
vision is the only symptom
Types:
According to the place of opacity
appear first
Cortical cataract
Nuclear cataract
Subcapsular cataract
Cataract Maturity
SUBCAPSULAR CATARACT

Anterior subcapsular cataract lies directly

under the lens capsule and is associated with
fibrous metaplasia of the lens epithelium
Due to its location at the nodal point of the
eye, a posterior subcapsular opacity often has
a particularly profound effect on vision.
Patients are characteristically troubled by
glare, for instance from the headlights of
oncoming cars, and symptoms are increased
by miosis, such as occurs during near visual
activity and in bright sunlight.
NUCLEAR CATARACT

Nuclear cataract is an exaggeration of

normal ageing change. It is often associated
with myopia due to an increase in the
refractive index of the nucleus, resulting in
some elderly patients being able to read
without spectacles again (second sight of the
aged)
At beginning, nucleus appears yellowish, its
color becomes more and more dark with
development
CORTICAL CATARACT

Cortical cataract may involve the anterior,

posterior or equatorial cortex. The opacities
start as clefts and vacuoles between lens
fibres due to cortical hydration. Subsequent
opacification results in typical cuneiform
(wedge-shaped) or radial spoke-like opacities,
often initially in the inferonasal quadrant. As
with posterior subcapsular opacity, glare is a
common symptom.
CATARACT MATURITY

Immature cataract is one in which the lens is partially opaque.

Mature cataract is one in which the lens is completely opaque
Hypermature cataract has a shrunken and wrinkled anterior capsule due to leakage of
water out of the lens.
Morgagnian cataract is a hypermature cataract in which liquefaction of the cortex has
allowed the nucleus to sink inferiorly
 CATARACT IN SYSTEMIC DISEASE

Diabetes mellitus: Hyperglycaemia is reflected in a high level of glucose in the aqueous humour,
which diffuses into the lens. Here glucose is metabolized into sorbitol, which accumulates within
the lens, resulting in secondary osmotic overhydration.
Myotonic dystrophy: About 90% of patients with myotonic dystrophy develop fine iridescent
cortical opacities in the third decade
Atopic dermatitis: About 10% of patients with severe atopic dermatitis develop cataracts in
the second to fourth decades; these are often bilateral and may mature quickly. Shield-like dense
anterior subcapsular plaque that wrinkles the anterior capsule is characteristic. Posterior
subcapsular opacities may also occur.
Neurofibromatosis type 2: Neurofibromatosis type 2 is associated with early cataract in more
than 60% of patients. Opacities are posterior subcapsular or capsular, cortical or mixed, and tend
to develop inearly adulthood.
SECONDAR CATARACT

Chronic anterior uveitis the incidence being related to the duration and intensity of inflammation.
Topical and systemic steroids used in treatment are also causative.
Acute congestive angle closure may cause small anterior greywhite subcapsular or capsular
opacities, glaukomflecken to form within the pupillary area. These represent focal infarcts of the lens
epithelium and are almost pathognomonic of prior acute angle-closure glaucoma.
High (pathological) myopia can be associated with posterior subcapsularlens opacities and early-
onset nuclear sclerosis, which ironically may increase the myopic refractive error.
Hereditary fundus dystrophies such as retinitis pigmentosa, Leber congenital amaurosis, gyrate
atrophy and Stickler syndrome, may be associated with posterior and, less commonly, anterior
subcapsular lens opacities (Fig. 9.5E). Cataract surgery may improve visual function even in the presence
of severe retinal changes.
 TRAUMATIC CATARACT

Trauma is the most common cause of unilateral cataract in young individuals.

Penetrating trauma
Blunt trauma may cause a characteristic flower-shaped opacity.
Electric shock is a rare cause of cataract, patterns including diffuse milky-white opacification and
multiple snowflakelike opacities, sometimes in a stellate subcapsular distribution
Infrared radiation, if intense as in glassblowers, may rarely cause true exfoliation of the anterior
lens capsule
Ionizing radiation exposure such as for ocular tumour treatment may cause posterior
subcapsular opacities ; these may not manifest for months or years.
 CONGENITAL CATARACT

It is a result of developmental disturbance of lens during the

process of development of fetus
Etiology
Genetic factor-autosomal dominant inheritance
Damage of fetal lens caused by systemic disorders of mother
or fetus-viral infections, nourishment and metabolic
disturbance of mother.
MANAGEMENT OF CATARACT

Treatment of cataract essentially consists of its surgical removal. However, certain non-
surgical measures may be of help, in peculiar circumstances, till surgery is taken up.
Indiction of surgical
Visual improvement.
Medical indication
Cosmetic indication
LENS SURGERY

1. Intracapsular cataract extraction (ICCE)

It involves complete removal of the lens within its
capsule. through a larger (12mm length) superior
limbal incision
The larger incision may increase the risk of wound-
related problems.
LENS SURGERY

Extracapsular cataract extraction (ECCE)

It involves removal of the lens nucleus and cortex
through an opening in the anterior capsule, leaving the
posterior capsule in place.
A superior limbal incision is made,it is shorter than
ICCE
The anterior portion of the capsule is ruptured and
removed
The nucleus is extracted
The cortex is either irrigated or aspirated from the eye
leaving the posterior capsule behind.
ECCE AND IOL
LENS SURGERY

Phacoemulsification(Phaco)
It is a relatively new technique.In recent years, it
has become popular.
It is a method of extracting the nucleus through a
small incision(3mm).
The nucleus is extracted by ultrasonic vibration.
This technique results in a lower incidence of
wound-related complications, faster healing, and
more rapid visual rehabilitation than procedures
requiring larger incisions.
PHACOEMULSIFICATION
(PHACO)
VISUAL REHABILITATION

Removal of the lens causes a marked reduction of the refractive power of the eye
(aphakia)
Aphakia may be corrected by three methods include spectacles (glasses), contact
lens or intraocular lens (IOL) to increase its refractive power
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