Chp10 Lens Diseases

7/27/2019 Chp10 Lens Diseases

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Lens Disease

China Medical University NO.4Affiliated hospital Ophthalmology;

Ophthalmology hospital of ChinaMedical University


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Introduction Lens disease:

Change of transparency

cataract Position and morphological

abnormality

dislocation

malformation


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Basic knowledge


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Anatomy

Capsule: integritymaintaintransparency

Lens epi. PCO Lens substance: lens fiber

Nucleus

Cortex


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Function

Refraction

Accommodation

Protection: UV filtration

What is accommodation?

The capability that eyes changerefractive condition in order to acquireclear near sight.

!


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What is cataract?

Turbidity of lens

WHO: turbidity of lens + VA


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What is cataract?


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Case: turbid lens, but VA=0.8


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Cataract

Cataract is the No. 1 eye disease that

causing blind. 46% blindness is caused by cataract

!


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Etiology

Any factors that change theintraocular environment to affectlens metabolism. Such as: ageing, mechanical,

chemical, operation, inflammation,metabolic

Malformation Congenital factors


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Risk factors

UV

Diarrhea

Malnutrition

Diabetes

Smoking

Drinking alcohol


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Classification

On etiology:

Congenital

Senile

Complicated

Metabolic

Drug induced or

toxic Traumatic

After cataract


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Classification

On location: Cortical

Nuclear

Subcapsular

On degree: Immature

Intumescent

Mature

Hypermature


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Pathogenesis

The common route that causingcataract is the oxidation injury byperoxide free radical.

Apoptosishot spot of research

!


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Clinical manifestations

Symptoms:

Progressive vision decrease

Contrast sensitivity decrease

Refraction changes Diplopia

Glare

Change of color sensation Visual field defect


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Functionality

vision

contrast

test

Positive

wave

contrast

test

CSF curve

contrast test


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Color

vision

excursion

glare visual field loss

Vision abnormity


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Clinical manifestations

Signs:

Turbidity of lens


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Senile Cataract

Now calledAge-related Cataract

Most commonly seen

>50 yrs old >80 yrs old100%

Degenerative changes


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Classification

Cortical

Nuclear

Subcapsular


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Cortical cataract

4 stages

Incipient stage: wedge turbidity


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Cortical cataract

4 stages

Intumescent stage

(immature): iris projection

Induce acute angle-closure glaucoma


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Cortical cataract

4 stages

Mature stage


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Cortical cataract

4 stages Hypermature stage:

Morgagni cataract

Phacoanaphylactic uveitis

Phacolytic glaucoma


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Nuclear cataract


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Subcapsular cataract

Affecting vision early


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Congenital cataract

Etiology:

Hereditary

Environmental: Virus infection

Malnutrition

Radiation

Drug

Systemic disease

VD deficiency


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Congenital cataract

Morphology


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Congenital cataract

Treatment

observation Early operation

AmblyopiaTreatment


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Complicated cataract

Caused by other eye diseases

Corneal ulcer

Glaucoma Uveitis

Retinal detachment

Retinitis pigmentosa

Intraocular tumor

myopia


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Old anterior uveitis Complicated cataract

glaucoma Complicatedcataractvogt spot

Pigmentosa eye Silicon oil eye

Kinds of Complicated cataract


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Metabolic cataract

Caused by systemic metabolic diseases Diabetic cataract

Galactosemia cataract

Hand-foot-twitch cataract


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Drug induced or toxic cataract

Glucocorticosteroid cataract

Chlorpromazine cataract

Miotic cataract

TNT cataract

Metal: copper, iron, mercury, silver, zinc


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Traumatic cataract

Contusive

Penetrating

Radiative Electric


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After cataract

Now usually called PCO (posteriorcapsular opacification)

Adult: 30-50%

Child: 100%

Pathogenesis:

Proliferation, migration & metaplasia of lens

epi.!


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Treatment

Drug? NO USE

Operation: the only effective therapy

ICCE (intracapsular cataract extraction)

ECCE (extracapsular cataract extraction)

PEA (phacoemulsification)

!


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ICCE ECCE

ICCE And ECCE


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Treatment

IOL (intraocular lens) implantation

AC and PC

Hard and foldable


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Treatment

IOL (intraocular lens) implantation


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Treatment

PEA & F-IOL


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PEA & F-IOL (video)


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Treatment

Correction of aphakia:

Frame glasses

Contact lens

IOL

Laser


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Lens Dislocation

Etiology:

Congenital

Marfan syndrome

Traumatic

Spontaneous


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Clinical Manifestations

Subluxation

Dislocation


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Clinical Manifestations

Complications: Uveitis

Secondary glaucoma

Retinal detachment Corneal turbidity


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Trends

Photolysis of cataract

Injective IOL

Accommodative IOL

Documents

Chp10 Lens Diseases