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Cataracts Cataracts Akif Akif Ö Ö zdamar zdamar ,MD. ,MD.

Cortical Cataracts

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  • CataractsCataracts

    Akif Akif zdamarzdamar,MD.,MD.

  • AnatomyAnatomyNormal Normal CrystallineCrystalline LensLenstransparent and biconvextransparent and biconvex

    responsible for 15responsible for 15--20 diopters of 20 diopters of convergent refractive powerconvergent refractive power

    avascularavascular structure with no blood structure with no blood supply or supply or lymphatic channelslymphatic channels

    measures 9 mm equatorially and 5 measures 9 mm equatorially and 5 mm mm anteroposteriorlyanteroposteriorly

  • CapsuleCapsule

    elastic, transparent basement membrane elastic, transparent basement membrane contains the lens substance contains the lens substance is capable of molding it during accommodative is capable of molding it during accommodative changeschangesanterior lens capsule is considerably thicker than anterior lens capsule is considerably thicker than the posterior capsule the posterior capsule

  • Zonular FibersZonular Fibers

    The lens is supported by zonular fibers The lens is supported by zonular fibers that originate from basal lamina of the that originate from basal lamina of the nonpigmentednonpigmented epithelium epithelium fibers are 5fibers are 5--30 micron in diameter30 micron in diametereosinophiliceosinophilic PAS positive structuresPAS positive structures

  • Lens EpitheliumLens Epitheliumsingle layer of epithelial cellssingle layer of epithelial cells behind the anterior behind the anterior lens capsule lens capsule mitotic and highest activity of mitotic and highest activity of premitoticpremitotic DNA DNA synthesis synthesis ring around the anterior lens known as ring around the anterior lens known as germinativegerminative zone. zone. newly formed cells migrate toward the equator,newly formed cells migrate toward the equator,the cells lose organelles including cell nuclei, the cells lose organelles including cell nuclei, mitochondria, and mitochondria, and ribosomesribosomes

  • Nucleus and CortexNucleus and CortexNew fibers are laid down; crowding and New fibers are laid down; crowding and compacting previously formed fibers with the compacting previously formed fibers with the oldest layers oldest layers The oldest of these, the embryonic and fetal lens The oldest of these, the embryonic and fetal lens nucleus, were produced in embryonic life nucleus, were produced in embryonic life The outermost fibers are the most recently The outermost fibers are the most recently formed and make up the cortex of the lens.formed and make up the cortex of the lens.Lens sutures are formed by the arrangement of Lens sutures are formed by the arrangement of interdigitationsinterdigitations of apical cell processes of apical cell processes

  • BiochemistryBiochemistry

    protein concentration of 33% of its wet protein concentration of 33% of its wet weightweightwater water solusolubleble ((crystallinecrystallines) s) and water and water insolubleinsoluble proteinsproteinscrystallinscrystallins represent approximately 86% of represent approximately 86% of the total lens proteins the total lens proteins alpha, beta and gamma alpha, beta and gamma crystallinscrystallins. .

  • BiochemistryBiochemistrylens proteins become water insoluble and aggregate to lens proteins become water insoluble and aggregate to form very large particles form very large particles scatter light, thus producing lens opacities scatter light, thus producing lens opacities water insoluble protein fraction increases with the age water insoluble protein fraction increases with the age even if the lens remains cleareven if the lens remains clearappears to be a natural process in lens fiber maturationappears to be a natural process in lens fiber maturationit may be accelerated or occur to excess in certain it may be accelerated or occur to excess in certain cataractouscataractous lenses.lenses.In cataracts, the increase in the amount of insoluble In cataracts, the increase in the amount of insoluble protein does correlate with the degree of opacificationprotein does correlate with the degree of opacification

  • Carbohydrate MetabolismCarbohydrate Metabolism

    GGlycoselycose transported into the lens transported into the lens phosphorylatedphosphorylated to a glucoseto a glucose--66--phosphatephosphateG6P enters one of two metabolic G6P enters one of two metabolic pathways; anaerobic pathways; anaerobic glycolysisglycolysis and the and the pentose phosphate pathwaypentose phosphate pathway (5%)(5%)

  • AccommodationAccommodationfocus from distant to near images focus from distant to near images ;; accommodation. accommodation. change in lens shape as a result of the action of ciliary musclechange in lens shape as a result of the action of ciliary muscle on on the zonular fibersthe zonular fibersSSphincterphincter muscle contractmuscle contractionion reducreducinging in in diameter of a muscle ring diameter of a muscle ring , , relaxing the tension on zonular fibersrelaxing the tension on zonular fibers, , allowing the lens to become allowing the lens to become more spherical more spherical CCiliaryiliary muscle muscle relaxerelaxetiontion,, increaseincrease in in zonular tensionzonular tension,, flatteningflattening of of thethe lenslens,, and and decreasedecrease in in its optic powerits optic powerAdolescents generally have 12Adolescents generally have 12--16 diopters of accommodation16 diopters of accommodationadults at age 40 have 4adults at age 40 have 4--8 diopters8 dioptersprincipal causeprincipal cause of of lossloss of of accommodationaccommodation;; hardening of the lens with hardening of the lens with ageage::PresbyopiaPresbyopia

  • EmbryologyEmbryology25 days of gestation25 days of gestation; O; Opticpticvesicles form from the vesicles form from the forebrainforebrain27 days of gestation27 days of gestation;; the lens the lens plateplate form.form.29 days of gestation29 days of gestation; ; The lens The lens pit appears as a small pit appears as a small indentindentaationtion inferior to the inferior to the center of lens pate.center of lens pate.AppearenceAppearence of of the lens vesiclethe lens vesiclePrimaryPrimary lens lens fibersfibers, , EmbryonicEmbryonicnucleusnucleusLens Lens epitheliumepithelium

  • Congenital DefectsCongenital Defects

    I.I. Congenital Congenital AphakiaAphakia

    PPrimaryrimary aaphakiaphakia; ; the lens plate fails to the lens plate fails to form from the surface ectodermform from the surface ectoderm

    SSecondaryecondary aphakiaaphakia; ; the developing lens the developing lens is spontaneously absorbedis spontaneously absorbed

  • II. II. Lenticonus and LentiglobusLenticonus and LentiglobusPosterPosteriior lenticonus or lenticonus MMore common than the ore common than the anterior lenticonus anterior lenticonus UUsuallysually unilateral and axial in unilateral and axial in locationlocationAnterior lenticonus Anterior lenticonus AssociatedAssociated withwith AlportAlportSyndromeSyndromeOftenOften bilateralbilateralPosterior lentiglobusPosterior lentiglobus; ; MMore common than in the ore common than in the anterior lentiglobus anterior lentiglobus AAssociatedssociated with opacities of with opacities of the posterior polethe posterior pole

  • III. III. Lens ColobomaLens Coloboma

    typically located inferiorlytypically located inferiorlyassociated with associated with colobomascolobomas of the of the uveauveaCortical lens opacification or thickening of Cortical lens opacification or thickening of the lens capsulethe lens capsule adjacentadjacent toto colobomacolobomaDefectDefect in in thethe zonular attachmentszonular attachments adjacentadjacenttoto colobomacoloboma

  • IV. IV. MicrospherophakiaMicrospherophakiaLens sLens small in diameter and mall in diameter and spherical in shapespherical in shapeIIncreasedncreased refractive power of refractive power of the spherical shape of the lensthe spherical shape of the lens; ; highly myopichighly myopic eyeeyemost often seen as a part of most often seen as a part of WeilWeil--MarchesaniMarchesani syndromesyndromecause cause pupillarypupillary blockblock; ; angleangle--closure glaucomaclosure glaucomaMioticsMiotics aggravateaggravate; ; CycloplegicsCycloplegics mmedicaledicaltreatment of choicetreatment of choice

  • Congenital and Infantile CataractCongenital and Infantile Cataract

    lens opacity present at birthlens opacity present at birth; ; CongenitalCongenital cataractcataractLens opacities that develop during the first year Lens opacities that develop during the first year of life of life ; ; InfantileInfantile cataractcataract1 out of every 2000 live births1 out of every 2000 live birthsone third of congenital or infantile cataracts are one third of congenital or infantile cataracts are associated with other disease syndromesassociated with other disease syndromesone third occur as inherited traitone third occur as inherited traitone third result from undetermined causesone third result from undetermined causes

  • ETIOLOGY OF PEDIATRIC CATARACTSETIOLOGY OF PEDIATRIC CATARACTSBilateralBilateral cataractscataractsIdiopathicIdiopathicHereditaryHereditary cataractscataracts

    ((autosomalautosomal dominant dominant mostmost commoncommon, , alsoalso autosomalautosomal recessiverecessive oror XX--linkedlinked))GeneticGenetic andand metabolicmetabolic diseasesdiseases

    DownDown syndromesyndromeHallermannHallermann--StreiffStreiff syndromesyndromeLoweLowe syndromesyndromeGalactosemiaGalactosemiaMarfanMarfan syndromesyndromeTrisomyTrisomy 1313--1515HypoglycemiaHypoglycemiaAlportAlport syndromesyndromeMyotonicMyotonic dystrophydystrophyFabryFabry diseasediseaseHypoparathyroidismHypoparathyroidismConradiConradi syndromesyndrome

    MaternalMaternal infectioninfectionRubellaRubellaCytomegalovirusCytomegalovirusVaricellaVaricellaSyphilisSyphilisToxoplasmosisToxoplasmosis

    Ocular Ocular anomaliesanomaliesAniridiaAniridiaAnteriorAnterior segmentsegment dysgenesisdysgenesis syndromesyndrome

    ToxicToxicCorticosteroidsCorticosteroids ,,RadiationRadiation ((maymay alsoalso be be unilateralunilateral))

  • ETIOLOGY OF PEDIATRIC CATARACTSETIOLOGY OF PEDIATRIC CATARACTSUnilateralUnilateral cataractscataracts

    IdiopathicIdiopathicOcular Ocular anomaliesanomaliesPersistentPersistent hyperplastichyperplastic primaryprimary vitreousvitreous (PHPV) (PHPV) AnteriorAnteriorsegmentsegment dysgenesisdysgenesisPosteriorPosterior lenticonuslenticonusPosteriorPosterior polepole tumorstumorsTraumaticTraumatic ((rulerule oufouf childchild abuseabuse))RubellaRubellaMaskedMasked bilateralbilateral cataractcataract

  • Morphologic classification of Morphologic classification of congenital and infantile cataractscongenital and infantile cataracts

    Polar CataractsPolar CataractsAnterior polar cataractsAnterior polar cataracts;; usually small, usually small, bilateral, symmetric, bilateral, symmetric, nonprogressivenonprogressiveopacities opacities do not impair visiondo not impair visionPosterior polar cataractsPosterior polar cataracts;;generally generally produce more visual impairment produce more visual impairment

  • SuturalSutural CataractsCataracts

    opacification of the Y sutures of the fetal opacification of the Y sutures of the fetal nucleus nucleus SeldomSeldom impairs visionimpairs visionautosomal dominant patternautosomal dominant pattern

  • Nuclear CataractsNuclear CataractsOOpacitiespacities of either the of either the embryonic nucleus embryonic nucleus alone or both the alone or both the embryonic and fetal embryonic and fetal nucleinucleicomplete complete oror limited to limited to discrete layers discrete layers

  • Capsular CataractsCapsular CataractsOOpacifications of the lens epithelium and pacifications of the lens epithelium and anterior lens capsule anterior lens capsule

    DiscDisc--shapedshaped configuraionconfiguraionMostMost commoncommon typetypeBilateralBilateral andand usuallyusually symetricsymetrichorseshoe shaped opacitieshorseshoe shaped opacities; ; riders.riders.

    LamellarLamellar CataractsCataracts

  • CompleteComplete CataractCataract

    OOpacificaitonspacificaitons of all the lens fibersof all the lens fibersCCompletelyompletely obscuredobscured rred reflexed reflexSSubtotalubtotal at birthat birth,, progress rapidly to progress rapidly to complete cataractscomplete cataracts

  • Membranous CataractsMembranous Cataracts

    lens proteins are lens proteins are resorbedresorbed from either an from either an intact or traumatized lensintact or traumatized lensanterior and posterior lens capsule anterior and posterior lens capsule fusedfused; ; dens white membranedens white membraneSSignificantignificant visual disabilityvisual disability

  • Rubella CataractRubella CataractMaternal infection with the rubella virus, an RNA Maternal infection with the rubella virus, an RNA togavirustogavirusSystemic manifestationsSystemic manifestations; ; cardiac defects, cardiac defects, deafness, and mental retardationdeafness, and mental retardationCCharacterizedharacterized by white nuclear by white nuclear opacificationsopacificationsSometimesSometimes ccompleteomplete cataractcataractLive virus particles Live virus particles in in thethe lens lens materialsmaterialsEExcessivexcessive postoperative inflammation postoperative inflammation

  • DEVELOPMANTAL DEFECTSDEVELOPMANTAL DEFECTS

    EctopiaEctopia LentisLentisSubluxatedSubluxated lenslensLuxatedLuxated oror dislocateddislocated lenslensCausesCauses::TraumaTrauma, , MarfanMarfan syndromesyndrome, , homohomo-- cystinuriacystinuria, , aniridiaaniridia, , andand congenitalcongenital glaucomaglaucoma. . FindingsFindings: : decreaseddecreased visionvision, , markedmarked astigmatismastigmatism, mono, mono--ocular ocular diplopiadiplopia, , andand iridodonesisiridodonesis

  • MarfanMarfan SyndromeSyndromeHeritableHeritable disorderdisorder, , autosomalautosomaldominant dominant abnormalityabnormality of of fibrillinfibrillin, a , a connectiveconnective tissuetissue componentcomponentTallTall peoplepeople, , arachnodactylyarachnodactyly andandchestchest wallwall deformitiesdeformitiesAssociatedAssociated cardiaccardiac abnormalitiesabnormalities; ; dilateddilated aorticaortic rootroot andand mitral mitral valvevalveprolapseprolapseFromFrom 50% 50% toto 80% of 80% of patientspatients withwithMarfanMarfan syndromesyndrome exhibitexhibit ectopiaectopialentislentislens lens subluxationsubluxation;;bilateralbilateral andandsymmetricsymmetric ,,usuallyusually superiorsuperior andandtemporaltemporal, , axialaxial myopiamyopia, , increasedincreased risk of risk of retinalretinal detachmentdetachment

  • HomocystinuriaHomocystinuriaautosomalautosomal recessiverecessive disorderdisorderinborninborn errorerror of of methioninemethionine metabolismmetabolismElevatedElevated serum serum levelslevels of of homocystinehomocystine andandmethioninemethionineseizuresseizures, , osteoporosisosteoporosis, , andand mentalmental retardationretardationproneprone toto thromboembolicthromboembolic episodesepisodesLens Lens dislocationdislocation tendstends toto be be bilateralbilateral andandsymmetricsymmetricLensesLenses usuallyusually subluxatedsubluxated inferiorlyinferiorly andand nasallynasally

  • HyperlysinemiaHyperlysinemiaectopiaectopia lentislentis, , mentalmental retardationretardation andand muscularmuscular hypotonyhypotony

    SulfiteSulfite OxidaseOxidase DeficiencyDeficiencyautosomalautosomal recessiverecessive metabolicmetabolic disorderdisorder of of sulfursulfurmetabolismmetabolismectopiaectopia lentislentis, , mentalmental retardationretardation andand seizuresseizures

  • AGING CHANGESAGING CHANGES

    AgeAge--relatedrelated cataractcataract; ; commoncommon causecause of of visualvisual impairmentimpairment in in olderolder adultsadultsPrevalencePrevalence; ; 50% 50% betweenbetween thethe agesages of 65 of 65 andand 747470% 70% overover thethe ageage of 75 of 75

  • AGING CHANGESAGING CHANGESIncreasesIncreases in in weightweight andand thicknessthicknessDecreasesDecreases in in accommodativeaccommodative powerpowerNucleusNucleus undergoesundergoes compressioncompression andand hardeninghardening ((nuclearnuclear sclerosissclerosis))CrystallinsCrystallins (lens (lens proteinsproteins) ) areare changedchanged byby chemicalchemical modificationmodificationAggregationAggregation intointo highhigh--molecularmolecular--weightweight protein protein FluctuationsFluctuations in in thethe refractiverefractive indexindex, , scatterscatter lightlight raysrays, , andand reducereducetranstrans-- parencyparencyYellowYellow oror brownishbrownish huehueDecreasedDecreased concentrationsconcentrations of of glutathioneglutathione andand potassiumpotassiumIncreasedIncreased concentrationsconcentrations of of sodiumsodium andand calciumcalcium, , andand increasedincreasedhydratationhydratation

  • AgeAge--relatedrelated CataractsCataracts

    NuclearNuclear CataractsCataractsCorticalCortical CataractsCataractsPosteriorPosterior SubcapsularSubcapsularCataractsCataracts

  • Nuclear CataractsNuclear CataractsExcessiveExcessive amountamount of of sclerosissclerosisandand yellowingyellowingProgressProgress slowlyslowlyUsuallyUsually bilateralbilateralCauseCause greatergreater impairmentimpairment of of distancedistance visionvision thanthan of of nearnearvisionvisionCausesCauses an an increaseincrease in in thetherefractiverefractive indexindex of of thethe lens, lens, myopicmyopic shiftshift in in refractionrefraction((lenticularlenticular myopiamyopia))lens lens nucleusnucleus becomesbecomes opaqueopaqueandand brownbrown ; ; brunescentbrunescentnuclearnuclear cataractcataract

  • CorticalCortical CataractsCataractsusuallyusually bilateralbilateralcorticalcortical spokesspokes appearappear as as whitewhite opacitiesopacitiescommoncommon symptomsymptom; ; glareglare fromfrom intenseintense focalfocal lightlight sourcessourcesAs As thethe lens lens continuescontinues toto taketake upup waterwater; it ; it maymay swellswell andand becomebecome an an intumescentintumescent corticalcortical cataractcataractWhenWhen thethe entireentire cortexcortex fromfrom thethe capsulecapsule toto thethe nucleusnucleus becomesbecomes whitewhite andandopaqueopaque; ; MMatureature cataractcataractWhenWhen degenerateddegenerated corticalcortical materialmaterial leaksleaks throughthrough thethe lens lens capsulecapsule; ; HHypermatureypermature cataractcataractA A morgagnianmorgagnian cataractcataract: : whenwhen furtherfurther liquefactionliquefaction of of thethe cortexcortex allowsallows freefreemovementmovement of of thethe nucleusnucleus withinwithin thethe capsularcapsular bagbag..

  • PosteriorPosterior SubcapsularSubcapsular CataractsCataractsOftenOften seenseen in in patientspatients youngeryounger thanthanwithwith nuclearnuclear oror corticalcortical cataractscataractsLocatedLocated in in thethe posteriorposterior corticalcortical layerlayerandand areare usuallyusually axialaxialOftenOften complainscomplains of of glareglare andand poorpoorvisionvision underunder brightbright lightinglighting conditionsconditionsObscuresObscures moremore of of thethe pupillarypupillary apertureaperturewhenwhen miosismiosis is is inducedinduced byby brightbright lightslights, , accommodationaccommodation, , oror mioticsmioticsNearNear visualvisual acuityacuity reducedreduced moremore thanthandistancedistance visualvisual acuityacuityCan Can occuroccur as a as a resultresult of of traumatrauma, , systemicsystemic andand topicaltopical corticosteroidcorticosteroid useuse, , inflammationinflammation, , andand exposureexposure toto ionizingionizingradiationradiation

  • DrugDrug--InducedInduced CataractsCataracts

    CorticosteroidsCorticosteroidsposteriorposterior subcapsularsubcapsular cataractscataractsrelatedrelated toto dosedose andand durationduration

    MioticsMioticsAnticholinesterasesAnticholinesterases ((echothiophateechothiophate iodideiodide andanddemecariumdemecarium bromidebromide))firstfirst appearappear as as smallsmall vacuolesvacuoles

  • TraumaticTraumatic CataractsCataracts

    MechanicalMechanical injuryinjuryPhysicalPhysical forcesforces ((radiationradiation, , electricalelectricalcurrentcurrent, , chemicalschemicals) ) OsmoticOsmotic influencesinfluences ((diabetesdiabetes mellitusmellitus))

  • VossiusVossius ringringpigment pigment fromfrom thethe pupillarypupillary imprintedimprinted ontoonto thethe anterioranterior surfacesurface of of thethe lenslensVisuallyVisually insignificantinsignificantIndicateIndicate priorprior traumatrauma

    TraumaticTraumatic cataractcataractbluntblunt, , nonperforatingnonperforating injuryinjury: : stellatestellate oror rosetterosette--shapedshapedopacificationopacification in in posteriorposterior lens lens capsulecapsule

    PerforatingPerforating andand PenetratingPenetrating InjuryInjuryopacificationopacification of of thethe cortexcortex at at thethe site of site of thethe rupturrupturprogressingprogressing rapidlyrapidly toto completecomplete opacificationopacificationsmallsmall perforatingperforating injuryinjury of of thethe lens lens capsulecapsule maymay healheal

  • RadiationRadiation--InducedInduced CataractsCataractsInfraredInfrared radiationradiation ((glassblowersglassblowers' ' cataractcataract))UltravioletUltraviolet radiationradiation

    UVB, UVB, prolongedprolonged sun sun exposureexposureCorticalCortical andand posteriorposterior subcapsularsubcapsular cataractscataracts

    ChemicalChemical InjuriesInjuriesAlkali Alkali injuriesinjuries toto thethe ocular ocular surfacesurfaceCorticalCortical cataractcataract formationformation

    SiderosisSiderosis bulbibulbirustyrusty brownbrown discolorationdiscolorationcompletecomplete corticalcortical cataractcataract formationformation

    ChalcosisChalcosisDescemet'sDescemet's membranemembrane, , anterioranterior lens lens capsulecapsuleSunflowerSunflower cataractcataract; ; DepositionDeposition of of yellowyellow oror brownbrown pigmentationpigmentationin in thethe lens lens capsulecapsule

    ElectricalElectrical InjuryInjurylinearlinear opacitiesopacities in in thethe anterioranterior subcapsularsubcapsular cortexcortex

  • MetabolicMetabolic CataractsCataractsDiabetesDiabetes MellitusMellitus

    IncreaseIncrease in in lenticularlenticular glucoseglucose, , influxinflux of of waterwater intointo thethe lens, lens, causingcausingswellingswelling of of thethe lens lens fibersfibersSomeSome of of thethe glucoseglucose is is convertedconverted byby thethe enzymeenzyme aldosealdose reductasereductasetoto sorbitolsorbitolTransientTransient refractiverefractive changeschanges, , mostmost commonlycommonly myopicmyopic

    TwoTwo typestypes of of diabeticdiabetic cataractcataract1.1. TheThe truetrue diabeticdiabetic cataractcataract ((sorbitolsorbitol cataractcataract ))2.2. SenecentSenecent cataractcataract..

    frequentlyfrequently observedobserved in in diabeticdiabetic patientspatientssuggestssuggests thatthat diabeticdiabetic patientspatients havehave increasedincreased risk of risk of ageage--relatedrelatedlens lens changeschanges

  • GalactosemiaGalactosemiaAutosomalAutosomal recessiverecessive, , inabilityinability toto convertconvert galactosegalactose toto glucoseglucoseTheThe mostmost commoncommon defectivedefective enzymeenzyme; ; transferasetransferase, , classicclassic galactosemiagalactosemiaGalactoseGalactose accumulatesaccumulates in body in body tissuestissues, , withwith furtherfurther metabolicmetabolic conversionconversion of of galactosegalactose toto galactitolgalactitol ((dulcitoldulcitol) ) ClassicClassic galactosemiagalactosemia;;malnutritionmalnutrition, , hepatomegalyhepatomegaly, , jaundicejaundice, , andand mentalmentaldeficiencydeficiencyDiagnosisDiagnosis; ; demonstrationdemonstration of of thethe nonnon--glucoseglucose--reducingreducing substancesubstance((galactosegalactose) in ) in thethe urineurine..75% 75% willwill developdevelop cataractcataract, , usuallyusually withinwithin thethe firstfirst fewfew weeksweeks afterafter birthbirthNucleusNucleus andand deepdeep cortexcortex becomebecome increasinglyincreasingly opacifiedopacified, , causingcausing an "an "oiloildropletdroplet" " appearenceappearenceTreatmentTreatment; ; eliminationelimination of of milkmilk andand milkmilk productsproducts fromfrom thethe dietdiet

  • Wilson Wilson DiseaseDisease((HepatolenticularHepatolenticular DegenerationDegeneration))autosomalautosomal recessiverecessive inheritedinherited disorderdisorder of of coppercopper metabolismmetabolism

    KayserKayser--FleischerFleischer ring, ring, SunflowerSunflower cataractcataractReddishReddish brownbrown pigment (pigment (cuprouscuprous oxideoxide) ) depositiondeposition in in thethe anterioranterior lens lens capsulecapsule andandsubsub-- capsularcapsular cortexcortex

  • MyotonicMyotonic DystropyDystropyAutosomalAutosomal dominant dominant

    DelayedDelayed relaxationrelaxation of of contractedcontracted musclesmuscles, , PtosisPtosis, , WeaknessWeakness of of thethe facialfacialmusculaturemusculature, , CardiacCardiac conductionconductiondefectsdefects, , ProminentProminent frontalfrontal balgingbalging

    PolychromaticPolychromatic iridescentiridescentcrystalscrystalsCorticalCortical opacificationopacification

  • CataractCataract AssociatedAssociated withwith UveitisUveitis((SecondarySecondary CataractCataract))

    AssociatedAssociated withwith chronicchronic uveitisuveitisPosteriorPosterior subcapsularsubcapsular cataractcataractPupillaryPupillary membranemembraneMay May progressprogress toto a a maturemature cataractcataract

  • ManagementManagement of of CataractsCataracts in in AdultsAdults

    SignsSigns andand SymptomsSymptoms of of CataractCataractDecreasedDecreased VisualVisual AcuityAcuityGlareGlareMyopicMyopic ShiftShiftMonocular Monocular DiplopiaDiplopia

  • TreatmentTreatment of of cataractcataract is is alwaysalwayssurgicalsurgical

    CouchingCouchingHystoricalHystorical methodmethod

  • IntracapsularIntracapsular CataractCataract ExtractionExtraction(ICCE)(ICCE)

    DisadvantagesDisadvantagesDelayedDelayed healinghealingDelayedDelayed visualvisualrehabilitationrehabilitationSignificantSignificant againstagainst--thethe--rulerule astigmatismastigmatismIrisIris incarcerationincarcerationPostoperativePostoperative woundwoundleaksleaks withwith inadvertentinadvertentfiltrationfiltrationVitreousVitreous incarcerationincarcerationCystoidCystoid macularmacular edemaedema..

  • ExtracapsularExtracapsular CataractCataract ExtractionExtraction (ECCE) (ECCE) withwithPosteriorPosterior ChamberChamber IntraocularIntraocular Lens Lens

    ImplantationImplantation ECCE ECCE withwith NucleusNucleus ExpressionExpression

  • ExtracapsularExtracapsular CataractCataract ExtractionExtraction (ECCE) (ECCE) withwithPosteriorPosterior ChamberChamber IntraocularIntraocular Lens Lens

    ImplantationImplantation

    ECCE ECCE withwith PhacoemulsificationPhacoemulsification

  • CataractCataract SurgerySurgery in in ChildernChildernSurgicalSurgical TechniqueTechnique

    SimpleSimple aspirationaspirationLensectomyLensectomy in in combinationcombination withwith anterioranteriorvitrectomyvitrectomy

    PosteriorPosterior continuouscontinuous curvilinearcurvilinear capsulorhexiscapsulorhexisPosteriorPosterior chamberchamber intraocularintraocular lens lens implantationimplantation

  • MAJOR POSTOPERATIVE COMPLICATIONS OF MAJOR POSTOPERATIVE COMPLICATIONS OF CATARACT SURGERYCATARACT SURGERY

    EndophthalmitisEndophthalmitisSterileSterileInfectiousInfectious

    CornealCorneal edemaedemaDetachedDetached Descemet'sDescemet's membranemembrane MechanicalMechanical traumatraumaVitreoVitreo--endothelialendothelial touchtouch IOLIOL--endothelialendothelial touchtouchToxicToxic solutionssolutions

    WoundWound distortiondistortion oror disruptiondisruption AstigmatismAstigmatismWoundWound leakleak

    InadvertentInadvertent filteringfiltering blebblebIrisIris prolapseprolapseHypotonyHypotony

    ShallowShallow oror flatflat anterioranterior chamberchamberWoundWound leakleakChoroidalChoroidal detachmentdetachment oror hemorrhagehemorrhage PupillaryPupillary blockblockCiliaryCiliary blockblock

    GlaucomaGlaucomaUveitisUveitisIOL IOL dislocationdislocationHemorrhageHemorrhage

    AnteriorAnterior segmentsegmentPosteriorPosterior segmentsegment

    RetinalRetinal detachmentdetachmentCystoidCystoid macularmacular edemaedemaRetainedRetained lens lens materialmaterialCapsularCapsular ruptureruptureVitreousVitreous lossloss

    CataractsAnatomy CapsuleZonular FibersLens EpitheliumNucleus and CortexBiochemistry BiochemistryCarbohydrate MetabolismAccommodation EmbryologyCongenital DefectsII. Lenticonus and LentiglobusIII. Lens ColobomaIV. MicrospherophakiaCongenital and Infantile CataractMorphologic classification of congenital and infantile cataractsSutural Cataracts Nuclear Cataracts Capsular CataractsComplete CataractMembranous CataractsRubella CataractDEVELOPMANTAL DEFECTSMarfan SyndromeHomocystinuriaAGING CHANGESAGING CHANGESAge-related Cataracts Nuclear CataractsCortical CataractsPosterior Subcapsular CataractsDrug-Induced CataractsTraumatic CataractsMetabolic CataractsDiabetes MellitusGalactosemiaWilson Disease (Hepatolenticular Degeneration)Myotonic DystropyCataract Associated with Uveitis (Secondary Cataract) Management of Cataracts in AdultsTreatment of cataract is always surgical Intracapsular Cataract Extraction (ICCE)Extracapsular Cataract Extraction (ECCE) with Posterior Chamber Intraocular Lens ImplantationExtracapsular Cataract Extraction (ECCE) with Posterior Chamber Intraocular Lens ImplantationCataract Surgery in ChildernMAJOR POSTOPERATIVE COMPLICATIONS OF CATARACT SURGERY