Diseases of the crystalline lens

Zoltán Nagy

Department of Ophthalmology, Mária utca

Budapest

Anatomy of the crystalline lens

Physiology of the lens

Development of lens

Diseases of the lens

Anatomy of the crystalline lens

Cataracta

Primary cataracts

– Congenital cataract

– Zonular cataract

– Anterior polar cataract/Posterior polar

– Juvenile cataract

– Senile cataract

– Cortical cataract

– Nuclear cataract

Cataracta

Consecutive catarcts (associated with other eye

diseases

– Complicated or Secondary cataract

• Iridocyclitis

• Heterochromic iridicyclitis

• Degeneratio pigmentosa retinae

• Glaucoma fere absolutum

• Inveterated

– Cataracta in oculo glaucomatoso

– Traumatic cataract

Cataracta

Cataract with general diseases

– Metabolic dieseases

• Diabetic cataract

• Tetanic cataract

• Galactosemic cataract

• Myotonic cataract

• Cortison (steroid) cataract

– Dermatologic diseases

• Cataracta dermatogenes

– Irradiation: Rtg, radium, electric current

– Poisons

• C-, D-vitamin insufficiency, selene overdosage

History

The history of cataract surgery can be

followed during 2600 years

The first written history by Susruta

Anatomical and pathological description

Types of cataracts

„Reclinatio lentis” according to Celsus was

performed until the XVIII th century

History

Among ancient Egyptian and antique Greek historical description there was no mention about cataract surgery

However, in Kos and Samos island knives were found, suitable for cataract surgery (reclination)

Hippokrates: cataract is a discharge in the anterior chamber, was kept until the XVIII th century

History

Celsus: the Indian (Susruta) knows the

cataract surgery from the Alexandrian

school (reclination)

With a special knife a wound was created

and the lens was pushed back into the

vitreous

– Herophilost

– (344-280 yr BC) and Philoxenest (250 yr BC)

were mentioned by names

History

The Medieval Arabic ophthalmology

followed the Alexandrian and Roman

traditions.

Two mentiones were found about cataract

surgery, but these descriptions contained

no new information.

History of the quality assurance

Hammurabi’s Law (XVIII.century

BC) „If a physician make a large incision with the operating

knife, and kill him, or open a tumor with the operating

knife, and cut out the eye, his hands shall be cut off. ”

(Outcome measurement)

History

Europe

Stephan BLAUKAART (The Netherland),

performed a corneal wound

Michel Pierre BRISSEAU 1705, in the

Academy of Sciences in Paris proved that

cataract is caused by the opacification of the

crystalline lens and not a discharge

History

Jaques DAVIEL 1748 (Paris)

– ECCE (extracapsularis cataracta extractio)

Samuel Sharp (London)

– ICCE (intracapsularis ctaracta extractio), he

exprimated the lens by his thumb

PAGENSTECHER (1871) removed the lens

with a special forceps

History

WILLIAMS (1867): sutured the wound

KOLLER (1884): cocaine eye drops foranesthesia

ELSCHNIG (1928): retrobulbaranesthesia

VÖRÖSMARTY, KETTESY: Oculopressure

History

KRAWITZ (1961): Kryoextractio lentis (ICCE)

GYŐRFFY István (1939): he proved for the firt

time that plexi material is biocompatible

Harold RIDLEY (1949) artificial lens from

plexi (war eye injuries)

STRAMPELLI (1953): anterior chamber lens

BINKHORST: iris fixated lens

History

HARMS és McKENSEN (1953):

operating microscopy

Charles KELLMANN (1967):

Phacoemulsification as a historical

landmark

Foreign body in lens

Marfan syndrome

Ectopia lentis

Mesenchymal diseases

– Marfan syndrome

– Marchesani syndrome

– Homocystinuria

Role of trauma

Treatment of the cataract

Extractio lentis intracapsularis

Extractio lentis extracapsularis

Phacoemulsification

– Foldable intraocular lens

– Accomodative and pseudoaccomodative lenses

Postoperative capsular fibrosis and

treatment (YAG capsulotomy)

Treatment of after cataract with

YAG capsulotomy

Accomodative lenses

Crystalens 1 CU Synchrony

Sarfarazi elliptical accomodative lens

Pseudoaccomodativ lenses

Acrysof Restor

Tecnis multifocal intraocular lens

Lenses of the future

Calhoun lens

Future lenses

Injectable polymers

Summary

Great development in treatment of refractive errors by refractive procedures or by the modern lens surgery

Treatment range has been widened, today all kind of refractive errors can be treated surgically.

New tasks: restoration of accomodation and prevention of PCO.

Thank you for your attention!