CATARACT Cataract is any opacity of lens, or its capsule either due to formation of opaque - PowerPoint Presentation

1. CATARACT

2. Cataract is any opacity of lens, or its capsule either due to formation of opaque lens fibres or due to degenerative process leading to opacification of normally formed lens fibres

3. CLASSIFICATION OF CATARACTEtiological classificationCongenital and developmental cataractAcquired cataractSenile cataractTraumatic cataractComplicated cataractMetabolic cataractElectric cataractRadiational cataractToxic cataractCataract associated with skin and osseous diseases

4. Morphological classificationCapsular cataractSubcapsular cataractCortical cataractSupranuclear cataractNuclear cataractPolar cataract

5. Malnutrition Maternal infectionsDrugs ingestion RadiationBirth traumaCONGENITAL AND DEVELOPMENTAL CATARACTEtiologyIt occurs due to some disturbance in the normal growth of the lens

6. Clinical typesCongenital capsular cataractPolar cataractCongenital nuclear cataractCataracta pulverulentaLamellar cataractSutural and axial cataractTotal nuclear cataractGeneralized cataractCoronary cataractBlue dot cataractTotal congenital cataract Congenital membranous cataract

7. Congenital capsular cataractAnterior capsular cataract- non axial, stationary and visually insignificant Posterior capsular cataract- rare

8. Polar cataractAnterior polar cataract- involves central part of anterior capsule and adjoining superficial most cortex -may be due to delayed development of anterior chamber or corneal perforationPosterior polar cataract- very common lens anomaly consists of a small circular circumscribed opacity involving the posterior pole

9. Congenital nuclear cataractsCataracta centralis pulverulenta- embryonic nuclear development, bilateral, small rounded opacity exactly in the centre of lens- powdery appearance and usually does not affect the vision

10. Lamellar cataract or zonular cataract- developmental cataract in which opacity occupies a discrete zone in the lens, common type presenting with visual impairment - occurs in a zone of fetal nucleus surrounding the embryonic nucleus

11. Sutural and axial cataract- punctate opacities scattered around interior and posterior Y sutures, usually static, bilateral and do not have much effect on vision

12. Total nuclear cataract- involves embryonic and fetal nucleus , characterized by dense chalky central white opacity seriously impairing vision, bilateral, non-progressive

13. Generalized cataractsCoronary cataract- common form of developmental cataract occurring at puberty, involves adolescent nucleus or deeper layer of cortex -opacities are often many in number, have a regular radial distribution in the periphery of lens

14. Blue dot cataract- cataracta punctata caerulea, - it forms in the first two decades of life - opacities in the form of rounded bluish dots

15. Total congenital cataract - important cause is maternal rubella - maternal rubella infection during first trimester may cause rubella cataract - rubella cataract- typically child is born with a pearly white nuclear cataract, progressive type

16. Congenital membranous cataract- total or partial absorption of congenital cataract, leaving behind thin membranous cataract

17. ACQUIRED CATARACTOpacification occurs due to degeneration of already formed lens

18. Age related cataractSENILE CATARACTUsually above 50 years of ageMorphologically it occurs in two forms,Cortical [soft cataract]Nuclear[hard cataract]

19. STAGES OF MATURATION

20. Stage of Lamellar SeparationStage of incipient cataractImmature senile cataractMature senile cataractHypermature senile cataract Maturation of cortical type

21. STAGE OF LAMELLAR SEPERATIONThe earliest senile change is demarcation of cortical fibres owing to their separation by fluidDemonstrated by slit lamp examinationThese changes are reversible

22. STAGE OF INCIPIENT CATARACTEarly detectable opacities with clear areas in between them are seenTwo types-Cuneiform senile cortical cataract- wedge shaped opacities with clear areas in between. On oblique illumination, typical radial spoke like pattern of greyish white opacitiesCupuliform senile cortical cataract- saucer shaped opacity develops

23. IMMATURE SENILE CATARACTOpacification becomes more diffuse and irregularThe lens appears greyish white but clear cortex is still present so iris shadow is visibleIntumescent cataract- lens may become swollen due to continued hydration

24. MATURE SENILE CATARACTOpacification becomes completeLens becomes pearly white It is labelled as ripe cataract

25. HYPERMATURE SENILE CATARACTMorgagnian- after maturity the whole cortex liquefies and lens is converted into a bag of milky fluid, the small nucleus settles at the bottomSclerotic-the cortex becomes disintegrated and the lens becomes shrunken due to leakage of water. The anterior capsule is wrinkled and thickened, a dense white capsular cataract may be formed in the pupillary area

26. Maturation of nuclear cataractProgressive nuclear sclerotic process renders lens inelastic and hard, decreases its ability to accommodate and obstructs the light raysThe nucleus may become diffusely cloudy(greyish) or tinted(yellow to black)The common pigmented nuclear cataracts are amber, brown(cataracta brunescens) or black(cataracta nigra) and rarely reddish (cataracta rubra) colored

27. CLINICAL FEATURESGlareSYMPTOMS

28. UNIOCULAR POLYOPIACOLORED HALOS

29. Black spots in front of eyesImage blur Deterioration of vision

30. EXAMINATIONNUCLEARISCMSCHMSC (M)HMSC (S)VISUAL ACUITY6/9 TO PL+6/9 TO CF+HM+ TO PL+PL+PL+Color of lensvariesGreyish whitePearly whiteMilky whiteDirty whiteIRIS SHADOW-+---DISTANT DIRECT OPHTHALMOSCOPYCentral dark area against red glowMultiple dark areasNo red glowNo red glowNo red glowSLIT LAMP EXAMINATIONNuclear opacity, clear cortexNormal areas with cataractous cortexComplete cortex is cataractousMilky white cortex with sunken brown nucleusShrunken lens & thickened ant. capsuleCLINICAL SIGNS

31. Phacoanaphylactic cataractLens induced glaucomaSubluxation or dislocation of lensCOMPLICATIONS

32. METABOLIC CATARACTSenile cataract in diabeticsTrue diabetic cataract- snow flake cataract or snow storm cataractDIABETIC CATARACT

33. Inborn error of galactose metabolism – occurs in two forms - Classical Galactosemia- deficiency of GPUT - Defeciency of galactokinase B/L cataract –oil droplet central lens opacities Lens changes are preventable if milk and milk products are eliminated from the diet if diagnosed early GALACTOSAEMIC CATARACT

34. Parathyroid tetany – atrophy or removal of parathyroid glandsMulticoloured crystals or small discrete white flecks of opacities in cortex – rarely mature Infants – hypocalcemia- zonular cataract- thin opacified lamella deep in the infantile cortex HYPOCALCEMIC (TETANIC ) CATARACT

35. wilsons disease (Hepatolenticular degeneration)Sunflower cataract - yellowish brown spots – due to deposition of cuprous oxide in the ant.capsule and subcapsular cortex in stellate pattern Kayser-Fleischer ring- golden ring due to deposition of copper in peripheral part of decemets Membrane in cornea Cataract due to error of copper metabolism

36. Oculo-cerebral-renal syndrome- rare inborn error of AA metabolism Ocular features – congenital cataract, glaucoma, blue scleraSystemic features – mental retardation, dwarfism, osteomalacia, muscular hypotonia, frontal prominenceCataract in LOWE’S SYNDROME

37. COMPLICATED CATARACTOpacification of lens secondary to some other intraocular diseaseETIOLOGY – Lens depends on intraocular circulation of fluids for its nutrition- any disturbance in this leads to cataract

38. Etiology Inflammatory – iridocyclitis, parsplanitis, choroiditis, endophthalmitisDegenerative – Retinitis pigmentosa, myopic chorioretinal degenerationRetinal detachment in long standing casesGlaucoma- disturbance of intraocular circulation Intraocular tumours – RB, melanoma

39. Clinical featuresStarts as post.subcapsular cortical cataractIn the beam of slit lamp opacities have-Breadcrumb appearancePolychromatic luster- characteristic sign (rainbow cataract)Diffuse yellow haze in the adjoining cortexDirty white or chalky white appearance

40. DRUG INDUCED CATARACTCORTICOSTEROID – post.subcapsular cataract -children are more susceptibleMIOTICS – ant.subcapsular granular type (long acting cholinesterase inhibitors like – ecothiophate, disopropyl flourophosphate )Others like – Amiodarone, chlorpromazine, busulphan, gold

41. RADIATIONAL CATARACTInfrared cataract – prolonged exposure may cause discoid posterior subcapsular opacities. Typically seen in persons working in glass industries, also called as glass blowers or glass workers cataractIrradiation cataract – X-rays, ɤ-rays or neutrons UV-radiation causes senile cataract

42. Electric cataractAfter passage of powerful current through the body Starts as punctate subcapsular opacities which mature rapidly

43. PREOPERATIVE EVALUATION GENERAL MEDICAL EXAMINATION – to exclude any systemic diseases like Diabetes mellitus, hypertension, COPD, any source of infection like UTI, septic gums

44. OCULAR EXAMINATIONVISUAL STATUS ASSESSMENT -Visual acuity -PL- absence of PL indicates nil visual prognosis -PR- inaccurate PR causes-old RD, Visual pathway defects, advanced glaucoma, large area of chorio retinal atrophy and sometimes even in dense cataract

45. PUPILS - Light reaction, RAPD -Ability of the pupil to dilate adequately before the surgeryANTERIOR SEGMENT -Cornea : scarring -KPs ( keratic precipitates) -Cataractous lens: morphology, maturity, grade of nuclear sclerosis -Other signs – Post.synechiae, pigments on ant.capsule, AC-depth

46. IOPLids, Conjuntiva, lacrimal apparatus – conjunctivitis, meibomitis, blepharitis, dacrocystitis- lacrimal syringingFundus examination- to rule out other causes of decreased visionMacular function tests -Two-light discrimination test -Maddox rod test -Color perception -Entopic visualization

47. Objective tests – if retinal pathology suspected-EOG, ERG, ultrasonic evaluation of Post.segment of the eye Keratometry and Biometry

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