Lecture 3 CATARACTS

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Lecture 3
CATARACTS
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Classification of
cataracts By age congenital, juvenile,
age-related (senile) By location opacities in
the lens as seen with slit beam cortical,
nuclear, anterior subcapsular, posterior
subcapsular By maturity early, immature,
mature, hypermature (Morgagnian cataract) By
pattern cuneiform (typical senile type),
zonular, polar, pyramidal (congenital types)
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DIFFERENTIAL DIAGNOSIS The same sign is
progressive (not acute) painless visual loss
Sign CATARACT GLAUCOMA MACULAR DEGENERATION
Visual acuity is decreased is decreased is decreased
Field of vision is not damaged constriction of nasal visual field, Bjerrums scotoma may be central scotoma
Intraocular pressure normal, if increased-secondary phakogenic glaucoma increased normal
Lens opaque transparent, if opaque complicated cataract transparent, if opaque complicated cataract
Fundus If is seen, not damaged. If damaged - complicated cataract optic disc changes - dislocation of vessels, pale colour, increased cupping degenerative patches in central area
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Artificial lens
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Artiphakia is a condition of eye with artificial
lens (IOL). Aphakia is a condition of eye
without lens. The visual acuity without
correction is very poor 0,02-0,04. Iridodenesis
(iris vibration) is typical. Thick plus glasses
are needed for vision for far distance sph
convex 10,0-12,0 D for near distance sph convex
13,0-15,0 D. Secondary cataract occurs
eventually in about 20 cases after cataract
surgery. It is opacity of natural posterior
capsule. It can be treated by YAG laser
capsulotomy. Attention! The term complicated
cataract is used to describe a lens opacity
which occurs as a result of some other disease of
the eye. Longstanding uveitits, an untreated
retinal detachment or an intraocular tumour are
all examples of an associated disease.
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CONGENITAL CATARACTS I degree visual acuity
is 0,3 and more the size of opacity is less then
1,5 mm the surgery may be done at the age of
14-16 years. II degree visual acuity is
0,05-0,2 the surgery is usually done at the age
of 3-4 years. III degree visual acuity is less
then 0,05 the surgery must be done during first
year of life.
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Ectopia lentis (displacement of the lens) may be
partial (subluxation) or complete
(luxation). Aethiology trauma, familial ectopia
lentis (may be associated with ectopic pupil),
associated with other ocular disorders (aniridia
and buphtalmos), Marfans and Weill-Marchesani
syndromes, metabolic (homocystinuria and
hyperlysinaemia). Clinical features
iridodenesis (vibration of iris) and not
proportional depth of anterior chamber. Marfans
syndrome tall person with partial displacement
of the lens (subluxation), fragile bones and
arachnodactyly.
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THANK YOU FOR ATTENTION !