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Risk factor
Aging
Cataract
Classificati
on
LENS CHANGES
Normal senescent changes occurring in lens, usually after presbyopia
(4) Age, UV, Nicotine, Substances (meds)
Slow increase in sagittal width and convexity;
Lens yellowing;
Decreased transmission of blue light
Any opacification of lens with some influence on vision
Based on anatomical location, cause of cataract or appearance
CATARACT CLASSIFICATION
1. Congenital/developmental cataracts
Presentatio
Non progressive
n
2/3 bilateral (Cause more likely to be established > common = genetic
mutation)
Unilateral aet less clear
Morph
Whitish-blue tinge (Cerulian cataract)
Association
Maternal infection (rubella, toxoplasmosis, CMV, varicella)
Chromosomal abnormalities (Downs)
Metabolic disorders (Galactosemia)
2. Presenile,
Aetiology
Drugs
Cortic
al
Nuclea
r
Pathogene
sis
Clinical
signs
Test
Prevalence
Capsul
ar
Intumesce
Lens swells > pupillary block danger
nt
Mature
Milky cortex + lens dehydration
Hypermat
Danger of phaco-anaphylactic uveitis and glaucoma
ure
Morgagnia
Liquefied cortex > nucleus moves freely in lens
n
1. Modification of lens fibre proteins into high molecular weight
proteins
2. increased lens density
3. gradual shift in myopia, affecting distance vision more than near
4. Senopia/second sight
Increased spherical aberration
Acccentuation of normal yellowing = cataract when it impacts vision
Temporary increase in acuity
Slow progression
Optic section + cobalt filter
Common
65+
Anterior
Location
Association
Posterior
Location
Association
Symptoms
Pathogenes
is
Pesentatio
n
Diabet
ic
(Any age) Sorbitol > osmotic pressure gradient > hydration and
opacification
Clinical appearance
Progressive yellowing
of lens nucleus
Pathogenesis
Increasing high
molecular weight
proteins
Cortical cataract
Vacuoles
Spokes
Milky clouding
Granular
Beaten copper
Posterior capsular
Alternating capsule
permeability
Hydration of cortex
Aberrant migration of
epithelial cells to
posterior subcapsular
Posterior subcapsular
cataract
Clinical features
Decreased distance
vision
Senopia
Slow progression
Unpredictable VA loss
Slow progression
Obscured fundus view
Decreased near VA
Younger
Dramatic vision loss
zone
pole
Cortical cataract
Due to electrolyte
imbalance
Nuclear
Due to modification of
lens fibre proteins
Results in high
molecular weight
proteins
Diabetic cataract
Sorbitol causes
osmotic pressure
gradient
Leads to hydration and
opacification
Ocular health
tests
Refer
1.
2.
3.
4.
5.
B. Late complications:
1. Wound
Included astigmatism > tight sutures cause steepening along that
meridian
Steeper vertical = minus cyl axis 180
Loose/exposed sutures > FB or GPC
2. Cornea
Biggest corneal complication = bullous keratopathy > endothelial
decompensation
Epithelial down-growth: corneal or conjunctival epithelial cells grow
down through wound and cover endothelium, iris and trabecular
meshwork
3. Capsule
Wrinkled capsule
After cataracts (Elschnig pearls = residual epithelial cells which grow
on capsule)
Remediation with YAG (laser) capsulotomy
Displaced IOL and pupillary capture
4. Retina
Cystsoid macular oedema
6 weeks to months post-op (confirm with Fang)
Mostly resolves without treatment
Can lead to permanent vision loss with or without macular hole
Increased risk of retinal detachment due to vitreous traction
Tends to occur within year post op
Risk less with ECCE
Common complaints/effects (even when op has gone well):
1. Glare
2. Reflections
3. Sparkles
4. Fusional problems
5. Eyes more tender/sensitive with IOL
E.
1.
2.
3.
4.
Anterior lenticonus
Bilateral axial projection into anterior chamber
Eg. Alport syndrome
Microspherophakia
Definition: Lens is small and spherical
Prevalence:
- Commonly associated with Weill-Marchesani syndrome
Lens is displaced superior temporally
Small stature
Deafness
High myopia
Management:
- Gonioscopy > determine presence of peripheral anterior synechiae
- Peripheral laser irodotomy > prevent repeated attacks of pupillary block glaucoma
and progressive closure of filtration angle by peripheral anterior synechiae
- Surery > surgeon should be prepared to suture intraocular lens to iris or sclera
- Anterior chamber lens usually contraindicated due to peripheral anterior synechiae
Presentation:
- Zonules loose > lens may eventually dis-insert > dislocation
Lens
coloboma
Characterized by segmental notching/agenesis at inferior equator
Absence of lens zonules in that area
May be associated with iris or fundus coloboma