Cataract

Deasy Mirayashi
(I11110003)

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Definition
A cataract is any opacity in the lens.
Cataract is present when the transparency
of the lens is reduced to the point that the
patients vision is impaired.
The term cataract comes from the Greek
word katarraktes (down-rushing: waterfall)

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 Aging is the most common cause of cataract,

but many other factors can be involved,
including trauma, toxins, systemic disease
(such as diabetes), smoking, and heredity.
Age-related cataract is a common cause of
visual impairment.

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Pathogenesis
Cataractous lenses are characterized by
protein aggregates that scatter light rays
and reduce transparency.
Other protein alterations result in yellow or
brown discoloration.
Additional findings may include vesicles
between lens fibers or migration and
aberrant enlargement of epithelial cells.
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General symptom
Development of the cataract and its
symptoms is generally
an occult process. Patients experience the
various symptoms such as
seeing only shades of gray, visual
impairment, blurred vision, distorted
vision, glare or star bursts, monocular
diplopia, altered color perception, etc.
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Classification
Cataract can be classified according to
several different criteria :
a. Time of occurance (acquired or
congenital)
b. Maturity
c. Morphology

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Etiology
Long term exposure to ultraviolet light
Exposure to radiation
Secondary effects of diseases
Diabetes, hypertensiion

Age
Trauma
Genetic
Drugs
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Classification
Age
Morphology

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Age
Congenital cataract
Juvenile cataract
Senile cataract

Insipien
Intumescent
Immature
Mature
Hypermature

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Congenital cataract
Hereditary Congenital Cataracts
Cataract from Transplacental Infection in
the First Trimester of Pregnancy
Without systemic association : isolated
hereditary cataracts
Systemic association :
metabolic(galactosemia, galaktokinase
deficiency), prenatal infection,chromosomal
abnormalities, skeletal syndrom
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Congenital Cataract
A statistical study by Pau (1986) cites the
following incidences of congenital cataract
with respect to systemic disease
contracted by themother during the first
trimester of pregnancy:
Rubella 4060%.
Mumps 1022%.
Hepatitis 16%.
Toxoplasmosis 5%.
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Juvenil Cataract
Cataract that occur in age > 1 years.
Cause : metabolic (diabetic, galactosemi,
hipocalsemi, nutrisional deficiency),
distrofi miotonik, traumatik, komplikata,
toksik.

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Cataract Intumescent
Sometime during the course maturation the
lens imbibes lot of fluid and becomes swollen.
Anterior chamber becomes shallow.
Angle of anterior chamber may close resulting
in glaucoma (Phacomorphic Glaucoma).

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Immature Cataract
The nucleus of this lens is opaque(nuclear
cataract), while the cortical layers remain
clear.The opacity appears as a dark shadow
against the red reflex. This particular cataract,
which is congenital,will obstruct vision more
when the pupil is small than when it is dilated,as
shown here.

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Immature Cataract

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Mature Cataract
A cataract is called mature when the lens is
totally opacified. A red reflex cannot be obtained;
the pupil appears white.The radial spokes in this
figure reflect variations in density of the radially
arranged fibers in the cortical layers of the lens.
Light still reaching the retina is totally diffused
and will allow the perception of light but not form.

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Mature Cataract

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Hypermature Cataract
A cataract isn't dangerous to the eye unless the
cataract becomes completely white, a condition
known as an overripe (hypermature) cataract
Mature cataract, which has become smaller and has
a wrinkled capsule as a result of leakage of water
out of lens.
This can cause inflammation, eye pain and
headache
A hypermature cataract is extremely rare and needs
removal

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Hypermature Cataract

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Hypermature Cataract
Morgagnian Cataract : A Hyper-mature
cataract, in which total liquefaction of
cortex allows the nucleus to sink inferiorly.

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Morphology
Nuclear cataract develops in the nucleus
or centre of the lens.
As it increases, there is an associated
yellow or brown discolouration of the lens.
smoking, heavy alcohol consumption,
sunlight exposure and diabetes increased
the risk of nuclear cataract.

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Nuclear Cataract

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Cortical cataract
Cortical cataract develops in the outer
shell of the lens as spokes and wedges
and commonly causes increasing glare
sensitivity.
A history of diabetes or previous heart
attack, and a blood factor (fibrinogen)
associated with vascular conditions
appeared to increase the risk
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Cortical Cataract

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Posterior subcapsular cataract

Posterior subcapsular cataract
develops at the back of the lens, often in
the visual axis, and so affects vision
rapidly and severely.
The majority of people needing cataract
surgery have some posterior subcapsular
cataract present at that time

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Posterior subcapsular cataract

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Subcapsular Cataract
Subcapsular Cataract : Starts as a small,
opaque area just under the capsule shell,
usually at the back of the lens, right in the path
of light on its way to the retina
This type of cataract may occur in both eyes but
tends to be more advanced in one eye than the
other
Often interferes with reading vision, reduces
your vision in bright light and causes glare or
halos around lights at night
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Sign n Symptoms
Blurred, hazy, or vision
Reduced intensity of colors
Increased sensitivity to glare from lights, particularly when driving at night
Increased difficulty seeing at night
Change in the eye's refractive error

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Methods of evaluation
Visual acuity : Checking vision of both eyes unaided and
aided with glasses and pin-hole vision to know the
improvement as well as to get the general idea about the
macular function of the eyes. This will help in prognostic
evaluation of visual recovery after cataract surgery.
Intra ocular pressure : If intra-ocular pressure increases as
a secondary to cataract, surgery is needed to prevent further
complications.
Slit-lamp examination : To know the type of cataract along
with its opacity, morphology and etiology or any associated
ocular pathology.
Direct and indirect ophthalmoscopy : Dense opacity
(cataract will prevent retinal evaluation)
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Treatments been used for Senile Cataract

Iodium liquid tear-drops, topical meds,
iontophoresis,
Calcium cysteine
Immunization in purpose to fix the lens
metabolic disorder
Lentokalin and cataractolysin made from fish
lens and high dose of vitamin
Recent treatment is surgical procedure (with
several condition; glaukoma, uveitis, or the
visual acuity is decreasing gradually and disturb
the daily activities)
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Surgical Processes
Types of surgical processes for cataract:
a. Extra Capsular Cataract Extraction

Surgical procedure to the cataract lens where the action is to do the incision
or tearing the lens in order to pulling out the contain of the lens
An opening is formed in the anterior capsule, and the nucleus and cortex of
the lens are removed
The intraocular lens is then placed in the empty "capsular bag," supported by
the intact posterior capsule

b. Intra Capsular Cataract Extraction

Surgical procedure where the lens is being pulled out with the
capsule
c. Phacoemulsification
It utilizes a handheld ultrasonic vibrator to disintegrate the hard
nucleus such that the nuclear material and cortex can be aspirated
through an incision of approximately 3 mm
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THANK YOU

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TREATMENT OF CATARACT

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Medical Treatment
In spite of theoretical approaches in animal research, the
effectiveness of conservative cataract treatment in
humans has not been demonstrated.
At present there are no available conservative methods
to prevent, delay, or reverse the development of a
cataract. Galactosemic cataracts are the only exception
to this rule.

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Surgical Treatment

Earlier surgical techniques were dependent upon the maturity of the

cataract.
Three types of surgical processes for cataract:
a. Extra Capsular Cataract Extraction(ECCE)
Surgical procedure to the cataract lens where the action is to do the
incision or tearing the lens in order to pulling out the contain of the lens
b.Intra Capsular Cataract Extraction(ICCE)
Surgical procedure where the lens is being pulled out with the capsule
c. Phacoemulsification (SICE)
Offers the surgeon the possibility to break the nucleus into smaller pieces
and even into a fine emulsion of material, all of which can be removed
through the probe used to achieve the break-up.
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Cataract Surgery in Children

Observe changes in the childs behavior: Children with congenital,
traumatic, or metabolic cataract will not necessarily communicate their
visual impairment verbally.
However, it can be diagnosed from these symptoms:
Leukocoria.
Oculodigital phenomenon: The child presses his or her finger against the eye
or eyes because this can produce light patterns the child finds interesting.
Strabismus: the first sign of visual impairment.
The child cries when the normal eye is covered.
The child has difficulty walking or grasping.
Erratic eye movement is present.
Nystagmus.

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 Operate as early as possible: Retinal

fixation and cortical visual responses
develop within the first six months of life.
This means that children who undergo
surgery after the age of one year have
significantly poorer chances of developing
normal vision.

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