Investigation and management of senile cataract
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Investigation and management of senile cataract

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investigation and management of senile cataract

investigation and management of senile cataract

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Investigation and management of senile cataract Presentation Transcript

  • 1. INVESTIGATION AND MANAGEMENT OF SENILE CATARACT NISHITA AFRIN B.OPTOM, 3RD BATCH INSTITUTE OF COMMUNITY OPHTHALMOLOGY
  • 2. SENILE CATARACT
  • 3. INVESTIGATION
  • 4. INVESTIGATION OF SENILE CATARACT  PREOPERATIVE EVALUATION OF SENILE CATARACT HISTORY General health of the patient Diabetes mellitus, Hypertension, ischemic heart disease , chronic obstructive pulmonary disease , bleeding disorders , parathyroid tetany, myotonic dystrophy, galactosaemia , down syndrome, atopic dermatitis, neurofibromatosis type 2
  • 5. CATARACT IN SYSTEMIC DISEASE a. Diabetic snowflake cataract b. advance diabetic catarct c. stellate posterior subcapsular cataract in myotonic dystrophy d. Advance left cataract in a patient with myotonic dystrophy e. bilateral advance cataract in atopic dermatitis f. shield like anterior sub capsular cataract in atopic dermatitis
  • 6. CONTINUE……….   Patient ocular history : Trauma, Inflammation, Amblyopia , glaucoma , optic nerve abnormalities , or retinal disease social history
  • 7. OCULAR INVESTIGATION… MEASUREMENTS OF VISUAL FUNCTION 1. Visual status assessment visual acuity, perception of light ((PL), perception of rays (PR) 2. Refraction – 3. Brightness acuity 4. Contrast sensitivity 5. Visual field testing
  • 8. VISUAL ACUITY TEST
  • 9. CONTRAST SENSITIVITY…
  • 10. PELLI-ROBSON CONTRAST SENSITIVITY CHART
  • 11. VISUAL FIELD TEST
  • 12. CONTINUE…..  External examination : a. Extra ocular Motility b. pupils c. cover test
  • 13. MOTILITY…
  • 14. PUPILLARY REACTION TEST a.Swingin g flash light test b.consen sual light reflex
  • 15. COVER TEST…..
  • 16. CONTINUE……    Special Tests : Potential acuity estimation Tests for Macular Function1. Two light discrimination test 2. maddox rod test 3. Color perception 4. Entoptic visualisation 5. Blue Light entoptoscopy 6. Purkinje’s entoptic phenomenon
  • 17. MADDOX ROD TEST…
  • 18. ENTOPTIC VISUALISATION
  • 19. BLUE LIGHT ENTOSCOPY…
  • 20. COLOR PERCEPTION…
  • 21. CONTINUE….  Retinal function test PR – must be present in all 4 quadrants Electro-retinogram Electro-oculogram Visual evoked potential
  • 22. CONTINUE….  Slit-Lamp Examination : Eyelids, Lacrimal apparatus, sclera Conjunctiva , Anterior chamber , Cornea Iris Crystalline Lens
  • 23. CONTINUE…….  Fundus Evaluation : - Ophthalmoscopy - Optic nerve - Fundus evaluation with opaque media
  • 24. OPHTHALMOSCOPY…
  • 25. CONTINUE….. Measurement of IOP  conjunctival swab for C/S  Sac patency test to exclude chronic dacryocystitis  Oro-dental check up to exclude septic foci 
  • 26. MEASUREMENT OF IOP…
  • 27. CONTINUE……  Preoperative Measurement : Biometry 1.keratometry 2. A- scan ultrasonography
  • 28. KERATOMETER…..
  • 29. CONTINUE…. B-scan ultrasonography Corneal Topography Corneal phachymetry Specular microscopy
  • 30. B-SCAN ULTRASONOGRAPHY
  • 31. CORNEAL TOPOGRAPHY….
  • 32. SYSTEMIC INVESTIGATION….   Clinical : - BP Lab test : - RBS/FBS - Urine - X-Ray chest and ECG – If needed
  • 33. MANAGEMENT……  NON-SURGICAL MEASURES ---1. Treatment of cause of cataract 2. Measures to delay progression topical preparation containing iodine salts of calcium and potassium, role of vitamin E and aspirin 3. Measures to improve in the presence of incipient and immature cataract----Refraction, Arrangement of illumination, use of dark goggles, Mydriatics
  • 34. CONTINUE…..  SURGICAL MANAGEMENT ----1. Visual improvement 2. Medical indication 3. cosmetic indication
  • 35. PREOPERATIVE MEDICAL AND PREPARATIONS Consent  Srcub bath, care of hair, and marking of the eye  Preoperative antibiotics and disinfectants  IOP lowering  Mydriasis 
  • 36. TYPES OF SURGERY  Intra capsular cataract (ICCE)  Extra capsular cataract (ECCE)  Pseudophakia – SICS , Phacoemulsification
  • 37. COUNSELING AFTER POSTOPERATIVE CATARACT SURGERY The post-operative recovery period (the period after cataract extraction is done) is usually short. The patient is usually ambulatory on the day of surgery but is advised to move cautiously and avoid straining or heavy lifting for about a month  The eye is usually patched on the day of surgery and at night using an eye shield is often suggested for several days after surgery 
  • 38.  . Intraocular lenses are usually monofocal, correcting for either distance or near vision, however, multifocal lenses may be implanted to improve near and distance vision simultaneously, but these lenses may increase the chance of unsatisfactory vision
  • 39. PREOPERATIVE COMPLICATIONS IN SENILE CATARACT      Anxiety Nausea and gastritis Irritative or allergic conjunctivitis Corneal abrasion complications due to local anaesthesia – - Retrobulbar haemorrhage - Oculocardiac reflex - Perforation of globe - Subconjunctival haemorrhage - Spontaneous dislocation of lens
  • 40. COMPLICATIONS OF CATARACT SURGERY        Retinal detachment Endophthalmitis Corneal edema Cystoid macular edema Pseudophakic bullos keratopathy Epithelial keratopathy Fibrous downgrowth
  • 41. LOW VISION MANAGEMENT FOR CATARACT High – add spectacles,  magnifiers,  CCTV ,  Telescopeic loupes for reading and close work  Direct lighting when reading or performing near work  Glare can be reduce by filter,tints, and sunlenses 
  • 42. CONTINUE….    Large print reading material Bold line writing paper and Typoscope
  • 43. REFERRANCES…….  LENS AND CATARACT – AMERICAN ACADEMY OF OPHTHALMOLOGY  COMPREHENSIVE OPHTHALMOLOGY – A. K. KHURANA  KANSKI CLINICAL OPHTHALMOLOGY  PARSON’S DISEASE OF THE EYE