mechanism of cataract types of cataract surgery of cataract

1. Cataract SurgeryCataract Surgery
What You should know
By/Mohamed Ahmed El –Shafie
Assistant Lecturer in ophthalmology department KafrELShiekh University

2. What is a cataract?
A cAtArAct is A clouding of the lens in
the eye thAt Affects vision.

3. How do cataracts develop?
Age-related cataracts develop in two ways:
1. clumps of protein reduce the
shArpness of the imAge reAching the
retinA.
2. the cleAr lens slowly chAnges to A
yellowish/brownish color,
Adding A brownish tint to vision.

4. Are there other types of
cataract?
• secondAry cAtArAct: glAucomA
surgery, diAbetes or steroid use.
• trAumAtic cAtArAct: After An eye
injury, sometimes yeArs lAter
• congenitAl cAtArAct.
• rAdiAtion cAtArAct.

5. Who is at risk for
cataract?
• certAin diseAses (for exAmple,
diAbetes).
• personAl behAvior (smoking,
Alcohol use).
• the environment (prolonged
exposure to ultrAviolet
sunlight).

6. What are symptoms of a
cataract?
• cloudy or blurry vision.
• colors seem fAded.
• glAre. heAdlights, lAmps, or
sunlight mAy AppeAr too bright.
A hAlo mAy AppeAr Around lights.
• poor night vision.
• double vision or multiple imAges in
one eye.
• frequent prescription chAnges in
your eyeglAsses or contAct
lenses.

7. How is a cataract detected?
• visuAl Acuity test.
• dilAted eye exAm.
• mAgnifying lens to exAmine your
retinA And optic nerve for signs of
dAmAge And other eye problems.
• tonometry.

8. Cataract typesCataract types
Nuclear sclerosis

9. Posterior subscapsular

10. Trauma

11. Congenital (rubella)

14. Intra capsular cataract extractionIntra capsular cataract extraction
(ICCE)(ICCE)
Management of CataractManagement of Cataract
 Cryo surgery
 Chemical dissolution of zonular fibers

15. Indications of ICCEIndications of ICCE
 Operating microscopes notOperating microscopes not
availableavailable
 Unstable / luxated cataractsUnstable / luxated cataracts
 Week zonular supportWeek zonular support

16. Management of CataractManagement of Cataract
• ECCE (Extracapsular cataract extraction)ECCE (Extracapsular cataract extraction)
But longer wound healing timeBut longer wound healing time

18. Cataract SurgeryCataract Surgery
• Small incisional PhacoemulsificationSmall incisional Phacoemulsification
surgery (Developed by Kelman, USA)surgery (Developed by Kelman, USA)

19. Before IOL implantation wasBefore IOL implantation was
developeddeveloped
• Aphakic spectaclesAphakic spectacles
• Contact lensesContact lenses

20. Pioneer of intraocular lensPioneer of intraocular lens
implantimplant
Sir Harold Ridley FRS FRCS

21. 1949-1950: First IOL implants1949-1950: First IOL implants

22. IOL choiceIOL choice
Why foldable/injectable?Why foldable/injectable?
Minimise incision size to reduceMinimise incision size to reduce
healing time and astigmatismhealing time and astigmatism
× PMMA(rigid) : Non-foldable+large incisionPMMA(rigid) : Non-foldable+large incision
√ Acrylic: Injectable through 2.2-3.2 mm currently.Acrylic: Injectable through 2.2-3.2 mm currently.

23. Phaco+IOLPhaco+IOL surgerysurgery
CapsulorexisCapsulorexis

24. Phaco+IOLPhaco+IOL surgerysurgery
HydrodissectionHydrodissection

25. Phaco+IOLPhaco+IOL surgerysurgery
PhacoemulsificationPhacoemulsification

26. Phaco+IOLPhaco+IOL surgerysurgery
Aspiration of cortexAspiration of cortex

27. Phaco+IOLPhaco+IOL surgerysurgery
Foldable IOL insertionFoldable IOL insertion

28. Typical injectable IOLTypical injectable IOL
Superflex lens: 6.25mm x 12.50mm
C-Flex lens 5.75mm x 12.00 mm

29. Cflex/Superflex injector

30. Loading the Superflex IOLLoading the Superflex IOL

31. Superflex insertionSuperflex insertion

32. Superflex insertionSuperflex insertion

33. Superflex insertionSuperflex insertion

34. Cataract surgeryCataract surgery
Postoperative managementPostoperative management
Eye pad overnightEye pad overnight
Antibiotic+steroid drops for up to one monthAntibiotic+steroid drops for up to one month
Change glasses at one monthChange glasses at one month

35. Complications of cataractComplications of cataract
surgery (many!)surgery (many!)
• Posterior capsular rupture and vitreousPosterior capsular rupture and vitreous
lossloss
• Dropped nucleusDropped nucleus
• IOL dislocationIOL dislocation
• EndophthalmitisEndophthalmitis
• Retinal detachmentRetinal detachment

36. Thank you!Thank you!