Senile cataract Presented by:- Dr Nikhil Bansal J.N.M.C.,Wardha
General Concepts Almost universal in people over 70 years of age. Occurs equally in men and women. Considerable genetic influence. Average age of onset is earlier in tropical countries.
Types of Senile cataract1. Cortical cataract2. Nuclear or sclerotic cataract
Cortical cataract Etio-pathogenesis:- Hydration followed by coagulation of lens proteins in the cortex. Features:- Occurs in following stages :-1. Stage of lamellar separation2. Stage of incipient cataract3. Immature senile cataract4. Mature senile cataract5. Hypermature senile cataract
Stage of lamellar separation Demarcation of cortical fibres owing to their separation by fluid. Demonstrated by Slit-lamp examination only. Characteristic grey appearance of pupil. Changes are reversible.
Stage of Incipient cataract Wedge shaped opacities with clear areas in between( Lens striae). Most common in periphery and lower nasal quadrant. Only seen in dilated pupil. Irregularities in refraction, visual deterioration and polyopia.
Immature senile cataract Opacification becomes more diffuse and irregular. Lens is swollen. Iris shadow still visible. Anterior chamber becomes shallow.
Mature senile cataract Complete opacification. Whole cortex is involved . Lens appears pearly white in colour. Also known as ripe cataract.
Hyper-mature senile cataract Cortex is disintegrated and transformed into pultaceous material. Usually occurs in two forms:-1. Morgagnian hyper–mature cataract2. Sclerotic hyper–mature cataract
Morgagnian hyper–maturecataract Complete cortex is liquefied and appears milky white in colour. Nucleus settles at the bottom. Calcium deposits may also be seen on the lens capsule.
Sclerotic hyper–mature cataract Disintegrated cortex. Shrunken lens. Wrinkled anterior capsule . Dense white capsular cataract in pupillary area. Deep Anterior-Chamber. Tremulous Iris .
Nuclear or Sclerotic cataractEtio-pathogenesis:- Intensification of age related degenerative changes associated with dehydration of and compaction of nucleus. Features:- Hard cataract is formed. Significant increase in water insoluble protein. Lens becomes in-elastic and looses power of accommodation. Changes begin centrally and slowly spread to periphery. Deposition of pigments gives characteristic colour to nucleus.