Stages of maturation : 👁️‍🗨️ Maturation of cortical type senile cataract 👉Stage of lamellar separation 👉Stage of incipient cataract 👉Immature senile cataract 👉Mature senile cataract 👉Hypermature senile cataract 👁️‍🗨️ Maturation of nuclear senile cataract 🕵️‍♀️ Clinical features and signs 👉Visual acuity 👉Test for iris shadow 👉Color of lens 👉 Morphology 👉Direct opthalmoscopic examination 👉Retinoscopy 👁️‍🗨️Iris shadow 👁️‍🗨️other causes of cataract

1. STAGES AND CLINICAL FEATURES
OF CATARACT
BY:
PRIYANKA SALUNKHE

2. MATURATION OF THE CORTICAL TYPE
OF SENILE CATARACT
1. Stage of lamellar separation .
2. Stage of incipient cataract.
a) Cuneiform senile cortical cataract.
b) Cupuliform senile cortical cataract.
3. Immature senile cataract [ ISC].
4. Mature senile cataract [MSC].
5. Hypermature senile cataract [HMSC].
a) Morgagnian hypermature cataract .
b) Sclerotic type hypermature cataract.
MATURATION OF NUCLEAR SENILE
CATARACT
STAGES OF MATURATION

3. COURSE OF EVENT INVOLVED IN
OCCURRENCE OF CORTICAL SENILE
CATARACT
With increasing age
Decreases in the function of
active transport pump
mechanism of lens.
Aquaporin or Mitochondrial
processing peptidase (MPP)
mutation.
Reduced oxidative reaction.
Reversal of Na+/K+ ratio
Hydration of lens fibres.
Decreased level of amino acid.
Decreased synthesis of
proteins in lens fibres.
Denaturation of lens proteins.
Opacification of cortical lens fibres.

4. MATURATION OF THE CORTICAL
TYPE OF SENILE CATARACT
1. STAGE OF LAMELLAR SEPARATION:
 The earliest sign of senile cataract is formation vacuoles
and water cleft in anterior and posterior cortex.
 This leads to demarcation of cortical fibres owing to
their separation by fluid.
 Phenomenon of lamellar separation can be
demonstrated by slit – lamp examination only.
 These changes are reversible.
Demarcation of
cortical fibres.
REVERSIBLE

5. CUNEIFORM SENILE CORTICAL
CATARACT:
# Characterised by wedge – shaped
opacities with clear areas in between.
# Extend from equator towards centre and
in early stages can only be demonstrated
after dilation of the pupil.
# First seen in the lower nasal quadrant.
# These opacities are present both in
anterior and posterior cortex and their
apices slowly progress towards the pupil.
# On oblique illumination these present a
typical radial spoke – like pattern of greyish
white opacities.
# On distant direct ophthalmoscopy, these
opacities appears as dark lines against the
red fundal glow.
# Saucer – shaped opacity develops just
below capsule usually in central part of
posterior cortex, which gradually extends
outwards.
# Usually a definite demarcation between
the cataract and the surrounding area of
clear cortex.
CUPULIFORM SENILE CORTICAL
CATARACT:
2. STAGES OF INCIPIENT CATARACT
 In this stage, early detectable opacities with clear areas between them are seen .

6. STAGES OF INCIPIENT CATARACT
Cuneiform senile cortical cataract: Cupuliform senile cortical cataract:

7. 3.IMMATURE SENILE CATARACT( ISC)
 In this stage, opacification progress further.
 Cuneiform or Cupuliform patterns can be recognised till the
advanced stage of ISC when opacification becomes more diffuse
and irregular.
 Lens appears greyish white but clear cortex is still present and so
iris shadow is visible.
 In some patients, at this stage lens may become swollen due to
continued hydration. This condition is called “ intumescent
cataract.

8. 4. MATURE SENILE CATARACT(MSC)
 In this stage, opacification becomes complete, whole of cortex is
involved.
 Lens becomes pearly white in colour.
 Such a cataract is also labelled as “ ripe cataract”.

9. 5. HYPERMATURE SENILE CATARACT
(HMSC)
 When mature cataract is left in situ, stage of hypermature sets in.
Morgagnian Hypermature cataract: Sclerotic type hypermature cataract:
 In some patients, after maturity whole cortex
liquefies and lens is converted into a bag of milky
fluid.
 Small brownish nucleus settles at bottom, altering
it’s position of the head.
 Such a cataract is called Morgagnian cataract.
 Sometimes after stage of maturity, the cortex
becomes disintegrated and lens becomes
shrunken due to leakage of Water.
 Anterior capsule is wrinkled and thickened due to
proliferation of anterior cells and a dense white
capsular cataract maybe formed in pupillary area.

10. MATURATION OF NUCLEAR SENILE
CATARACT
 Progressive nuclear sclerotic process renders lens inelastic and hard, decreases
it’s ability to accommodate and obstructs light rays.
 These changes begin centrally and spread slowly peripherally almost up to the
capsule when it becomes mature ;
 However a very thin layer of clear cortex may remain unaffected.
 Nucleus may become diffusely cloudy ( greyish) or tinted (yellow to black) due to
deposition of pigments.
 In practice, commonly observed pigmented nuclear cataracts are either amber,
brown (cataracta brunescens) or black (cataracta nigra) and rarely reddish (
cataracta rubra) in colour.

11. CLINICAL FEATURES
SYMPTOMS:
1. Glare. 2. Unilocular diplopia or
polyopia.
3. Coloured halos
around light.
4. Poor colour
discrimination.
5. Black spots in front of eyes.
6. Image blur.
7. Misty vision.
8. Deterioration of vision

12. SIGNS
Following examination should be carried out to look for different signs of cataract described
below:
 Oblique illumination examination,
 Iris shadow test,
 Slit- lamp examination,
 Distant direct ophthalmoscopy.
1. Visual acuity.
2. Test for iris shadow.
3. Colour of lens.
4. Morphology of cataractous lens.
5. Distant direct ophthalmoscopic examination.
6. Refraction/ retinoscopy.
Depending upon location and maturation of cataract, visual acuity
may range from 6/9 to just PL +
Black Crescent.
Presence of clear interval between iris and lens opacity.
Amber, brown, black or reddish, greyish white pearly white,
milky white , Dirty white with hyper white spots.
slit – lamp examination using direct illumination and in optical
section of lens with fully dilated pupil.
A reddish yellow fundal glow is observed in absence of
any opacity in media.
Nuclear sclerosis – Myopia.
Cuneiform cortical cataract-Hypermetropia.

14. IRIS SHADOW AND GRADING OF
NUCLEUS HARDNESS.
IRIS SHADOW :
 when an oblique beam of light is thrown
on the pupil, a crescentic shadow of
pupillary margin of iris will be formed on
greyish opacity of the lens, as long as
clear cortex is present between opacity
and the pupillary margin.
GRADING OF NUCLEUS
HARDNESS:

15. OTHER CAUSES OF CATARACT
 TRAUMATIC CATARACT.
 METABOLIC CATARACTS.
 HYPOCALCAEMIC(Tetanic)
CATARACT.
 CATARACT DUE TO ERROR OF
COPPER METABOLISM.
 CATARACT IN LOWE’S SYNDROME.
Diabetic cataract.
Galactosaemic
cataract.
Senile cataract in diabetic.
True diabetic cataract.
Deficiency of (GPUT) .
Deficiency of galactokinase.
Multicoloured crystals.
Zonular cataract.
Sunflower cataract.
Kayser– Fleischer ring.
Ocular – congenital cataract, glaucoma, blue sclera.
Systemic – mental retardation, dwarfism, osteomalacia.
 GPUT – galactose-1 phosphate
uridyltransferase.

16. Traumatic cataract. Metabolic cataracts. Hypocalcaemic cataract.
Cataract – copper
metabolism.
Cataract- Lowe’s
syndrome.
 Clouding of lens
and eyes that may
occur after either
blunt or
penetrating ocular
trauma that
disrupts and
damages lens
fibres.
 These cataracts occur due
to endocrine disorders and
biochemical abnormalities.
 Diabetic cataract.
Senile cataract
in diabetes.
True
diabetic
cataract.
Appears at an
early age &
progress
rapidly.
‘snowflake
cataract’ Or
'snowstorm
cataract ‘.
 Occurs in young
adults.
 Due to osmotic over
hydration of lens.
 Occur due to atrophy or
inadvertent removal
(during thyroidectomy)
of parathyroid glands.
 Multicoloured crystals or
small discrete white
flecks of opacities are
formed in cortex which
seldom mature.
 Zonular cataract
characterized by a thin
opacified lamella deep
in infantile cortex is
typically seen in infants
with hypocalcaemia.
 Inborn error of
copper metabolism
results in Wilson’s
disease
(hepatolenticular
degeneration)
 Sunflower cataract
characterized
yellowish brown
dots.
 Kayser – Fleischer
ring (KF ring) shows
a golden ring due to
deposition of
copper in the
peripheral part of
Descemet’s
membrane in the
cornea.common-
Wilson’s disease.
 Lowe’s syndrome is a
rare inborn error of
amino acids
metabolism.

17. Traumatic cataract. Snowflake cataract. Galactosaemic cataract. Zonular cataract.
Sunflower cataract.
Kayser - Fleischer ring.
Lowe’s syndrome.

18. Complicated Cataract. Radiational cataract. Electric cataract. Syndermatotic Cataract.
 It refers to opacification of
the lens secondary to
some other intraocular
disease.
 Due to inflammatory
conditions of the eye or
uveitis, Glaucoma,
intraocular tumours.
 Exposure to almost all types of
radiant energy is known to
produce cataract by causing
damage to the lens
epithelium.
 It has three types:
1. Infrarded ( heat) cataract.
2. Irradiation cataract.
3. Ultraviloet radiation cataract.
 It is known to occur after
passage of powerful
electric current through
the body. The cataract
usually starts as punctate
subcapsular opacities
which mature rapidly.
 Lens opacities
associated with
cutaneous diseases are
termed syndermatotic
cataracts. Such cataracts
are bilateral and occur
at a young age.
 Eg : Atopic cataract,
scleroderma, keratosis
follicularis.

19. THANK YOU