This document summarizes the case presentation of a 15-year-old female student who underwent cataract surgery in her right eye 2 years ago. Her previous prescription showed mild hyperopia and astigmatism. On examination, her best corrected vision was 6/6 and her refraction showed mild residual hyperopia and astigmatism. She was diagnosed with pseudophakia and prescribed bifocal glasses. The document then provides background information on different types of cataracts, their causes, signs, symptoms, management including surgery and optical correction options.

1. Case presentation
By sivaraja rathinavel

2. Patient detail
 Age 15/F
 Class:XI
 Come to our camp for screening

3. History &
complaints
Chief complaints
 H/o undergoing cataract surgery in OD about 2 years back.The
cause of the cataract is unknown .
 H/o wearing spectacle since 2 years (on and off).
 Had no specific complaints.
 No H/o Ocular or head injury.

4. Screening &
refraction
Previous glass prescription
Sph Cyl Axis
OD +0.75 -1.00 5
Os ± -0.75 10
Visual acuity
OD OS
Distance (aided) 6/9P 6/9
Near ( unaided) 6/24 6/6

5. Refraction
Objective refraction (autorefractometry)
Sph Cyl Axis
OD +0.50 -1.00 175
Os -0.25 -0.75 170
Subjective refraction (prescription)
Sph Cyl Axis Add BCVA
OD +0.50 -1.25 175 +3.00 6/6P
OS ± -0.75 180 6/6P

6. Ocular
Examinations
Torch light examination
Parts OD OS
Cornea Clear Clear
Anterior chamber quiet quiet
Iris Normal Normal
Pupil R/R/R R/R/R
Lens Clear (PCIOL) Clear

7. External
Examinations
 Slit lamp examination not done.
 Hirsh BergTest : Central
 Extra Ocular Muscle MovementTest
Full, Free in all the gazes

8. Diagnosis
 Pseudophakia(s/p – Operated for developmental cataract)

9. Pseudophakia
 Pseudophakia is an aphakic eye with an artificial intraocular lens
implant.

10. Management
 Spectacles Prescribed.
 Counseling for regular use of spectacles.
OD OS
Bifocal (kryptok) Single vision

11. Types of
Cataract
Cataract
Etiological Morphological
Congenital & Acquired 1 Capsule
Development 2 Subcapsule
1 Senile 3 Cortical
2 Traumatic 4 Supranuclear
3 Complicated 5 Nuclear
4 Metabolic 6 Polar
5 Electric
6 Radiational
7 Toxic
8 Other diseases

12. Acquired
cataract
 1.Senile
 2.Traumatic
 3.Complicated
 4.Lamellar
 5.Electric
 6.Radiational
 7.Toxic

13. Clinical types
 1 Anterior capsular cataract
 2 Posterior capsular cataract
 3 Anterior polar cataract
 4 Posterior polar cataract
 5 Nuclear cataract

14. Clinical types
 7 Sutural & axial cataract
 8 Floriform cataract
 9 Coralliform cataract
 10 Spear shaped cataract
 11Anterior embryonic
 12 Coronary

15. Clinical types
 13 Blue-dot
 14 total-congenital

16. Cataract
 The Opacification of any part of the crystalline lens is termed as
cataract.

17. Congenital &
developmental
cataract
Disturbance in development of normal growth of lens
http://www.epainassist.com/eye-pain/congenital-or-acquired-cataracts-in-children

18. Continuation
CONGENITALCATARACT
1. When the disturbance
occurs before birth.
2. The opacity is limited to
either embryonic or foetal
nucleus.
3. Age of onset – 0 to 30 days
of life.
DEVELOPMENTALCATARACT
1. It occurs from infantile to
adolescence.
2. The opacity may involve in
infantile or adult nucleus,
deeper part of cortex or
capsule.
3. Age of onset – 1 month to
18 years of life.
Congenital and developmental cataract occurs due to some disturbance in the
normal growth of the lens.

19. Etiology
 Idiopathic
 Heredity
 Maternal factors
 Foetal or infantile factors

20. Investigation
 Slit lamp Examination
 Dilated ocular examination
 Biometry – A scan& B scan,Keratometry

21. Signs
 A noticeable cloudiness in the pupil
 Dull retinoscopic reflex
Ref: https://www.southerncross.co.nz/group/medical-library/cataracts-causes-symptoms-treatment-
surgery

22. Symptoms
 Increased glare from lights.
 Double vision (diplopia)
 Poor vision in sunlight.
 Cloudy, blurry, fuzzy, foggy or filmy vision

23. Differential
diagnosis
 Leukocoria
 Retinopathy of prematurity.
 Persistent hyper plastic primary vitreous.
 Retinoblastoma.

24. Management
 Surgery
 Spectacles and contact lenses
 Patching therapy in cases of amblyopia

25. Surgery
 Power of IOL- below 2 years ( 20% under correction)
b/w 2-8 years (10% Under correction)
 IOL calculation
Ref: IOL Power Calculation in Children Sandeep Gupta MS, DNB, Parth Patel MBBS, Gagandeep Kaur MBBS, V.S. Gurunadh MS, M.A. Khan MS, V.K.
Mohindra MS Armed Forces Medical College, Pune, Maharashtra

26. Surgical
options
 Phacoaspiration with primary posterior capsulotomy with or
without anterior vitrectomy and (with/without IOL implantation)
 Anterior capsulorrhexis and irrigation aspiration of the lens matter
or lensectomy.

27. Glasses
Ref;:http://www.jcor.in/article.asp?issn=2320-3897;year=2013;volume=1;issue=3;spage=169;epage=173;aulast=Sainani

28. Dispensing
aspect
 Tinted glasses / Photo chromatic lenses / Ultraviolet protection
 Polycarbonate glasses
 Frame:
- Shell frame
- Comfort cable temple
Ref: Special considerations for prescription of glasses in children
Ashwin Sainani
Department of Ophthalmology, PD Hinduja Hospital and Medical Research Center, Mahim, Mumbai, India

29. Aphakia
 The absence of crystalline lens of the eye.
 Optically, the lens is absent from pupillary area.
 It produces high degree of hypermetropia.

30. Causes
 Congenital absence
 Surgical aphakia
 Traumatic
 Dislocation of the lens

31. Optics
 Highly hyperopic
 Total power of the eye is reduced to about +44D from + 60 D.
 Total loss of accommodation.

32. Symptoms
 Defective vision
 Erythropsia & cyanopsia

33. Signs
 Limbal scar
 Anterior chamber is deeper than normal
 Iridodonesis
 Pupil color – jet black

34. Signs
 Purkinje’s image test shows only 2 images
 Fundus exam - hypermetropic small disc
 High hypermetropia in retinoscopy

35. Treatment
 Optically, convex lenses for appropriate power.
 Modalities for correcting aphakia:
 Spectacle
 Contact lenses
 Intra ocular lenses

36. Contact lenses
Ref: Special considerations for prescription of glasses in children
ashwin sainani
Department of Ophthalmology, PD Hinduja Hospital and Medical Research Center, Mahim, Mumbai, India

37. Thank you