During this lecturer, you are going to learn the following:
Definition
Causes
Symptoms & Signs
Pathogenesis
Stages of senile cataract?
DD between immature and mature senile cataract
Management of cataract
TataKelola dan KamSiber Kecerdasan Buatan v022.pdf
Senile Cataract Stages Causes Symptoms Management
1. Dr. Abdelmonem Hamed
Fellow of Baylor of College of Medicine, USA
Professor of ophthalmology, Benha University, ARE
LENS
1
حامد المنعم عبد اد
بنها جامعة ، العين وجراحة طب استاذ
بأمريكا بيلور طب كلية زميل
2. During this lecturer, you are going
to learn the following
Senile cataract:
Definition
Causes
Symptoms & Signs
Pathogenesis
Stages of senile cataract?
DD between immature and mature senile cataract
Traumatic & complicated cataract
Ectopia lentis
Management of cataract
13. Pathogenesis:
Change in water content :
hydration of cortex ;
changes in the permeability of lens capsule
water drops go inside cortex which
becomes opaque.
sclerosis of nucleus
SENILE CATARACT
i
30. Any Shadow to be formed must have?
Light
Opaque Body
Distance
Opaque background
31. What is the iris shadow?
black crescent .Why?
Light
Opaque Body
Distance
Opaque background
32. Intumescent cataract
Hydration of the lens
shallow AC
pupillary block
(phacomorphic
glaucoma )
Pushes iris ant.
1. Swelling of the lens
2. Colored halos
33. Mature cataract
Signs:
Entire cortex is opaque.
Vision is hand movement
Iris shadow is absent.
R.R. is absent
وبالتالى
34. Hypermature cataract
1. Entire cortex is opaque vision is HM
R.R. is absent
2. The lens shrink (thick wrinkled capsule +
cholesterol deposition)
1. Iris shadow may be present.
2. Tremulous iris
3. A.C. deep
3. IOP: may be elevated
(Phacolytic glaucoma)
وبالتالى
38. How to differentiate Immature and
Mature Cataract?
IMMATURE CATARACT
1. VA is reduced to
counting finger.
2. Lens is partially opaque
3. Iris shadow is present
4. Fundus may be visible.
MATURE CATARACT
1. VA reduced to HM or PL
2. Lens is totally opaque
3. No iris shadow
4. No fundus details
Prof . Dr. Abdelmonem Hamed
V.S.
39. 1. Immature cataract
Incipient (sectorial opacities at the
periphery).
Intumescent.
2. Mature cataract (totally opaque)
3. Hypermature cataract (loses water
& shrink)
STAGES OF SENILE CORTICAL
CATARACT
مراجعة
40. Senile nuclear cataract
Definition
Sclerosis of the central nuclear fibers
Etiology
UV
Formation of brown pigment
deposition of abnormal lipoproteins.
reduction in glutathione formation.
calcium concentration
photo – oxidation of amino acids
41. Senile nuclear cataract
Definition
Sclerosis of the central nuclear fibers
Etiology
UV
Formation of brown pigment
deposition of abnormal lipoproteins.
reduction in glutathione formation.
calcium concentration
photo – oxidation of amino acids
42. Senile nuclear cataract
Definition
Sclerosis of the central nuclear fibers
Etiology
UV
Formation of brown pigment
deposition of abnormal lipoproteins.
reduction in glutathione formation.
calcium concentration
photo – oxidation of amino acids
43. Senile nuclear cataract
Definition
Sclerosis of the central nuclear fibers
Etiology
UV
Formation of brown pigment
deposition of abnormal lipoproteins.
reduction in glutathione formation.
calcium concentration
photo – oxidation of amino acids
44. Incidence:
> 40 years of age
Clinical grades (1+ to 4+):
due to deposition of melanin
pigment derived from amino acids in the lens
The nucleus becomes yellowish, brown, red &
then black
Black cataract ( )
Senile nuclear cataract
45. The sclerosis gradually
spreads towards the
cortex, then
extends up to the capsule ,
then the entire lens
functions as a nucleus
(Mature nuclear cataract ).
Senile nuclear cataract
PS. Hypermaturity does not occur as the
process is very slow
i
46. Symptom:
↓ VA due to progressive
myopia and central opacity.
Signs:
Red reflex : hazy to black
Slit-lamp examination:
nuclear cataract.
Senile nuclear cataract
47. D.D. of painless gradual
diminution of vision
Cataract
Chronic open angle glaucoma
Corneal dystrophy
Macular degeneration
Optic atrophy
Retinopathy associated with systemic disorders
(diabetes)
47
Prof . Dr. Abdelmonem Hamed
هام
48. Investigations
1. Macular function test with
I. two pin hole test.
If the retina is good, the patient
appreciates the two lights.
II. Projection of light rays.
III. Pupillary reaction
2. Other investigations
I. IOP
II. Fundus examination if possible.
III. Ultrasonography
IV. ERG
Prof . Dr. Abdelmonem Hamed
49. Treatment of cataract
Indication for surgery:
1. ↓ VA
2. Lens induced complications like
Subluxated or dislocated lens
phacolytic uveitis / glaucoma,
phacomorphic glaucoma.
49
Prof . Dr. Abdelmonem Hamed
50. Treatment of cataract
SurgicalTreatment:
Options
I. Intracapsular lens
extraction (ICCE):
the entire lens
including the
capsule is removed
50
Prof . Dr. Abdelmonem Hamed
52. COMPLICATIONS OF CATARACT SURGERY
•Vitreous loss
1. Operative complications
• Posterior loss of lens fragments
• Suprachoroidal haemorrhage
• Iris prolapse
• Striate keratopathy
• Bacterial endophthalmitis
2. Early postoperative complications
3. Late postoperative complications
• Capsular opacification
• Implant displacement
• Corneal decompensation
• Retinal detachment
53. After cataract
After cataract is opacity in papillary area
immediately following cataract operation or
trauma.
It is formed of:
Parts of anterior and posterior capsule.
Lens fibers left behind during surgery.
Proliferation of remaining subcapsular epithelium
54. After cataract
Treatment
No interference is necessary if the vision is
not affected.
If the after cataract is thick, surgical
intervention is necessary.
NB: Late opacification of the posterior lens
capsule (PCO) is not an after cataract.
55. Treatment of capsular opacification
YAG laser capsulotomy
55
Prof . Dr. Abdelmonem Hamed
56. APHAKIA
Absence of the crystalline lens in the papillary
area.
Causes:
Congenital: very rare.
Posterior dislocation.
Surgical removal.
57. APHAKIA
Signs:
Poor vision.
Black pupil.
Tremulous iris.
DeepAC.
One purkinje- sanson image.
Scar of cataract surgery in cases of surgical
removal.