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Types of Cataract
By
Prof. Naimatullah Khan Kundi
Head, Department of Ophthalmology
Khyber Teaching Hospital
Peshawar
Metabolic Cataract
 Diabetes Mellitus

True diabetic cataract rare

Snow storm opacities – subcapsular
opacities in you...
Pathways for glucose metabolism in the lens
Metabolic Cataract
 Metabolic Cataract
 Diabetes Mellitus

Glycolysis, Pentose shunt and Kreb’s cycle
depend on glucose...
Metabolic Cataract
Metabolic Cataract
 Metabolic Cataract
 Diabetes Mellitus

Sorbitol sugar can not defuse through lens fibers

↑ intral...
Metabolic Cataract
 Metabolic Cataract
 Galactosemia

Types
 Transferase deficiency type (classic)
 Galactokinase def...
Metabolic Cataract
 Metabolic Cataract
 Galactosemia

Galactokinase deficiency type
 Features

Infantile cataract
Metabolic Cataract
 Metabolic Cataract
 Pathogenesis

Dulcitol, sugar similar to sorbitol causes osmotic swelling
with ...
Metabolic Cataract
Metabolic Cataract
 Metabolic Cataract
 Hypocalcaemia

Infantile tetany

Hypo para thyroidism

Rickets
 Punctate opa...
Metabolic Cataract
 Metabolic Cataract
 Wilson’s disease

Deposition of metallic copper in the lens
capsule

Sun flowe...
Glaucomatous flecks
 Cataracta glaucomatosa

Multiple white punctate opacities in anterior
subcapsular clear zone due to...
Dermatogenic Cataract
 Skin and lens – Ectodermal
 Cataract BL
 Young age
 Atopic dermatitis

Allergic condition with...
 Infectious diseases associated with cataract
 Viral

Congenital rubella syndrome

Congenital cytomegalovirus disease
...
 Cataract associated with systemic disease
 Dystrophica myotonica

Autosomal dominant

Excessive contractility and slo...
Types of Cataract  (Part-II)19-05-2008.ppt
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Types of Cataract (Part-II)19-05-2008.ppt

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Types of Cataract (Part-II)19-05-2008.ppt

  1. 1. Types of Cataract By Prof. Naimatullah Khan Kundi Head, Department of Ophthalmology Khyber Teaching Hospital Peshawar
  2. 2. Metabolic Cataract  Diabetes Mellitus  True diabetic cataract rare  Snow storm opacities – subcapsular opacities in young uncontrolled diabetics  ↑ blood sugar – myopia  ↓ blood sugar – hyperopia  Lens uses glucose through four pathways  Glycolysis  Pentose shunt  Kreb’s cycle  Sorbitol pathway
  3. 3. Pathways for glucose metabolism in the lens
  4. 4. Metabolic Cataract  Metabolic Cataract  Diabetes Mellitus  Glycolysis, Pentose shunt and Kreb’s cycle depend on glucose – 6 – P  At high glucose level Hexokinase saturated  Sorbitol pathway becomes significant
  5. 5. Metabolic Cataract
  6. 6. Metabolic Cataract  Metabolic Cataract  Diabetes Mellitus  Sorbitol sugar can not defuse through lens fibers  ↑ intralenticular osmolarity  Water is drawn  Water vacuoles developed  Hydropic lens fibers more permeable and rupture  Na+ influx → further water absorption  Loss of K+ , AA, glutathione and proteins
  7. 7. Metabolic Cataract  Metabolic Cataract  Galactosemia  Types  Transferase deficiency type (classic)  Galactokinase deficiency type (milder)  Transferase deficiency type  Galactose – 1 – PO4 uridyl tranferase deficiency  Cataract  75%  Droplet opacities  Anterior/posterior
  8. 8. Metabolic Cataract  Metabolic Cataract  Galactosemia  Galactokinase deficiency type  Features  Infantile cataract
  9. 9. Metabolic Cataract  Metabolic Cataract  Pathogenesis  Dulcitol, sugar similar to sorbitol causes osmotic swelling with lens fiber membrane damage and ↑ permeability  Diagnosis  Reducing sugars in urine  Treatment  Elimination of lactose and glactose from the diet and replacing with synthetic formulas for milk and milk products.
  10. 10. Metabolic Cataract
  11. 11. Metabolic Cataract  Metabolic Cataract  Hypocalcaemia  Infantile tetany  Hypo para thyroidism  Rickets  Punctate opacities in subcapsular area  With treatment these opacities sink and form lamellar cataract  Progression to maturity
  12. 12. Metabolic Cataract  Metabolic Cataract  Wilson’s disease  Deposition of metallic copper in the lens capsule  Sun flower cataract
  13. 13. Glaucomatous flecks  Cataracta glaucomatosa  Multiple white punctate opacities in anterior subcapsular clear zone due to damage of the lens epithelium  Vaculation of subcapsular cortex with focal necrosis of affected fibers and adjacent epithelium  With time opacity sink
  14. 14. Dermatogenic Cataract  Skin and lens – Ectodermal  Cataract BL  Young age  Atopic dermatitis  Allergic condition with familiar tendency  PSC 10%  Most common skin disease associated with cataract  Other skin diseases  Rothmund syndrome  Werner’s syndrome
  15. 15.  Infectious diseases associated with cataract  Viral  Congenital rubella syndrome  Congenital cytomegalovirus disease  Herpes simplex  Variola (small pox)  Treponemal  Congenital syphilis  Protozoal  Congenital toxoplasmosis  Nematode  Onchocerciasis
  16. 16.  Cataract associated with systemic disease  Dystrophica myotonica  Autosomal dominant  Excessive contractility and slow relaxation of muscles  PSC 90%  Ptosis  Retinal pigmentary degeneration  Sluggish pupillary response  Down’s syndrome  Other syndromes

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