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Cataract

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most common ophthalmic disorder seen in all over world. in India 2015 incidence of cataract patient was 62.6 % (9 million). so the awareness and the management is very important for this disease condition. i hope this presentation is very helpful to all the student and people to understanding the cataract refractive ophthalmic disease

Published in: Health & Medicine
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Cataract

  1. 1. The lensIt’s crystalline. Cross section: 1. Capsule 2. Cortex 3. nucleus
  2. 2. Ciliary muscle •Function: • Constricts ciliary body • Relaxes tension on lens • Lens become spherical, which increase the refractive power Ciliary process •Attaches to the lenses by suspensory ligament (zonular fibers) •Secrete the Aqueous humor into the post. chamber
  3. 3. DEFINITION • A cataract is a clouding or capacity that develops in the crystalline lens of the eye or in its envelope, varying in degree from slight to capacity and obstructing the passage of light. • The term cataract is derived from the Greek word cataractos, which describes rapidly running water or falling water.
  4. 4. Epidemiology 1. Cataracts remain the leading cause of blindness. 2. Age-related cataract is responsible for 48% of world blindness, which represents about 18 million people. 3. Cataracts are also an important cause of low vision in both developed and developing countries.
  5. 5. Causes of cataract • Old age (commonest)>65 Year • Ocular & systemic diseases – DM – Uveitis – Previous ocular surgery • Systemic medication – Steroids – Phenothiazines • Trauma & intraocular foreign bodies • Ionizing radiation – X-ray – UV • Congenital – Part of a syndrome – Abnormal galactose metabolism – Hypoglycemia • Inherited abnormality – Myotonic dystrophy – Marfan’s syndrom – Rubella – High myopia 8
  6. 6. Any physical or chemical cause ↓ Disturbs the intracellular and extracellular equilbrium of water and electrolytes ↓ Deranges the colloid system in lens fibres ↓ Aberrant fibres are formed from germinal epithelium of lens ↓ Epithelial cell necrosis ↓ Focal opacification of lens epithelium (glaucomflecken) ↓ Opacification of lens PATHOMECHANISM
  7. 7. Opacification of lens takeplace by 3 biochemical changes. 1. Hydration 2.Denaturation of 3.Slow lens protein sclerosis Abnormalities of lens proteins & Disorganisation of lens fibres Loss of transparency of lens Cataract
  8. 8. CLASSIFICATION : BASED ON : •MORPHOLOGY •AGE OF ONSET •MATURITY •ETIOLOGY
  9. 9. Cataract Divided to : • Acquired cataract Age - related cataract Metabolic cataract Radiation or electric cataract Traumatic cataract Toxic cataract Secondary cataract
  10. 10. AGE OF ONSET: 1.CONGENITAL 2.INFANTILE 3.JUVINILE 4.PRE-SENILE 5.SENILE
  11. 11. CONGENITAL CATARACT
  12. 12. INFANTILE AND JUVINILE CATARACT
  13. 13. Age -related cataract It is the Most commonly occurred. Classified according to: Morphological Classification •Capsular cataract •Sub capsular cataract •Cortical cataract •Supra nuclear cataract •Nuclear cataract •Polar cataract
  14. 14. Nuclear cataract • Most common typeMost common type • Age-relatedAge-related • Occur in theOccur in the centercenter ofof the lens.the lens. • It involves the nucleusIt involves the nucleus of the crystalline lens.of the crystalline lens. The nucleus becomesThe nucleus becomes diffusely cloudy anddiffusely cloudy and obstructs the light rays.obstructs the light rays.
  15. 15. Cortical cataract • Occur on the outer edge of the lens (cortex). • Begins as whitish, wedge-shaped opacities. • The lens fibers of the cortex are mainly affected. There is hydration due to accumulation of water droplets in between the fibers and the protein are first denaturated and then are coagulated forming opacity.
  16. 16. Subcapsular cataract •It involves superficial part of the cortex(just below the capsule) and includes anterior sub capsule or posterior sub capsule. capsular cataract • It involves the capsule and may be anterior capsule or posterior capsule.
  17. 17. MATURITY: 1.IMMATURE CATARCT 2.MATURE CATARACT 3.HYPERMATURE CATARACT
  18. 18. MATURE AND IMMATURE CATARACT
  19. 19. Mature Cataract • Lens is completely opaque. • Vision reduced to just perception of light • Iris shadow is not seen • Lens appears pearly white Right eye mature cataract, with obvious white opacity at the centre of pupil
  20. 20. IMMATURE CATARACT
  21. 21. Hypermature Cataract • Shrunken and wrinkled anterior capsule due to leakage of water out of the lense. • This may take any of two forms: 1.Liquefactive/Morgagnian Type 2.Sclerotic Cataract
  22. 22. Liquefactive/Morgagnian Type • Cortex undergoes auto-lytic liquefaction and turns uniformly milky white. • The nucleus loses support and settles to the bottom.
  23. 23. Sclerotic Cataract • The fluid from the cortex gets absorbed and the lens becomes shrunken. • There may be deposition of calcific material on the lens capsule. • Iridodonesis: Anterior chamber deepens and iris becomes tremulous. • The zonules become weak, increasing the risk of subluxation / dislocation of lens.
  24. 24. SUBJECTIVE CLASSIFICATION: • GRADE 0: CLEAR LENS • GRADE 1: SWOLLEN FIBRES AND SUB CAPSULAR OPACITIES • GRADE 2: NUCLEAR CATARACT AND VISIBLE LENS FIBRES • GRADE 3: STRONG NUCLEAR CATARACT WITH PERINUCLEAR AREA OPACITY • GRADE 4: TOTAL OPACITY
  25. 25. SUBJECTIVE CLASSIFICATION
  26. 26. Clinical Manifestations •Gradual painless burning •Loss of vision due to lens opacity •Increased glare in bright light •Decreased color perception •Decreased visual acuity •Poorvision at night • Photophobia(lightPhotophobia(light sensitivity)sensitivity) • Blurred or distorted imagesBlurred or distorted images • Light scatteringLight scattering • Leukokoria or white pupilLeukokoria or white pupil • Reduced light transmissionReduced light transmission • Contrast sensitivity is alsoContrast sensitivity is also lostlost
  27. 27. BLURRED VISION DUE TO SCATTERING OF LIGHT ON THE RETINA
  28. 28. GLARED VIEW(TROUBLE DRIVING AT NIGHT)
  29. 29. CHANGE IN COLOUR VISION(DIMNESS)
  30. 30. 1. History collection 2. Visual acuity test 3. Dilated eye exam 4. Tonometry
  31. 31. Treatment • Glasses: Cataract alters the refractive power of the natural lens so glasses may allow good vision to be maintained. • Surgical removal: when visual acuity can't be improved with glasses. • Surgical techniques –Phacoemulsification method. –Extracapsular cataract extraction. –Intra capsular cataract extraction. –Intraocular lens implantation –cryosurgery
  32. 32. Phacoemulsification in cataract surgery involves insertion of a tiny, hollowed tip that uses high frequency (ultrasonic) vibrations to "break up" the eye's cloudy lens (cataract). The same tip is used to suction out the lens .
  33. 33. Intra-capsular Cataract Extraction Intracapsular Cataract Extraction. From the late 1800s until the 1970s, the technique of choice for cataract extraction was intracapsular cataract extraction (ICCE). The entire lens (ie, nucleus, cortex, and capsule) is removed, and fine sutures close the incision. ICCE is infrequently performed today; however, it is indicated when there is a need to remove the entire lens, such as with a subluxated cataract (ie, partially or completely dislocated lens).
  34. 34. Extra-capsular Cataract Extraction (ECCE) • Extracapsular Surgery. Extracapsular cataract extraction (ECCE) achieves the intactness of smaller incisional wounds (less trauma to the eye) and maintenance of the posterior capsule of the lens, reducing postoperative complications, particularly aphakic retinal detachment and cystoid macular edema.
  35. 35. Postoperative care after cataract surgery • Steroid drops (inflammation) • Antibiotic drops (infection) • Avoid • Very strenuous exertion (rise the pressure in the eyeball) • Ocular trauma.
  36. 36. Complications of cataract surgery • Infective endophthalmitis – Rare but can cause permanent severe reduction of vision. – Most cases within two weeks of surgery. – Typically patients present with a short history of a reduction in their vision and a red painful eye. – This is an ophthalmic emergency. – Low grade infection with pathogen such as Propionibacterium species can lead patients to present several weeks after initial surgery with a refractory uveitis • Suprachoroidal haemorrhage. – Severe intraoperative bleeding can lead to serious and permanent reduction in vision.
  37. 37. • Uveitis • Ocular perforation. • Postoperative refractive error • Posterior capsular rupture and • vitreous loss
  38. 38. Retinal detachment. Cystoid macular oedema Glaucoma Posterior capsular opacification
  39. 39. Nursing diagnosis • Anxiety related to lack of knowledge about post operative care. • Risk for infection related to surgical incision and self care after surgery. • Risk for injury related to sensory deficit while operated eye is patched.

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