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
• Constricts ciliary body
• Relaxes tension on lens
• Lens become spherical,
which increase the
•Attaches to the lenses by
suspensory ligament (zonular
•Secrete the Aqueous humor
into the post. chamber
• 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
• The term cataract is derived from the Greek
word cataractos, which describes rapidly
running water or falling water.
1. Cataracts remain the
leading cause of blindness.
2. Age-related cataract is
responsible for 48% of
world blindness, which
represents about 18
3. Cataracts are also an
important cause of low
vision in both developed
and developing countries.
Causes of cataract
• Old age (commonest)>65 Year
• Ocular & systemic diseases
– Previous ocular surgery
• Systemic medication
• Trauma & intraocular foreign
• Ionizing radiation
– Part of a syndrome
– Abnormal galactose
• Inherited abnormality
– Myotonic dystrophy
– Marfan’s syndrom
– High myopia
Any physical or chemical cause
Disturbs the intracellular and extracellular equilbrium of water and
Deranges the colloid system in lens fibres
Aberrant fibres are formed from germinal epithelium of lens
Epithelial cell necrosis
Focal opacification of lens epithelium
Opacification of lens
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
BASED ON :
•AGE OF ONSET
Divided to :
• Acquired cataract
Age - related cataract
Radiation or electric cataract
AGE OF ONSET:
Age -related cataract
It is the Most commonly occurred.
Classified according to:
•Sub capsular cataract
•Supra nuclear cataract
• Most common typeMost common type
• 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.
• 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.
•It involves superficial part of the cortex(just
below the capsule) and includes anterior sub
capsule or posterior sub capsule.
• It involves the capsule and may be
anterior capsule or posterior capsule.
• 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
• Shrunken and wrinkled anterior capsule due to leakage of water
out of the lense.
• This may take any of two forms:
• Cortex undergoes auto-lytic liquefaction and turns uniformly
• The nucleus loses support and settles to the bottom.
• 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
• GRADE 0: CLEAR LENS
• GRADE 1: SWOLLEN FIBRES AND SUB
• GRADE 2: NUCLEAR CATARACT AND
VISIBLE LENS FIBRES
• GRADE 3: STRONG NUCLEAR CATARACT
WITH PERINUCLEAR AREA OPACITY
• GRADE 4: TOTAL OPACITY
•Loss of vision due to
•Increased glare in
•Poorvision at night
• 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
BLURRED VISION DUE TO SCATTERING
OF LIGHT ON THE RETINA
1. History collection
2. Visual acuity test
3. Dilated eye exam
• 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
• Surgical techniques
–Extracapsular cataract extraction.
–Intra capsular cataract extraction.
–Intraocular lens implantation
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
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).
Extra-capsular Cataract Extraction
• 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.
Postoperative care after cataract
• Steroid drops (inflammation)
• Antibiotic drops (infection)
• Very strenuous exertion (rise the pressure in the eyeball)
• Ocular trauma.
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.
• Ocular perforation.
• Postoperative refractive error
• Posterior capsular rupture and
• vitreous loss
• 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.