This document discusses cataracts, including their classification, causes, symptoms, diagnosis, and treatment. It notes that cataracts are the opacification and clouding of the lens of the eye. They are classified morphologically or etiologically. Senile cataracts related to aging affect over 90% of people by age 70 and are the most common type. Examination involves assessing visual acuity, eye pressure, and examining the anterior segment and fundus. Treatment options include glasses initially, but surgery such as phacoemulsification is often needed for more advanced cases. Complications of surgery can include inflammation, edema, and retinal detachment.

1. Approach to a
Case of Cataract
Sandeep Saxena MS, FRCS (Edin), FRCS (Glasg)
Professor, Ophthalmology, KGMU

2. Differential diagnosis
Painless, progressive diminution of vision
• Cataract
• Primary open angle glaucoma
• Diabetic retinopathy
• Corneal dystrophies and degenerations
• Age related macular degeneration
• Retinitis pigmentosa

3. Cataract
• Opacification of the human crystalline lens
• Major cause of blindness worldwide
• Classification-
-Etiological
-Morphological

4. Morphological classification
• Capsular cataract
-Anterior
-Posterior
• Subcapsular cataract
-Anterior
-Posterior
• Cortical cataract
• Nuclear cataract
• Polar cataract

5. Etiological classification
I. Congenital and Developmental cataract
II. Acquired cataract
• Senile cataract
• Traumatic cataract (blunt, penetrating, radiation,
electric shock, glass blowers, infra-red)
• Complicated cataract (uveitis-induced)
• Metabolic cataract (Diabetes - snowflake, Wilson’s
disease-sunflower)
• Drug induced cataract- corticosteroids, miotics
• Cataract associated with syndromes

6. • Congenital or Developmental cataract
- Occur due to maternal infection or malnutrition,
perinatal hypoxia – APH, or may be hereditary
- Various morphological forms:
– Blue dot
– Sutural
– Fusiform or spindle shaped
– Embryonal nuclear
– Zonular
– Coronary
– Anterior or posterior polar

7. Senile cataract
• ‘Age-related cataract’
• By the age of 70 years, over 90% of the
individuals develop senile cataract
• Usually bilateral, but almost always
asymmetrical

8. Symptoms
• Gradual, painless progressive loss of vision
• Discomfort / glare in daylight – nuclear
cataract; better vision in daylight – cortical
cataract
• Uniocular polyopia
• Coloured halos
• Black spots in front of eyes
• ‘Second sight’

9. Signs
• Iris shadow
• Depth of anterior chamber
• Pupillary reflex
• Visual acuity
• Plain mirror examination under mydriasis

10. Iris
shadow
A.C.
Depth
Pupillary
reflex
Visual
acuity
Intumescent Present Shallow Greyish white FC to 6/18
Incipient Present Normal Greyish white FC to 6/18
Mature Absent Normal Pearly white HM to FC
close to face
Hypermature
Morgagnian
Absent Shallow Milky white HM +
Hypermature
Calcified
Absent Normal or
deep
Milky
chalky
HM +

11. Patient workup
• Retinoscopy and best corrected visual acuity
• Intraocular pressure
• Slit lamp examination
• Fundus evaluation – direct & indirect
• Macular function tests
• Ultrasonography
• IOL power calculation

12. General investigations
• Blood pressure
• Blood sugar
• Complete haemogram
• HIV, Hepatitis B & C
• Causes of straining
• Foci of infection
• Systemic examination

13. Management
• An un-operated eye is more comfortable than an
operated eye if visual diminution is mild.
• Early cataract :
-Refraction and glasses
-Dark glasses or photochromatic glasses for
nuclear cataract
-Rule out other causes of visual diminution
-If BCVA not to patient’s satisfaction, then
operate.

14. Surgical techniques
• Intracapsular cataract extraction (ICCE)
• Extracapsular cataract extraction (ECCE)
– Conventional ECCE
– Small Incision Cataract Surgery
– Phacoemulsification
– Lens aspiration in paediatric (soft) cataract

15. Complications of cataract surgery
• Intraoperative
– Incision related complications
– Posterior capsular rupture
– Zonular dehisence
– Vitreous loss
– Nuclear drop
– Posterior loss of lens fragments
– Injury to the cornea, iris and lens
– Expulsive choroidal haemorrhage

16. • Early post operative complications
– Hyphaema
– Iris prolapse
– Striate keratopathy
– Postoperative anterior uveitis
– Bacterial endophthalmitis
• Late postoperative complications
– Cystoid macular edema
– Pseudophakic bullous keraopathy
– Retinal detachment
– Delayed postoperative endophthalmitis
– After cataract
• Soemmering’s ring
• Elschnig’s pearls

17. Intraocular Lenses
Types
• Anterior chamber IOL
• Iris supported lens
• Posterior chamber IOL
• Rigid
• Foldable
Calculation of IOL power
• SRK formula

18. Thank you