Cataract is an opacity in the lens. There are different types and stages of cataract development. Extra capsular cataract extraction is the preferred surgery technique as it has fewer complications than intra capsular extraction. Phacoemulsification is now the best technique as it allows for a small incision, use of topical anesthesia, and faster recovery. Accurate biometry measurements and IOL power calculations are important for good visual outcomes after surgery. Post-operative care involves medications and follow-up to monitor for and treat complications such as infection, inflammation, and posterior capsule opacification.

1. CATARACT
1) what is cataract?
@ Any opacity in the lens is called cataract
2) What are the clinical course of development of senile cortical cataract?
@ Stage of lamellar separation
incipient stage
intumescent stage
mature cataract
hyper mature cataract
3) What are the complications which may occur during immature stage?
@ Progressive swelling of lens due to swelling of lens fiber can push the iris forward and
can lead to secondary angle closure glaucoma.(phaco morphic glaucoma)
4) What complications can occur if senile mature cataract is not operated?
@ If senile mature cataract is not operated and lens not removed, it causes subluxation,
lens dislocation, secondary glaucoma (phaecolytic), phaco anaphylactic uveitis.
5) Why glaucoma develops during hyper mature stage?
@ After hyper maturity of cataract small pores appears on anterior capsule through
which liquefied protein material comes out of the lens which blocks the trabecular
mesh work and this protein material is engulfed by macrophages which block
trabecular mesh work leading to phaecolytic open angle glaucoma.

2. 6) How will you differentiate phacomorphic glaucoma from phacolytic
glaucoma?
7) How will you differentiate immature and mature cataract?
signs Immature cataract Mature cataract
Colour of lens Grayish white Pearly white
Iris shadow Present Absent
Visual acuity 6/9- counting fingers close
to face
HM –perception of light
signs phacomorphic phacolytic
Depth of anterior
chamber
shallow deep
Color of lens Grayish white with iris
shadow
Pearly white
Visual acuity Counting fingers
close to face --6/9
Perception of light&
projection of rays

3. 8) How will you conform your diagnosis?
@ by - slit lamp examination--few transparent and few opaque fibers are
seen in immature cataract and completely
opaque fibers are seen in mature cataract.
-distant direct ophthalmoscopy-- black shadow are seen against red
glow in immature cataract and no red
glow seen in mature cataract.
9) How will you clinically differentiate cortical from nuclear cataract?
Signs nuclear cataract cortical cataract
Colour of lens Brown or black Grayish white or pearly
white
Visual acuity Distant vision is diminished
and near vision is good
Both distant and near
vision are affected.
Opacity Usually central Central or peripheral

4. 10) Why the lens in senile nuclear cataract looks black or brown?
@ There is deposition of melanin derives from tryptophan group of amino acids in sclerosed fibers
imparting yellow or brown colour to lens.
11) How the patient of nuclear cataract will able to see the near objects clearly?
@ In nuclear cataract, nuclear sclerosis increases the refractive index of lens leading to myopia resulting in
improving his near vision. This is also called second sight of old.
12) Which cataract matures fast? cortical or nuclear?
@ Cortical cataract takes relatively fast time than nuclear cataract.
13) Hyper maturity complications are present in nuclear cataract are not?
@ No. nuclear cataract rarely becomes hyper mature.
14) How will you grade the lenticular opacities in nuclear cataract?
@ Opacities of lens are divided in 1-4 grades
Grade 1-looks grey (soft cataract)
Grade 2-looks yellow (medium soft)
Grade 3- looks brown (medium hard)
Grade4 –looks black (hard cataract)
15) Is it safe to perform phaco emulsification in grade 4 nuclear sclerosis?
@ No---soft cataract are better for phaco emulsification.
16) Why you take the history of diabetes mellitus in a case of cataract?
@ Uncontrolled diabetes at the time of operation can lead to delayed wound healing and post operative
infection like iridocyclitis and endophthalmitis.so history of diabetes should be taken and diabetes should
be under controlled at time of operation

5. 17) Why we should take the history of hypertension in case of caract?
@ Uncontrolled hypertension during operation can lead to expulsive choroidal
hemorrhage on table. so history of hypertension should be taken and it
should be under control at the time operation.
18) what other causes can lead to expulsive choroidal hemorrhage?
@ Increased intra ocular pressure during operation can lead to expulsive
choroidal hemorrhage.
19) how will you evaluate a case of cataract before surgery?
@ General evaluation
clinical 1) pulse
2) blood pressure
3) heart and lungs
4) any infection surrounding the eye
lab 1) blood sugar
2) complete urine examination
3) x ray –chest
4) ECG
5) HBs Ag in suspected cases only
6) Elisa test for HIV

6. Ocular evaluation 1) slit lamp examination---for any infection in the anterior
segment, lids, KPs, morphology of
lens, synechiae ,signs of pseudo
exfoliation, any corneal opacities.
2) direct and indirect ophthalmoscopy---for evaluating
posterior segment with
particular emphasis on
disc and macula
3) macular function tests like--- pupillary reactions,
perception of light, Maddox rod
test, colour vision test etc.
4) IOP recording
5) regurgitation test and syringing to rule out any lacrimal
Infection
6) A-scan biometry to calculate IOL power
7) B-scan---in cases of mature cataract where posterior
segment evaluation in not possible by direct ad
indirect ophtlmoscope.
8) specular microscopy

7. 20) How will you calculate IOL power?
@ For IOL power calculation 1) keratometry is done by keratometer and horizontal/
vertical diameter of cornea(refractive power of
cornea in horizontal and vertical meridians) is
measured in dioptres.
2) axial length of eye ball is measured by A-scan
3) a formulae is selected (usually SRK II formulae)
4) these parameters are given to small computer
attached to A-scan machine which gives
us the power of the IOL to be implanted in
that particular eye.
21) what is SRK formulae?
P= A-2.5L-0.9K
where P = power of IOL
A = constant specific for each lens type written on box by
manufacturer company
L = axial length of eye ball
K = corneal curvature
22) why calculation of IOL power is called biometry?
@ The ultrasound machine equipped with A-scan is having soft ware in it to calculate
the IOL power. That software is called biometer. So the procedure is called biometry.
23) what is full form of SRK?
@ “Sanders retzlaff and kraff”

8. 24) What are types of anesthesia used in cataract surgery?
@ 1) topical anesthesia
2) local anesthesia-
a)retro bulbar anesthesia along with facial block
b) peri bulbar anesthesia
3) general anesthesia
25) what are indications for general anesthesia?
@ Infants and children, anxious, uncooperative, mentally retarded adults
26) In local anesthesia which is preferred? retro or peri bulbar anesthesia?
@ Peri bulbar is preferred because a) only one injection is needed. no facil block
is needed.
b) complications are less in peri bulbar
27) what are the complications of retro bulbar anesthesia?
@ --retro bulbar hemorrhage
--perforation of globe
--optic nerve injury
--extra ocular muscle palsies
28) what anesthetic solution is used for local anesthesia?
@ It consists of a mixture of 2% xylocaine,0.5% bupivacaine in ratio of 2:1 with
hyalouronidase 5 IU/ml with or with out adrenaline 1 in 100000.
adrenaline is not used in cardiac patients and hypertensive patients.

9. 29) What types of surgeries can be performed under surface(topical anesthesia)?
@ Only phaco emulsification can be done under topical anesthesia.
30) what are the main type of cataract operations?
@ There are 2 main types of cataract operations -intra capsular cataract extraction
-extra capsular cataract extraction
31) which one is preferable and why?
@ Extra capsular cataract extraction is better because
a)universal operation can be performed at all ages(ICCE cannot be performed
under 40 years of age)
b)posterior chamber IOL can be implanted in ECCE where as anterior chamber IOL has
to be implanted in ICCE which is having more complications than posterior
chamber IOL
c)vitreous loss and its related complications like pupillary block glaucoma, vitreous
touch syndrome, vitreous vick syndrome,retinal detachment are more
common with ICCE where as they are rare in ECCE
d)incidence of post operative complications such as endophthalmitis, cystoid macular
edema are less in ECCE
e)incision related problems like more astigmatism and delayed rehabilitation are more
with ICCE

10. 32) Is still any indications for ICCE?
@ ICCE is indicated in grossly subluxated and dislocated lenses.
33) What is the main disadvantage in ECCE when compared to ICCE?
@ Post operative opacification of posterior capsule is seen in ECCE where it is not
seen in ICCE
34) What are the type of ECCE?
--conventional extra capsular cataract extraction (ECCE)
--manual small incision cataract surgery (SICS)
--phaco emulsification
35) Which one is best and why?
@ Phaco emulsification is best, because
--it can be performed under topical anesthesia.so complications of local
anesthesia can be avoided
--early rehabilitation
--post operative astigmatism is negligible
--intra operative complications like expulsive choroidal hemorrhage is less
36) What is basic difference between conventional ECCE surgery and SICS?
@ In SICS— sclero corneal tunnel is made through which all the procedures will be

11. In conventional ECCE surgery—Ab externo incision is given at limbus which is close by 3-
5 sutures, so astigmatism is more and complications like shallow anterior chamber, iris
prolapse, expulsive choroidal hemorrhage and suture related complications are more.
37) what is basic difference between phaco surgery and SICS?
@ In phaco---clear corneal incision is smaller than in SICS i.e. 2.5-3.5mm(in SICS 5.5-
7.5mm)
--- nucleus is emulsified in posterior chamber and aspirated where as
in SICS ,nucleus is brought into anterior chamber and taken
out with vectis.
38) Tell me 2 dreaded complications of cataract surgery on the table?
@ a) expulsive choroidal hemorrhage
b) nuclear drop
39) Tell me 2 common post operative complications?
@ a) endophthalmitis
b) posterior capsular opacification
40) what is the most common complication in ECCE?
@ --posterior capsular opacification
41) How will you treat PCO (posterior capsular opacification)
@ PCO is treated by ND YAG laser capsulotomy
42) what will you do if YAG laser is not available?
@ dicision with cystitome.

12. 43) What do you mean by toxic cataract?
@ Cataract induced by certain medicines is called toxic cataract.
44) what are the medicines which causes toxic cataract?
@ Corticosteroids, miotics like pilocarpine, chlorpromazine
45) what do you understand by complicated cataract?
@ It refers to opacification of lens secondary to other ocular pathology
46) what are the conditions which produces complicated cataract?
a) inflammatory conditions like iridocyclitis, hypopyon corneal ulcer
b) degenerative conditions like retinitis pigmentosa and myopic chorio-retinal
degeneration.
c) intra ocular tumors like retinoblastoma,
d) retinal detachment
e) glaucoma primary or secondary
47) what are indications of cataract surgery?
a) to improve the vision
b) to prevent complications like lens induced glaucoma, phaco anaphylactic
uveitis, subluxation & dislocation in hyper mature cataract
c) to treat diseases like diabetic retinopathy and retinal detachment-treatment
of which is being hampered by presence of cataractous lens.
48) At what stage u want to perform the cataract surgery in case of immature
cataract?

13. @ It is a need based surgery when ever patients day to day work is hampered by
his diminution of vision, patient can be taken up for surgery.
49) what are the pre medications before cataract surgery?
@ --Antibiotic drops three days before surgery
--dilatation of pupil by tropicamide + phenylephrine eye drops 1 hour before
surgery
--non steroidal anti inflammatory drops 1 hour before surgery like flurbiprofen
or nepafenac
--xylocaine sensitivity test
50) what is the role of non steroidal anti inflammatory drugs before surgery?
@ Because of its anti prostaglandin action it prevents 1) intra operative miosis
2)post operative cystoid macular edema
51) what medicines will you prescribe post operatively?
1-oral anti biotics like ciprofloxacin 500mg BD for 5 days
2- oral anti inflammatory like acceclofenac BD for 5 days
3- oral acetazolamide 250mg BD for two days
4- topical anti biotics like moxifloxacin eye drops starting with 1 drop 1hrly
reduce with time, use for 15-30 days depending on type of surgery
5- prednisolone eye drops starting 1 drop 1hrly tapered with time, use for 30-45
days depending upon type of surgery
6- topical tropicamide eye drops one drop at bed time for 1 week

14. 52) What are the types of senile cataract?
@ there are three types of senile cataract-cortical
-posterior sub capsular
-nuclear
53) which one is the most common type of senile cataract?
@ cuneiform cortical cataract is the most common
54) what type of energy is used phaco emulsification for the fragmentation of
nucleus?
@ ultrasonic 1mm titanium needle vibrates at the speed of 40000 times/sec to
emulsify the nucleus.
55) what are the advantages of topical/surface anesthesia in cataract surgery?
@ -pain of injection is not present
-immediate visual recovery, no need of pad and bandage
-site threatening complications like globe perforation, optic nerve damage
are not present
-non site threatening complications like post operative ptosis are less
-cost effective
56) can perforation of globe can occur in peri bulbar anesthesia?
@ yes, in high myopes having axial length of eye >26mm,the risk of perforation
is more.

15. 57) What are the causes of post operative ptosis after cataract surgery?
@ mild ptosis after cataract surgery is due to –use of eye lid speculum
--superior rectus bridle suture
--pressure on globe and upper eyelid
--prolong upper eye lid patching
58) what other than SRK formulae can be used for IOL calculation?
@ -- colon brandar formulae
-- brinkhorst formulae
-- holladay formulae
59) what is the normal endothelial cell count? How many endothelial cells are needed
to maintain the integrity of cornea?
@ normal cell count is 2500-3500cells/sq.mm
minimum 500cellls/sq.mm are needed to maintain its integrity
60) what is the importance of specular microscopy?
@ always a number of cells will die during surgery. So cell count should be done in all
cases of cataract surgery. Cell count of 1500-2500/sq.mm are at slightly
higher risk and cells <1500/sq.mm is to be considered to be at serious risk for the
development of bullous keratopathy post operatively.
61) what are the causes of gradual diminution of vision painless?
@ senile cataract, open angle glaucoma, age related macular degenerations, refractive
errors, corneal degenerations and dystrophies, progressive pterygium
involving pupillary area, diabetic maculopathy.