Cataract is a clouding of the normally clear lens of the eye. It occurs when the lens proteins clump together, preventing clear images from reaching the retina. Risk factors include increasing age, diabetes, smoking, obesity, and corticosteroid use. Symptoms include blurred vision, sensitivity to light, and fading colors. Cataract surgery involves removing the cloudy lens and replacing it with an artificial intraocular lens, improving vision. Complications may include infection, swelling, bleeding or retinal detachment.

1. CATARACT

2. ANATOMY OF THE LENS
STRUCTURE OF THE
LENS:
 LENS CAPSULE
 ANTERIOR LENS
EPITHELIUM
 LENS FIBER

3. CATARACT
WHAT IS CATARACT?
Cataract is a clouding of the lens or any opacity within the lens
which leads to a decrease in vision

4. DEFINITION
• A cataract is a clouding of the normally clear lens of
eye
• A cataract is a dense, cloudy area that forms in the
lens of the eye.
• A cataract begins when proteins in the eye form
clumps that prevent the lens from sending clear
images to the retina.
• The retina works by converting the light that comes
through the lens into signals. It sends the signals to
the optic nerve, which carries them to the brain.

5. CATARACT

6. RISK FACTORS
• Increasing age (protein break in lens)
• Diabetes
• Excessive exposure to sunlight
• Smoking
• Obesity
• High blood pressure
• Previous eye injury or inflammation
• Previous eye surgery
• Prolonged use of corticosteroid medications
• Drinking excessive amounts of alcohol
• an overproduction of oxidants, which are oxygen molecules
that have been chemically altered due to normal daily life
• ultraviolet radiation
• Trauma
• Nutritional deficiency – vitamin- A, B1, C

7. INCIDENCE
Incidence of Lens opacities in the “normal”
population with aging.
(Cinotti & Patti,1968)
AGE GROUP (YEARS) LENS OPACITY (%)
50 – 59 65
60 – 69 83
70 – 79 91
> 80 100

8. CAUSES
CONGENITAL
AGE
METABOLIC
 Familial
 Intrauterine infections
 Maternal drug ingestions
 Elderly
 Diabetes
 Hypocalcaemia
 Wilson’s Disease
 Galactosemia

9. CAUSES
DRUG - INDUCED
TRAUMATIC AND
INFLAMMATORY
DISEASE
ASSOCIATED
 Corticosteroids
 Miotics
 Amiodarone
 Phenothiazines
 Post intra-ocular surgery
 Uveitis
 Down’s Syndrome
 Dystrophia Myotonica
 Lowe’s Syndrome
 Atopic dermatitis

10. CLASSIFICATION
MORPHOLOGICAL CLASSIFICATION
1. Subcapsular cataract
- Anterior subcapsular cataract
- Posterior subcapsular cataract
2. Nuclear cataract
- Involves the nucleus of lens. Yellow to brown
coloration
3. Cortical cataract
- Wedge shaped or radial spike-like opacities.
4. Polar cataract
- Central posterior part of the lens

11. CLASSIFICATION
MORPHOLOGICAL CLASSIFICATION

12. CLASSIFICATION

13. CLASSIFICATION
HYPERMATURE
Cataract is shrunken
and wrinkled anterior
capsule due to leakage
of water out of the lens
MORGAGNIAN
Cataract is a
hypermature cataract in
which liquefaction of
the cortex has allowed
the nucleus to sink
inferiorly
BASED ON DEGREE OF MATURITY
MATURE IMMATURE
Cataract is one in which
the lens is completely
opaque.
Cataract is one in which
the lens is partially
opaque.

14. MATURE CATARACT

15. MATURE VS IMMATURE
HOW TO DIFFERENTIATE MATURE AND IMMATURE CATARACT?
IMMATURE CATARACT MATURE CATARACT
 Visual acuity is reduced to
counting fingers
 Visual acuity is reduced to hand
movement or perception of light
 Lens is partially opaque  Lens in totally opaque
 Fundus may be visible  No fundus details

16. HYPERMATURE CATARACT

17. MORGAGNIAN CATARACT
 Complete cortex is liquefied and appears milky white in
colour.
 Nucleus settles at the bottom
 Calcium deposits may also be seen on the lens capsule.

18. CLINICAL PRESENTATION
• Painless Clouded, blurred or dim vision
• Increasing difficulty with vision at night
• Sensitivity to light and glare
• Need for brighter light for reading and other activities
• Seeing "halos" around lights
• Frequent changes in eyeglass or contact lens
prescription
• Fading or yellowing of colors
• Double vision in a single eye
• color shift (the aging lens become progressively
more absorbent at the blue end of the spectrum)
• Brunescens (color values shift to yellow-brown)

19. VISUAL ACUITY
Blurred vision due to scattering of light on the retina

20. VISUAL ACUITY

21. VISUAL ACUITY

22. LENS OPACITY
Normal eye – Good
red reflex
Cataractous eye – Poor red
reflex

23. DIAGNOSIS
• History collection of patient
• Physical examination
• Snellen Visual acuity test
• Opthalmoscopy- visualization of eye
• Retinoscopy- Retinal exam

24. MANAGEMENT

25. TREATMENT
The aim of treatment is:
1. Improve vision
2. Increase mobility and independence
3. Relief from the fear of going blind

26. INDICATIONS
1. Work or lifestyle is affected by vision problems
caused by the cataract.
2. Glare caused by bright lights is a problem.
3. Cannot pass a vision test
4. Have double vision.
5. Notice a big difference in vision when you
compare one eye to the other.
6. Have another vision-threatening eye disease, such
as diabetic retinopathy or macular degeneration.

27. TREATMENT
The treatment of cataracts is :
1. Glasses
2. Better lighting
3. Surgery
a. Phacoemulsification
b. ECCE ( Extracapsular Cataract Extraction)
c. ICCE (not performed now)
Sometimes a cataract should be removed even if it doesn't
cause major problems with vision, if it is preventing the
treatment of another eye problem, such as age-related
macular degeneration, diabetic retinopathy or retinal
detachment

28. SURGERY: ECCE
 Extracapsular cataract extraction
 An 5 mm to 6 mm incision is made in the eye where the
clear front covering of the eye (cornea) meets the white
of the eye (sclera).
 Another small incision is made into the front portion of
the lens capsule. The lens is removed, along with any
remaining lens material.
 An IOL may then be placed inside the lens capsule. And
the incision is closed.
*it is usually done if the cataract is too large to be destroyed
by ultrasound

29. SURGERY: ECCE

30. SURGERY: ICCE
 Intracapsular cataract extraction
 Involves extraction of the entire lens, including the
posterior capsule and zonules
 Weak and degenerated zonules are a pre-requisite for this
method
 This is the surgery of choice if there is markedly
subluxated or dislocated lens
 This technique of surgery has largely been replaced by
ECCE

31. COMPLICATIONS
1. Infection in the eye (endophthalmitis).
1. Swelling and fluid in the center of the nerve layer (cystoid
macular edema).
1. Swelling of the clear covering of the eye (corneal edema).
1. Bleeding in the front of the eye (hyphema).
1. Detachment of the nerve layer at the back of the eye (retinal
detachment).

32. ICCE VS ECCE
ECCE ICCE
Small incision 5-6mm Large incision 10-12mm
Posterior lens conserved Removal entire lens
No stiches required, self healing Required stiches, long rehabilitation
time
IOL implant Aphakic eye
Post operative complication minimal Added risk for retinal detachment,
corneal edema and vitreous loss

33. PHARMACOEMULSIFICATION
 Two small incisions are made in the eye where the clear front
covering (cornea) meets the white of the eye (sclera).
 A circular opening is created on the lens surface (capsule)
 A small surgical instrument (phaco probe) is inserted into the
eye.
 Sound waves (ultrasound) are used to break the cataract into
small pieces. Sometimes a laser is used too. The cataract and
lens pieces are removed from the eye using suction.
 An intraocular lens implant (IOL) may then be placed inside
the lens capsule.
 Usually, the incisions seal themselves without stitches.

34. PHARMACOEMULSIFICATION

35. INTRAOCULAR LENS
• Insertion of IOLs during cataract surgery is
the usual approach to lens replacement. After
cataract extraction, or phacoemulsification,
the surgeon implants an IOL.
• IOL implantation is contraindicated in
patients with recurrent uveitis, proliferative
diabetic retinopathy, glaucoma.

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