During this lecturer, you are going to learn the following: Definition Causes Symptoms & Signs Pathogenesis Stages of senile cataract? DD between immature and mature senile cataract Management of cataract

1. Dr. Abdelmonem Hamed
Fellow of Baylor of College of Medicine, USA
Professor of ophthalmology, Benha University, ARE
LENS
1
‫حامد‬ ‫المنعم‬ ‫عبد‬ ‫اد‬
‫بنها‬ ‫جامعة‬ ، ‫العين‬ ‫وجراحة‬ ‫طب‬ ‫استاذ‬
‫بأمريكا‬ ‫بيلور‬ ‫طب‬ ‫كلية‬ ‫زميل‬

2. During this lecturer, you are going
to learn the following
 Senile cataract:
 Definition
 Causes
 Symptoms & Signs
 Pathogenesis
 Stages of senile cataract?
 DD between immature and mature senile cataract
 Traumatic & complicated cataract
 Ectopia lentis
 Management of cataract

3. 3
SENILE
CATARACT

4. SENILE CATARACT
Definition:
Gradual,
progressive lens opacity,
affecting elderly,
who is not suffering from local or systemic disease.
Bilateral,

5. SENILE CATARACT
Definition:
Gradual,
progressive lens opacity,
affecting elderly,
who is not suffering from local or systemic disease.
Bilateral,

6. SENILE CATARACT
Definition:
Gradual,
progressive lens opacity,
affecting elderly,
who is not suffering from local or systemic disease.
Bilateral,

7. SENILE CATARACT
Definition:
Gradual,
progressive lens opacity,
affecting old age people,
who are not suffering from local or systemic disease.
Bilateral,

8. SENILE CATARACT
Definition:
Gradual,
progressive lens opacity,
affecting old age people,
who are not suffering from local or systemic disease.
Bilateral,

9. SENILE CATARACT
Incidence:
 Age: ˃ 50 years
 Sex: males = females.
 Laterality: It affects
both eyes equally

10. SENILE CATARACT
Incidence:
 Age: ˃ 50 years
 Sex: males = females.
 Laterality: It affects
both eyes equally

11. SENILE CATARACT
Incidence:
 Age: ˃ 50 years
 Sex: males = females.
 Laterality: It affects
both eyes equally

12. Etiology:
 4D
1. Disturbed capsular permeability.
2. Disturbed Ph. around lens
3. Disturbed metabolites ( ↓ vit. C &
glutathione)
4. Disturbed endocrine hormones.
 UV rays Exposure.
SENILE CATARACT
4D & 1U

13. Pathogenesis:
 Change in water content :
 hydration of cortex ;
changes in the permeability of lens capsule
water drops go inside cortex which
becomes opaque.
 sclerosis of nucleus
SENILE CATARACT
i

14. Types:
1. Cortical
2. Nuclear
3. Corticonuclear
SENILE CATARACT

15. Types:
1. Cortical
2. Nuclear
3. Corticonuclear
SENILE CATARACT

16. Types:
1. Cortical
2. Nuclear
3. Corticonuclear
SENILE CATARACT

17. SENILE CATARACT
I. Torchlight
II. Slitlamp
III. Red reflex
Methods of examination:

18. SENILE CATARACT
I. Torchlight
II. Slitlamp
III. Red reflex
Methods of examination:

19. SENILE CATARACT
I. Torchlight
II. Slitlamp
III. Red reflex
Methods of examination:

20. STAGES OF SENILE CORTICAL
CATARACT
1. Immature cataract
 Incipient (sectorial
opacities at the
periphery).
 Intumescent.
Incipient cataract

21. 1. Immature cataract
 Incipient
 Intumescent.
Intumescent cataract
STAGES OF SENILE CORTICAL
CATARACT

22. 2. Mature cataract
(totally opaque)
Mature cataract
STAGES OF SENILE CORTICAL
CATARACT

23. 3. Hypermature cataract
(loses water & shrink)
Hypermature cataract
STAGES OF SENILE CORTICAL
CATARACT

24. Immature cataract
Showing
 Lens is not totally
opaque
 wedge – shaped
opacities appear in the
periphery of the lens

25. Immature cataract
Symptoms:
1. Gradual diminution of vision,
as the visual axis is not involved
‫من‬ ‫كلها‬
‫المريض‬

26. Immature cataract
Symptoms:
2. Uni-ocular diplopia, due to
sectorial change in the
refractive index.
‫من‬ ‫كلها‬
‫المريض‬

27. Immature cataract
Symptoms:
3. Colored halos are seen around
light due to light scattering.
‫من‬ ‫كلها‬
‫المريض‬

28. Immature cataract
Signs:
Oblique illumination:
Iris shadow
Red reflex:
black sectors against
reddish background
‫عن‬ ‫كلها‬
‫الطبيب‬

29. Immature cataract
Signs:
Oblique illumination:
Iris shadow
Red reflex:
black sectors against
reddish background

30. Any Shadow to be formed must have?
Light
Opaque Body
Distance
 Opaque background

31. What is the iris shadow?
 black crescent .Why?
Light
Opaque Body
Distance
Opaque background

32. Intumescent cataract
Hydration of the lens
shallow AC
pupillary block
(phacomorphic
glaucoma )
Pushes iris ant.
1. Swelling of the lens
2. Colored halos

33. Mature cataract
Signs:
 Entire cortex is opaque.
 Vision is hand movement
 Iris shadow is absent.
 R.R. is absent
‫وبالتالى‬

34. Hypermature cataract
1. Entire cortex is opaque vision is HM
R.R. is absent
2. The lens shrink (thick wrinkled capsule +
cholesterol deposition)
1. Iris shadow may be present.
2. Tremulous iris
3. A.C. deep
3. IOP: may be elevated
(Phacolytic glaucoma)
‫وبالتالى‬

35. Hypermature cataract
Complications
 Subluxation or
dislocation of
lens, due to
degeneration of
zonules.

36. Hypermature cataract
Complications
 leakage of lens
protein
 Phacolytic glaucoma,
lens protein is
ingested by the
phagocytes.
Obstruction of angle
of AC
 Phacotoxic uveitis

37. Hypermature cataract
Complications
 Morgagnian
cataract:
liquefaction of
lens matter into a
milky fluid,
nucleus sinks
down by gravity

38. How to differentiate Immature and
Mature Cataract?
IMMATURE CATARACT
1. VA is reduced to
counting finger.
2. Lens is partially opaque
3. Iris shadow is present
4. Fundus may be visible.
MATURE CATARACT
1. VA reduced to HM or PL
2. Lens is totally opaque
3. No iris shadow
4. No fundus details
Prof . Dr. Abdelmonem Hamed
V.S.

39. 1. Immature cataract
 Incipient (sectorial opacities at the
periphery).
 Intumescent.
2. Mature cataract (totally opaque)
3. Hypermature cataract (loses water
& shrink)
STAGES OF SENILE CORTICAL
CATARACT
‫مراجعة‬

40. Senile nuclear cataract
Definition
 Sclerosis of the central nuclear fibers
Etiology
UV
 Formation of brown pigment
 deposition of abnormal lipoproteins.
 reduction in glutathione formation.
 calcium concentration
photo – oxidation of amino acids

41. Senile nuclear cataract
Definition
 Sclerosis of the central nuclear fibers
Etiology
UV
 Formation of brown pigment
 deposition of abnormal lipoproteins.
 reduction in glutathione formation.
 calcium concentration
photo – oxidation of amino acids

42. Senile nuclear cataract
Definition
 Sclerosis of the central nuclear fibers
Etiology
UV
 Formation of brown pigment
 deposition of abnormal lipoproteins.
 reduction in glutathione formation.
 calcium concentration
photo – oxidation of amino acids

43. Senile nuclear cataract
Definition
 Sclerosis of the central nuclear fibers
Etiology
UV
 Formation of brown pigment
 deposition of abnormal lipoproteins.
 reduction in glutathione formation.
 calcium concentration
photo – oxidation of amino acids

44. Incidence:
 > 40 years of age
Clinical grades (1+ to 4+):
 due to deposition of melanin
 pigment derived from amino acids in the lens
 The nucleus becomes yellowish, brown, red &
then black
Black cataract ( )
Senile nuclear cataract

45.  The sclerosis gradually
spreads towards the
cortex, then
extends up to the capsule ,
then the entire lens
functions as a nucleus
(Mature nuclear cataract ).
Senile nuclear cataract
PS. Hypermaturity does not occur as the
process is very slow
i

46. Symptom:
 ↓ VA due to progressive
myopia and central opacity.
Signs:
 Red reflex : hazy to black
 Slit-lamp examination:
nuclear cataract.
Senile nuclear cataract

47. D.D. of painless gradual
diminution of vision
 Cataract
 Chronic open angle glaucoma
 Corneal dystrophy
 Macular degeneration
 Optic atrophy
 Retinopathy associated with systemic disorders
(diabetes)
47
Prof . Dr. Abdelmonem Hamed
‫هام‬

48. Investigations
1. Macular function test with
I. two pin hole test.
If the retina is good, the patient
appreciates the two lights.
II. Projection of light rays.
III. Pupillary reaction
2. Other investigations
I. IOP
II. Fundus examination if possible.
III. Ultrasonography
IV. ERG
Prof . Dr. Abdelmonem Hamed

49. Treatment of cataract
Indication for surgery:
1. ↓ VA
2. Lens induced complications like
 Subluxated or dislocated lens
 phacolytic uveitis / glaucoma,
 phacomorphic glaucoma.
49
Prof . Dr. Abdelmonem Hamed

50. Treatment of cataract
 SurgicalTreatment:
Options
I. Intracapsular lens
extraction (ICCE):
the entire lens
including the
capsule is removed
50
Prof . Dr. Abdelmonem Hamed

51. II. Extracapsular
Cataract Extraction
(ECCE):
Methods :
1. ECCE
2. Phacoemulsification
(ultrasonic vibration)
3. phacolaser (erbium
YAG)
51
Prof . Dr. Abdelmonem Hamed
Treatment of cataract

52. COMPLICATIONS OF CATARACT SURGERY
•Vitreous loss
1. Operative complications
• Posterior loss of lens fragments
• Suprachoroidal haemorrhage
• Iris prolapse
• Striate keratopathy
• Bacterial endophthalmitis
2. Early postoperative complications
3. Late postoperative complications
• Capsular opacification
• Implant displacement
• Corneal decompensation
• Retinal detachment

53. After cataract
After cataract is opacity in papillary area
immediately following cataract operation or
trauma.
It is formed of:
 Parts of anterior and posterior capsule.
 Lens fibers left behind during surgery.
 Proliferation of remaining subcapsular epithelium

54. After cataract
Treatment
 No interference is necessary if the vision is
not affected.
 If the after cataract is thick, surgical
intervention is necessary.
NB: Late opacification of the posterior lens
capsule (PCO) is not an after cataract.

55. Treatment of capsular opacification
YAG laser capsulotomy
55
Prof . Dr. Abdelmonem Hamed

56. APHAKIA
 Absence of the crystalline lens in the papillary
area.
 Causes:
 Congenital: very rare.
 Posterior dislocation.
 Surgical removal.

57. APHAKIA
 Signs:
 Poor vision.
 Black pupil.
 Tremulous iris.
 DeepAC.
 One purkinje- sanson image.
 Scar of cataract surgery in cases of surgical
removal.

58. APHAKIA
 Management:
 Bilateral aphakia: Eyeglasses
 Unilateral aphakia:
 Eyeglasses causes aniso-konia and diplopia.
 IOL implantation.

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