This document discusses pathology of the lens and glaucoma. It begins with the anatomy of the crystalline lens, then discusses various pathologies that can affect the size, shape and position of the lens. These include coloboma, lenticonus, microphakia, and dislocation. It also covers different types of cataracts like anterior polar, posterior polar, and zonular cataracts. Next, it discusses glaucoma, including the classification of primary and secondary glaucoma, examinations used for diagnosis, and treatments like medications, laser surgery and other surgical procedures like trabeculectomy. In summary, it provides an overview of common lens pathologies, classifications of cataract types, and examinations and

1. THEMETHEME::
Pathology of thePathology of the
lens.lens.
GlaucomaGlaucoma..

2. Anatomy of crystalline lensAnatomy of crystalline lens
 Anterior poleAnterior pole
 Posterior polePosterior pole
 EquatorEquator

3. Pathology of the lensPathology of the lens
 1.1. Pathology of the size and shapePathology of the size and shape::
 -- lens colobomalens coloboma
 -- lenticonuslenticonus
 -- microphakiamicrophakia
 -- sherophakiasherophakia
 2.2. Pathology of the positionPathology of the position ((dislocationdislocation):):
 -- subluxationsubluxation
 -- luxationluxation
 а)а) into the anterior chamberinto the anterior chamber
 б)б) in the vitreous bodyin the vitreous body

4. Lens colobomaLens coloboma

5. SponsoredSponsored
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6. Anterior lenticonusAnterior lenticonus

7. Marfan’s syndromeMarfan’s syndrome
Mental retardation, excessive height, genu valgum,
kyphoscoliosis, pectus excavatum.
In 90% of patients, the lens is dislocated or subluxed,
inferiorly or inferonasally.

8. Weill-Marchesani syndromeWeill-Marchesani syndrome
 Weill-MarchesaniWeill-Marchesani
syndrome, ansyndrome, an
autosomalautosomal
recessive disorderrecessive disorder
of short stature,of short stature,
short, stubbyshort, stubby
fingers, andfingers, and
microspherophakiamicrospherophakia

9. Subluxation of the lensSubluxation of the lens
 Luxation (ectopia) of theLuxation (ectopia) of the
lenslens::
 -- to anterior chamberto anterior chamber
 -- to vitreous bodyto vitreous body

10. Classification of the cataractClassification of the cataract
Congenital Acquired
1. Anterior polar
2. Posterior polar
3. Zonular (lamellar)
4. Total (complete)
Primary Secondary
Simple Compli-
cated
Occurs after extracapsular
cataract extraction, in case of
Elschnig's cells remain
1.Traumatic
2. Age-related (senile)
А) Types
- Cortical (grey)
- Nuclear (brunescent)
Б) Stages
1) primary
2) immature
- swollen
- immature
-premature
3) mature
4) hyper mature
- Lens calcification
- Morgagnian
1. Associated with ocular pathology:
1) myopic
2) uveal
3) glaucomatous
4) neoplastic
5) ablational
2. Not associated with ocular pathology:
1) myotonic
2) tetany
3) radiation exposure
4) hyperthermia
5) toxic
6) diabetic

11. Congenital anterior polar cataractCongenital anterior polar cataract

12. Posterior polar cataractPosterior polar cataract

13. Congenital zonular cataractCongenital zonular cataract

14. Congenital nuclear cataractCongenital nuclear cataract

15. Traumatic stellate cataractTraumatic stellate cataract

16. True complicated diabetic cataractTrue complicated diabetic cataract

17. Polar cataractPolar cataract

18. Nuclear cataractNuclear cataract

19. Age-related initial cataractAge-related initial cataract

20. ““Lens starLens star”” symptomsymptom

21. Age-related premature cataractAge-related premature cataract

22. Age-related mature cataractAge-related mature cataract

23. Mature intumescent (swollen) cataractMature intumescent (swollen) cataract

24. Age-related hypermature cataractAge-related hypermature cataract

25. Cataract treatmentCataract treatment
І.І. ConservativeConservative ((initialinitial,, immature stageimmature stage):):
-- QuinaxQuinax;;
-- Ophthan-catachromOphthan-catachrom;;
-- VitaVita--ioduroliodurol;;
-- SenSen--catalincatalin

26. Cataract treatmentCataract treatment
ІІ.ІІ. SurgicalSurgical::
1.1. Intracapsular cataract extractionIntracapsular cataract extraction -- may lead to the vitreousmay lead to the vitreous
herniahernia;;
2.2. Extracapsular cataract extractionExtracapsular cataract extraction
-- secondary cataractsecondary cataract;;
-- aphakiaaphakia ((absence of the lens)absence of the lens);;
А)А) Signs of aphakiaSigns of aphakia::
1.1. Deep anterior chamberDeep anterior chamber;;
2.2. IridodenesisIridodenesis;;
3.3. Absence of theAbsence of the ІІІІ andand ІІІІІІ Purkinje imagesPurkinje images;;
4.4. High grade hypermetropia.High grade hypermetropia.
Б)Б) CorrectionCorrection::
11.. SpectaclesSpectacles (+10,0(+10,0DD
- +11,0- +11,0DD
));;
2.2. Contact lensesContact lenses;;
3.3. Intraocular lensIntraocular lens ((IOLIOL) –) – pseudophakiapseudophakia (+21,0(+21,0DD
- +- +2424,0,0DD
));;
-- Anterior chamber fixationAnterior chamber fixation;;
-- Posterior chamber fixationPosterior chamber fixation..

27. Intraocular lensesIntraocular lenses

28. Phakoemulsification of the cataractPhakoemulsification of the cataract,,
IOL implantationIOL implantation

31. Anterior chamber angleAnterior chamber angle

32. Ways of intraocular humor outflowWays of intraocular humor outflow
 AnteriorAnterior –– throughthrough
the anterior chamberthe anterior chamber
angleangle
 MediumMedium –– throughthrough
the suprachoroidthe suprachoroid
spasespase
 PosteriorPosterior–– throughthrough
the perineural andthe perineural and
perivascular spaces ofperivascular spaces of
the optic nervethe optic nerve

33. Classification of glaucoma
І Primary
1. By anterior chamber angle shape:
- Open-angle;
- Angle-closure;
- Combined-angle;
2. By the stage (Vis, visual fields, optic nerve)
- initial;
- developed;
- advanced (deep);
- terminal;
3. By compensation of IOP (IOP level, daily fluctuations)
- a – normal IOP (<26 mm Hg), ↕ 5 mm (normal tension glaucoma);
- b – moderately increased IOP (27-32 mm Hg), ↕ 10 mm;
- с – high IOP (>35 mm Hg), ↕>10 mm;
- d – acute glaucoma attack.
4. By visual functions stability:
- stabile;
- unstable;

34. Classification of glaucoma
3. After thrombosis
4. Neoplastic
5. Degenerative
- pigmentary;
- exfoliative;
- diabetic;
- aterosclerotic.
ІІ Secondary
1. Uveal:
- Posterior synechiae;
- goniosynechiae ;
- Seclusio pupillae;
- Occlusio pupillae;
2. Lens-induced
(phakogenous):
- phakotopic
а) lens luxation;
б) lens subluxation;
- Phakomorphic:
а) swollen cataract;
- Phakolytic
а) hypermature
(Morgagnian)
cataract;

35.  Subjective
(palpation)
Tp – N
Tp +1+2+3
Tp -1-2-3
 ObjectiveObjective
((instrumentalinstrumental):):
Indentation tonometers --
(Schiøtz)
Applanation tonometers
-- Fick-Lifcshitz tonometerFick-Lifcshitz tonometer
-- Maklakoff tonometertonometer
-- Goldmann tonometerGoldmann tonometer
Noncontact tonometersNoncontact tonometers
Normal IOP rate 16-26 (27) mm Hg
Measuring methods:

36. Maklakoff’s tonometrytonometry Goldman's tonometryGoldman's tonometry

37. Schiøtz tonometry Tonopen Pneumotonometry

38. Examinations for glaucoma diagnosticsExaminations for glaucoma diagnostics
- Visometry ;
- Ophthalmoscopy;
- iris and pupil biomicroscopy ;
- perimetry;
- campimetry;
- electric phosphenes diagnostics;
- elastotonometry;
- daily tonometry:
* Mах IOP level;
* daily fluctuations (<5 mm Hg in norm);
- gonioscopy;
- Nesterov’s tonography:
* Р0= 15-17 mm Hg (true IOP);
* С - 0,3-0,6 (facility of outflow coefficient)
* F - 2,5-4,5 (volume of IOH production per minute)
* Bakker coefficient (<100% in norm)

39. GonioscopyGonioscopy

40. Development of glaucomatous ON cuppingDevelopment of glaucomatous ON cupping

41. Optic nerve discOptic nerve disc
In normIn norm In glaucomaIn glaucoma

42. ExfoliationsExfoliations

43. Humphrey perimetryHumphrey perimetry:: dynamics of visual fields
effect at glaucoma

44. Progression of a glaucomatous field defects

45. Congenital glaucoma. Buphthalmos,Congenital glaucoma. Buphthalmos,
megalocorneamegalocornea

46. Primary congenital glaucoma. BuphthalmosPrimary congenital glaucoma. Buphthalmos
and corneal clouding.and corneal clouding.

47. Clinics of primaryClinics of primary
open-angleopen-angle
glaucomaglaucoma
Stages:Stages:
- initialinitial;;
- developeddeveloped;;
- advancedadvanced ((deepdeep););
- terminalterminal

48. Clinics of close-angle glaucomaClinics of close-angle glaucoma
 Anterior chamber angle is narrow or closedAnterior chamber angle is narrow or closed;;
 Initially is characterized by microattacsInitially is characterized by microattacs
((cloudiness of visioncloudiness of vision,, rainbow halos around ofrainbow halos around of
light sourcelight source,, headacheheadache))
 ObjectivelyObjectively:: congestive injection of conjunctivacongestive injection of conjunctiva,,
edemaedema,, roughness of cornearoughness of cornea,, shallow anteriorshallow anterior
chamberchamber,, pupil is dilated ovallypupil is dilated ovally,, poor lightpoor light
reactionreaction
 OphthalmoscopyOphthalmoscopy–– optic nerve edemaoptic nerve edema
 TonometryTonometry –– IOP raise overIOP raise over 4040 mm Hgmm Hg

50. Conservative glaucoma treatmentConservative glaucoma treatment
1.1. M-cholinomimeticsM-cholinomimetics ((trabecular meshwork outflowtrabecular meshwork outflow
increaseincrease):):
-- PilocarpinePilocarpine 1%;1%;
-- CarbacholineCarbacholine 0,75%;0,75%;
2.2. ββ--blockersblockers ((IOH production decreaseIOH production decrease):):
-- TimololTimolol 0,25%, 0,5%;0,25%, 0,5%;
-- BetopticBetoptic 0,25%, 0,5%;0,25%, 0,5%;
3.3. ProstaglandinesProstaglandines ((uveo-scleral outflow increaseuveo-scleral outflow increase):):
-- XalatanXalatan;;
-- TravatanTravatan;;
4.4. Carbonic anhydrase inhibitorsCarbonic anhydrase inhibitors ((IOH productionIOH production
decreasedecrease):):
- -- AzoptAzopt
- -- TrusoptTrusopt

51. Acute glaucoma attack treatmentAcute glaucoma attack treatment
-- Pilocarpine hydrochloride 2-4Pilocarpine hydrochloride 2-4%:%:
1-1-stst hourhour–– everyevery1515’’
2-2-ndnd hourhour–– everyevery 3030’’
furtherfurther –– every hourevery hour
TimololTimolol 0,5% - 20,5% - 2tt//dayday;;
- Oral osmotic agentsOral osmotic agents;;
- Carbonic anhydrase inhibitorsCarbonic anhydrase inhibitors ::
** Acetazolamide 250 mg orallyAcetazolamide 250 mg orally
** Azopt, trusopt -eyedropsAzopt, trusopt -eyedrops;;
** furosemidefurosemide,, lasixlasix;;
- Retrobulber injectionRetrobulber injection::
* Sol. Novocaini 2% - 2,0* Sol. Novocaini 2% - 2,0;;
- SedativesSedatives ((tazepamtazepam););
- AtAt ↑↑blood pressureblood pressure –– hypotensiveshypotensives..
- peripheral iridotomyperipheral iridotomy

52. Laser glaucoma surgeryLaser glaucoma surgery
 Laser iridotomyLaser iridotomy

53. Laser glaucoma surgeryLaser glaucoma surgery
 cyclophotocoagulationcyclophotocoagulation

54. Laser glaucoma surgeryLaser glaucoma surgery
 Laser trabeculoplastyLaser trabeculoplasty

55. Glaucoma surgeryGlaucoma surgery
 trabeculectomytrabeculectomy,, trabeculotomytrabeculotomy

56. Thank youThank you for yourfor your
attention!attention!