1. Senile cataracts are age-related and affect over 90% of people by age 70. They are usually bilateral but asymmetrical. 2. There are three main types of senile cataract - cortical, nuclear, and mixed. Cortical cataracts present as wedge-shaped opacities while nuclear cataracts cause hardening of the lens. 3. Risk factors include age, heredity, UV exposure, diet, dehydration, and smoking. Surgery involves removing the opaque lens and replacing it with an intraocular lens, with various techniques available.

1. DISEASES OF LENS

2. Senile cataract
• ‘Age-related cataract’
• Opacification is mainly due to degeneration of
the already formed normal fibres
• By the age of 70 years, over 90% of the
individuals develop senile cataract
• Usually bilateral, but almost always
asymmetrical

3. Morphological types of senile cataract
1. Cortical senile cataract (soft cataract)
• Cuneiform (M/C)
• Cupuliform-posterior subcapsular (PSC)
2. Nuclear cataract (Hard cataract)
3. Mixed cortical and nuclear
Commonly both types co-exist in same eye

4. Risk factors
I . Age- usually seen >50 yrs if occurs < 45 years of age it is called pre-senile
cataract
2. Sex – affects both sexes, but prevalence is greater in females than males
at all ages
3. Heredity-role in onset and maturation
4. Ultraviolet irradiations
5. Dietary factors - Diet deficient in certain proteins, amino acids, vitamins
(riboflavin, vitamin A, C and E)
6. Dehydrational crisis -due to diarrhoea, cholera, etc
7. Smoking - Accumulation of pigmented molecules-3-hydroxykynurenine
and chromophores, which lead to yellowing

5. Causes of pre-senile cataract
l. Heredity
2. Diabetes mellitus –nuclear cataract is more common
and progess rapidly
3. Myotonic dystrophy -posterior subcapsular type of
pre-senile cataract ,Christmas tree cataract
4. Atopic dermatitis - Atopic cataract

6. Mechanism of loss of transparency
I. Cortical senile cataract

7. 2.)Nuclear senile cataract
• Etio-pathogenesis: - Intensification of age
related degenerative changes associated
with dehydration & compaction of nucleus
• Features: -
• Hard cataract is formed
• Significant increase in water insoluble protein
• Lens become in elastic & looses power of
accomodation
• Changes begin centrally and slowly spreads
to periphery
• Deposition of pigments gives characteristic
colour to nucleus

8. Stages of Maturation
a)Cortical type
1. Stage of lamellar separation
-Earliest change is demarcation of cortical fibres owing to separation
by fluid
Demostrated by slit-lamp examination only
- changes are reversible
- Characteristic symptom-coloured halos / grey appearance of pupil

9. • 2. Stage of incipient cataract
-Early detectable opacities with clear areas
in b/w them
-onley seen in dilated pupil
-characteristic symptom-polyopia

10. Cuneiform senile cortical cataract Cupuliform senile cortical cataract
Wedge shaped opacities with clear
areas b/w them
Saucer shaped opacity just below the
capsule
Extends from equator towards centre Gradually extends outwards
Opacities present in both anterior &
posterior cortex
Clear demarcation b/w cataract &
surrounding clear cortex
Visual disturbances seen at late stages Causes early loss of v/a

11. 3. Immature senile cataract - (ISC)
• Opacification becomes more diffuse and
irregular
• Lens - Greyish white
• Cortex - Clear
• Iris shadow – visible
• Intumuscent cataract may develop in
some and may even persist in next stage
of maturation

12. 4.Mature senile cataract (MSC)
• Opacification - complete cortex is involved
• Lens - pearly white
• Iris shadow is absent
• DDO- no fundal glow
• Also labelled as RIPE CATARACT

13. • 5.)Hypermature senile cataract (HMSC)
Morgangian type HMSC Sclerotic type HMSC
Cortex is liquified and lens is
converted into milky fluid
Cortex become disintegrated and
lens become shrunken
Calcium deposits may be seen on
lens capsule
AC become deep and iris becomes
tremulous (iridodonesis)

15. B.)Maturation of nuclear senile cataract
• In it ,sclerotic process renders the lens
inelastic and hard, decreases its ability to
accommodate and obstructs the light rays
• These changes begin centrally and spread
slowly peripherally almost upto the capsule
when it becomes mature

16. Grade of hardness Description of hardness Colour of nucleus
Grade 1 soft White or greenish yellow
Grade 2 Soft-medium yellowish
Grade 3 Medium-hard amber
Grade 4 hard brownish
Grade 5 Ultrahard black

17. A-cataracta brunescens
B-cataracta nigra
C-cataracta rubra

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

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

22. D/D-IMSC V/S NS

23. D/D-MSC V/S LEUCOCORIA

24. Complications
1.) Phacoanaphylactic uveitis
2. )Lens-induced glaucoma
i. Phacomorphic glaucoma - by intumescent (swollen and
cataractous) lens. Type of secondary angle closure
glaucoma
ii. Phacolytic glaucoma-Lens proteins are leaked into the
anterior chamber in cases With Morgagnian hypermature
cataract
iii. Phacotopic glaucoma-Hypermature cataractous lens
may subluxate/dislocate and cause glaucoma by blocking
the pupil or angle of AC
3.) Subluxation or dislocation of lens-d/t degeneration of
zonules in hypermature stage

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

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

27. 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.

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

30. Intraocular Lenses
Types
• Anterior chamber IOL
• Iris supported lens
• Posterior chamber IOL
• Rigid
• Foldable
Calculation of IOL power
• SRK formula
• IOL power- A-0.9k – 2.5L
(A-constant ,K-keratometry , L-axial length

31. Thank you