Cataract,Types, clinical features Pathogenesis, Surgery, Complications.

1. CATARACT
Dr.sharada, Shri Babu Singh Daddu ji Ayurveda medical college and
Hospital, Farurukhabad.

2. B. Morphological classification
1. Capsular cataract. It involves the capsule and may be:
i. Anterior capsular cataract
ii. Posterior capsular cataract
2. Subcapsular cataract. It involves the superficial part of the cortex (just below the
capsule) and includes:
i. Anterior subcapsular cataract
ii. Posterior subcapsular cataract
3. Cortical cataract. It involves the major part of the cortex.
4. Supranuclear cataract. It involves only the deeper parts of cortex (just outside the
nucleus).
5. Nuclear cataract. It involves the nucleus of the crystalline lens.
6. Polar cataract. It involves the capsule and superficial part of the cortex in the polar
region only and may be:
i. Anterior polar cataract
ii. Posterior polar cataract

3. DEFINITION
• Development of an opacity in the lens is known as cataract
• Classification
A. Etiological classification
• I. Congenital and developmental cataract
• II. Acquired cataract
1. Senile cataract
2. Traumatic cataract
3. Complicated cataract
4. Metabolic cataract
5. Electric cataract
6. Radiational cataract.

6. CONGENITAL AND DEVELOPMENTAL
CATARACTS
• CONGENITAL :
• When the disturbance occurs before birth, the child is born with a
congenital cataract. (opacity is limited to either embryonic or foetal
nucleus.)
• Developmental cataract :
• may occur from infancy to adolescence.(infantile or adult nucleus,
deeper parts of cortex or capsule)

7. ETIOLOGY
I. Heredity.
II. Maternal factors
1. Malnutrition during pregnancy
2. Infections. Maternal infections like rubella are associated with cataract in
50 percent of cases.
III. Fetal or infantile factors
1. Deficient oxygenation (anoxia) owing to placental haemorrhage.
2. Metabolic disorders of the foetus or infant such as galactosemia,

8. CLINICAL TYPES CONGENITAL AND
DEVELOPMENTAL CATARACTS
I. Congenital capsular cataracts
1. Anterior capsular cataract
2. Posterior capsular cataract
II. Polar cataracts
1. Anterior polar cataract
2. Posterior polar cataract
III. Nuclear cataract
1. Cataracta centralis pulverulenta
2. Total nuclear cataract.
iV. Generalized cataracts
1. Coronary cataract
2. Blue dot cataract.
3. Total congenital cataract.

9. I. Congenital capsular cataracts
1. Anterior capsular cataracts are visually insignificant.
2. Posterior capsular cataracts are rare
II. Polar cataracts
1. Anterior polar cataract.
It involves the central part of the anterior capsule and the adjoining
superficial-most cortex
2. Posterior polar cataract.
It is a very common lens anomaly and consists of a small circular
circumscribed opacity involving the posterior pole.

10. III. Nuclear cataracts
i. Cataracta centralis pulverulenta (Embryonic nuclear cataract).
• It has dominant genetic trait and occurs due to inhibition of the lens
development at a very early stage and thus, involves the embryonic nucleus.
• The condition is bilateral and is characterised by a small rounded opacity lying
exactly in the centre of the lens.
• The opacity has a powdery appearance (pulverulenta)
ii. Total nuclear cataract.
• It usually involves the embryonic and fetal nucleus and sometimes infantile
nucleus as well.
• It is characterized by a dense chalky white central opacity seriously impairing
vision.
• The opacities are usually bilateral

12. GENERALIZED
CATARACTS
1. Coronary cataract
• involving either the adolescent nucleus
or deeper layer of the cortex.
• the opacities are situated peripherally,
vision is usually unaffected.

13. 2. Blue dot cataract.
• It is also called cataractapunctata-caerulea.
• opacities are in the form of rounded bluish dots situated in the peripheral
part of adolescent nucleus and deeper layer of the cortex.
3. Total congenital cataract.
• The child is born with a dense white nuclear cataract.
• It is a progressive type of cataract.

15. DIFFERENTIAL DIAGNOSIS
• Leukocoria need to be differentiated from various other
conditions presenting with leukocoria such as
• Retinoblastoma,
• Retinopathy of prematurity,

16. ACQUIRED CATARACT
SENILE CATARACT
• Called as ‘age-related cataract’
• commonest type
• The condition is usually bilateral
Etiology
1. Heredity.
2. Ultraviolet irradiations
3. Dietary factors.
4. Dehydrational crisis
5. Smoking

17. MECHANISM OF LOSS OF
TRANSPARENCY
• With increasing age
Decrease in function of active
transport pump mechanism of
lens
Reduced
oxidative
stress
Reversal of NA , K ratio Decreased level of
aminio acids
Hydration of
lens fibres
Decreased synthesis of
protein in lens fibres
Denaturation of lens proteins, opacification of lens fibres

18. • Stages of maturation
Stage of
lamellar
separation
Stage of
incipient
catarct
Immature
catarat
Mature
cataract
Hypermature
cataract

19. • Demarcation of cortical fibres owing to their separation by fluid(stage of
lamellar separation)
Opacity starts at periphery and extends centrally, visual disturbences in later
stages(stage of incipient ,cuneiniform cataract);;
Opacification further progress, becomes more diffuse and irregular; lens appears
– greyish white( Stage of IMC)
Opacification becomes complete, lens appears – pearly white.( mature
cataract/ripe)
Mature cataract left in situ
Hypermature cataract( lens- milky white)

21. CLINICAL FEATURES OF
CATARACT
•Glare
•Coloured halos
• back spots
•Blurring of visison
•Deteriotion of visison
•Pain less progressive vision loss
•Frequent cshnage of glasses

22. SIGNS OF CATARCT
examination immature mature Hypermature
Viasual acuity 6/9- CF + HM TO PL + PL+
COLOR OF LENS
DIATANT DIRECT
ophthalmoscope
GrEYISH white
Multiple dark areas
against red fundal glow
Pearly white
No red glow
Milky white
No red glow

23. NON SURGICAL MANAGEMENT OF
CATARACT
• Adequate control of diabetes mellitus, when discovered.
• Removal of cataractogenic drugs such as corticosteroids.
• Removal of irradiation (infrared or X-rays) may also delay
or prevent cataract formation.
•Early and adequate treatment of ocular diseases like uveitis
may prevent occurrence of complicated cataract.

24. SURGICAL MANAGEMENT
I. General medical examination of the patient to exclude the presence of serious
systemic diseases especially: diabetes mellitus; hypertension and cardiac problems;
obstructive lung disorders and any potential source of infection in the body such as
septic gums, urinary tract infection etc.
II. Ocular examination.
• Visula acuity
• pupils –RAPD
• cornea- note about any scarring,KPs
• IOP
• Fundus examination
• Examination sac , conjunvtiva

25. MANUAL SMALL INCISION
CATARACT SURGERY(SICS)
• anaesthesia
• Conjuctival flap and exposure of sclera by sharp scissors along the limbus
• Haemostasis by cautery
• Sclerocornealn tunnel incision with the cresent knife
• Side port entry corneal incision is made at 9 o clock position
• Anterior capsulotomy is done
• hydrodessiection

26. • Prolapse of nucleus(cataract) is completed
• Removal of nucleus (cataract) is done
• Aspirate the remaining cortex material by side port entry
• IOL implantion
• Injecting of RL through side port entry
• Wound closure

27. POST OP INSTRUCTION
• Not to rub the eye
• Exposure of eye to dust , smoke
• Use protective goggles
• No head bath for two wks
• Use of prescribed eye drops
• To report immediately if patient notice redness, oain , reduced
vision

28. • Complications
Preoperative operative Post op
Anxiety
Nausea
Gastritis
SRM – laceration
Ex.bleding
Irregualr incision
Hyphema
Iris prolapse
Ant.uveitis
Bactrerial
endophthalmitis
Cornael abrasion during
anaesthesia
Perforation of globe
during anaesthesia
Injury to cornea , lens
Vitreous loss
Nucleus drop