LENS AND CATARACT Dr.

Ramirez ANATOMY Biconvex Avascular thats why could be removed in surgery Colorless Transparent 4mm thick 9mm in diameter Suspended behind the iris o Zonules Aqueous anteriorly Vitreous posteriorly

FUNCTION Focus light rays upon the retina o Distant object Ciliary muscle relaxes Zonular fibers tautens Reduction of A-P diameter of lens Refractive power of lens is minimized o Near object Ciliary muscle contracts Zonular tension released Capsule molds lens to a more spherical body Greater refractive power ACCOMMODATION Interplay of: o Ciliary body o Zonules o Lens As the lens ages, its accommodative power is greatly reduced PHYSIOLOGY Disorders of the lens o Opacification o Distortion o Dislocation o Geometric anomalies CATARACT Signs and Symptoms 1. Painless progressive blurring of vision 2. Blurring of vision described as cloudiness 3. Monocular diplopia 4. Glare they can see clearly but less light

COMPOSITION 65% water 35% protein (highest protein content of any tissue of the body) Trace minerals o Potassium is more concentrated in the lens than in most tissues o Ascorbic acid, glutathione No pain fibers, blood vessels or nerves LAYERS OF THE LENS

Lens opacity Usually associated with aging Mostly bilateral But rate of progression in each eye is seldom equal Lens edema o Varies directly wit the stage of cataract development Protein alteration Necrosis Disruption of normal continuity of the lens fibers

AGE-RELATED CATARACT Most common type of cataract Blurred vision and visual distortion No medical treatment Cataract surgery is indicated when visual impairment interferes with the patients normal activities If glaucoma secondary to lens swelling (intumescent) occurs, surgery is indicated COMPLICATIONS Glaucoma swollen lens may come in contact with iris (angle closure) Lens-induced uveitis CHILDHOOD CATARACT Congenital o Present at birth or appear shortly thereafter o Uni or bilateral o Dense central congenital cataracts require surgery st Amblyopia if not treated within 1 2 months of life (even if cataract removed) Acquired o Juvenile Cataract o Aimed at preventing amblyopia Surgical treatment Optical correction o Spectacles o Contact lens o IOL TRAUMATIC CATARACT Foreign body injury o BB shot frequent cause o Rocks, iron, overexposure to heat (glassblowers cataract) o X-rays, radioactive materials o Lens becomes white soon after entry of the foreign body CATARACT SECONDARY TO INTRAOCULAR DISEASE (COMPLICATED CATARACT) Chronic recurrent uveitis Glaucoma Retinal detachment Prognosis not good

CATARACT FORMATION Reduction in oxygen uptake Initial increase in water content Dehydration Na and Ca content increased Ka, Ascorbic Acid, Protein content decreased UV Light o Significant factor STAGES OF CATARACT DEVELOPMENT Immature (incipient) o Slightly opaque o Scattered opacities are separated by clear zones Intumescent (swollen) o Water content is maximal and capsule is stretched; more spherical shape Paradoxically, distant vision is blurred but near vision may improve slightly o Second Sight o Artificial myopia greater convexity of the lens in the incipient stage Mature o Completely opaque o Somewhat edematous Hypermature o Water has escaped from the lens o Relatively dehydrated, very opaque lens o Wrinkled capsule

CATARACT ASSOCIATED WITH SYSTEMIC DISEASE Diabetes mellitus most common Hypoparathyroidism Myotonic dystrophy Atopic dermatitis Galactosemia Downs syndrome Marfans Disease DISLOCATED LENS (ECTOPIA LENTIS) Hereditary Lens Dislocation o Coloboma of the lens o Homocystinuria o Marfans syndrome dislocated lens o Marchesanis syndrome Traumatic Lens Dislocation o Following contusion injury o Iridodonesis (quivering of iris) TYPES OF CATARACT SURGERY Intracapsular Cataract Extraction (ICCE) whole lens (anterior, posterior capsule with nucleus) done in traumatic injury where zonules are detached, implant cannot be placed Extracapsular Cataract Extraction (ECCE) with Intraocular Lens Implant (IOL) posterior capsule left intact; wide incision, puncture anterior capsule o remove nucleus, place implant then suture Phacoemulsification (Phaco) with IOL small incision with phacoemulsification machine, suction the lens, less traumatic 2.7 mm Femtosecond Cataract Surgery newer machine, with lens implant after Intraocular Lens Multifocal lens no need for reading glasses AFTER-CATARACT (SECONDARY MEMBRANE) Opacification of posterior capsule o Traumatic cataract o Cataract surgery Persistent subcapsular lens epithelium may attempt regeneration of lens Elschnigs pearls Neodymium YAG laser