Cataract

Cataract
Opacity of the lens
Symptoms
Clouded, blurred or dim vision
Increasing difficulty with vision at night
Sensitivity to light and glare
Frequent changes in eyeglass or contact lens
prescription
Fading or yellowing of colors
Double vision in a single eye
Second sight
 Epidemiology
In 2002, the WHO estimated that cataracts
caused reversible blindness in more than 17
million (47.8%) of the 37 million blind
individuals worldwide
This number is projected to reach 40 million
by 2020
 Pathology
Aging ChangesAs the lens ages, it increases in weight and
thickness and decreases in accommodative power
As new layers of cortical fibers are formed concentrically, the lens
nucleus undergoes compression and hardening (nuclear sclerosis).
Chemical modification and proteolytic cleavage of crystallins (lens
proteins) result in the formation of high-molecular-weight protein
aggregates scattering light and reducing transparency
Chemical modification of lens nuclear proteins also increases
pigmentation.
Decreased concentrations of glutathione and potassium and
increased concentrations of sodium and calcium in the lens cell
cytoplasm.
 There are 3 main types of age-related
cataracts based on morphology
Nuclear
Cortical
Posterior subcapsular.
Nuclear cataract
Cortical cataract
Posterior capsule cataract
 There are 3 main types of age-related
cataracts based on maturity
Immature
Mature
Hyper mature
Morgagnian
Classification according to maturity

Immature Mature

Hypermature Morgagnian
Mature cataract
Hyper mature cataract
Morgagnian cataract
 Cataract based on Age
Congenital cataract
Juvenile cataract
Senile cataract
 Drug-Induced Lens Changes
Corticosteroids
Phenothiazines
Miotics
Amiodarone
Statin
 Traumatic cataract
 Perforating and penetrating injury
 Metabolic cataract
Diabetic Mellitus
Galactosemia
Wilson disease
Myotonic dystrophy
Hypocalsemia
 Extracapsular cataract extraction
1. Anterior 2. Completion of
capsulotomy incision

3. Expression of 4. Cortical cleanup

nucleus

5. Care not to aspirate

posterior capsule 6. Polishing of posterior
accidentally capsule, if appropriate
 Extracapsular cataract extraction ( cont. )

7. Injection of 8. Grasping of IOL and

viscoelastic coating with viscoelastic
substance substance

9. Insertion of inferior 10. Insertion of superior

haptic and optic haptic

11. Placement of haptics

into capsular bag
and not into ciliary 12. Dialling of IOL into
sulcus horizontal position
 Phacoemulsification
1. Capsulorrhexis 2. Hydrodissection

3. Sculpting of nucleus 4. Cracking of nucleus

5. Emulsification of 6. Cortical cleanup and

each quadrant insertion of IOL
COMPLICATIONS OF CATARACT SURGERY
1. Operative complications
Vitreous loss
Posterior loss of lens fragments
Suprachoroidal (expulsive) haemorrhage
2. Early postoperative complications
Iris prolapse
Striate keratopathy
Acute bacterial endophthalmitis
3. Late postoperative complications
Capsular opacification
Implant displacement
Corneal decompensation
Retinal detachment
Chronic bacterial endophthalmitis
Early postoperative complications
Iris prolapse
Cause
Usually inadequate
suturing of incision
Most frequently follows
inappropriate management
of vitreous loss

Treatment
Excise prolapsed iris tissue

Resuture incision
 Striate keratopathy
Corneal oedema and folds in Descemet membrane

Cause
Damage to
endothelium
during surgery

Treatment
Most cases resolve
within a few days

Occasionally persistent
cases may require
penetrating
keratoplasty
Acute bacterial endophthalmitis
Incidence - about 1:1,000

Common causative
organisms
Staph. epidermidis
Staph. aureus
Pseudomonas sp.

Source of infection

Patients own external

bacterial flora is most
frequent culprit
Contaminated solutions
and instruments
Environmental flora including
that of surgeon and
operating room personnel
 Signs of severe endophthalmitis

Pain and marked visual loss Absent or poor red reflex

Corneal haze, fibrinous exudate and Inability to visualize fundus with
hypopyon indirect ophthalmoscope
 Late complication: PCO
Elschnig pearls Fibrosis

Proliferation of lens epithelium Usually occurs within 2-6 months

Occurs after 3-5 years May involve remnants of anterior
capsule and cause phimosis
 Implant displacement
Decentration Optic capture

May occur if one haptic is inserted Reposition may be necessary

into sulcus and other into bag
Remove and replace if severe