Disease of lens

Anatomy lens capsule + lens fibe Character transparent avascular avascular nourishment come from aqueous humor nourishment come from aqueous humor Lens

Cataract

General description of cataract Definition When there are changes of aqueous humor component osmotic character of lens capsule osmotic character of lens capsule metabolic disturbance metabolic disturbance caused by various factors caused by various factors lens protein degeneration transparent lens becomes opaque transparent lens becomes opaque called cataract called cataract

According to Cause age-related traumatic complicated Age occurred congenital acquired Site of opacity nuclear cortical capsular subcapsular Shape of opacity punctate coronary lamellar Degree of opacity incipient immature mature hypermature Classification

Clinical findings Progressive blurred vision Contrast sensitivity change Increase in the refractive index Monocular diplopia or polyopia Dazzle Change of color sensation Defect of visual field

Age-related cataract (senile cataract) Clinical findings progressive blurred vision 3 categories cortical cataract nuclear cataract subcapsular cataract

Cortical cataract 4 stages 4 stages  incipient stage  intumescent stage or immature stage  mature stage  hypermature stage

Incipient stage Incipient stage cuneiform opacity in peripheral tip towards to centre pupillary area not affected difficult to find without mydriasis no blurred vision take place

Intumescent stage Intumescent stage uneven milk-white opacity vision decrease obviously fundus difficult to be seen swollen cortex ---push iris forward ---shallow anterior chamber---glaucoma ---shallow anterior chamber---glaucoma be careful to mydriasis

mature stage mature stage  entire lens appear as grey-white opacity  fundus can not to be seen  vision decrease to FC or HM  swollen cortex decrease---normal anterior chamber

Hypermature stage—Morgagni cataract  cortex fibers decomposed  entire lens reduced capsule shrank  nucleus fallen down  anterior chamber become deeper  iridodonesis  vision increase  lens-induced uveitis  Phacolytic glaucoma

nuclear cataract  develop slowly  from embryonic nucleus to adult’s nucleus  grey-yellowish in centre  less affect vision in early stage

Posterior subcapsular cataract Posterior subcapsular cataract  at subcapsular cortex in posterior pole of lens  appear as plate shape  blurred vision take place in early stage

Congenital cataract Etiology Genetic factor autosomal dominant inheritance autosomal dominant inheritance Environmental factor viral infection rubella viral infection rubella nourishment disturbance Vit D nourishment disturbance Vit D

Morphology Morphology  anterior polar cataract  posterior polar cataract  perinuclear or zonular cataract  coronary cataract  total cataract Congenital cataract

Complicated cataract l Induced by ocular inflammation or degenerative disorders l Anterior segment disorder---cortex opaque l Posterior segment disorder---nucleus opaque

Metabolic cataract Metabolic cataract  diabetic cataract  galactose cataract  tetany cataract

Diabetic cataract l Combine with senile cataract l Single diabetic cataract

Tetany cataract l Hypocalcemia l After extraction of parathyroid

Drug-induced or toxic cataract l Glucocorticosteroid cataract l Chlorpromazine cataract l Miotic cataract l Trinitrotoluence cataract l Metal-induced cataract

Traumatic cataract l Contusive cataract l Penetrating cataract l Radiative cataract l Electric cataract

After cataract l After extracapsular cataract extraction or aspiration of lens l Symptom blurred vision l Treatment YAG laser

Dislocated lens l Hereditary lens dislocation l Traumatic lens dislocation partial dislocation completely dislocation

Surgery of cataract Surgery of cataract OccasionExaminationMethod

Surgery procedures Surgery procedures  Intracapsular cataract extraction Extracapsular  cataract extraction + IOL implantation ECCE + IOL ECCE + IOL  Phacoemulsifaction + IOL implantation PHACO + IOL PHACO + IOL

Intracapsular cataract extraction

白内障现代囊外摘 除术 + 人工晶体植入 术 ECCE+IOL

PHACO + IOL

SUMMARY CATARACT

I.Classification of cataract I.Classification of cataract ※ Congenital cataract ※ Senile cataract ※ Traumatic cataract ※ Secondary cataract ※ Complicated cataract

( 一 ) Cortical cataract 1. incipient stage 2. premature stage 3. mature stage 4. hypermature stage ( 二 ) Neuclear cataract

II.Diagnosis of cataract (1) age (1) age (2) gradual decrease of vision (2) gradual decrease of vision (3) lens opacity (3) lens opacity

III. Treatment of cataract operation methods: Intracapsular cataract extraction (ICCE) Extracapsular cataract extraction (ECCE) PhacoemusificationPhacoemusification ECCE+IOL ECCE+IOL

Thank You ！