Lens Disease China Medical University NO.4 Affiliated hospital Ophthalmology; Ophthalmology hospital of China Medical University

Introduction Lens disease: –Change of transparency cataract –Position and morphological abnormality dislocation malformation

Basic knowledge

Anatomy Equator Anterior capsule Posterior capsule Diameter:9-10mm Thickness:4-5mm Lens zonule

Anatomy Capsule: integrity—maintain transparency Lens epi. — PCO Lens substance: lens fiber –Nucleus –Cortex

Function Refraction Accommodation Protection: UV filtration What is accommodation? –The capability that eyes change refractive condition in order to acquire clear near sight. !

What is cataract? Turbidity of lens WHO: turbidity of lens + VA<0.5

What is cataract?

Case: turbid lens, but VA=0.8

Cataract Cataract is the No. 1 eye disease that causing blind. 46% blindness is caused by cataract !

Etiology Any factors that change the intraocular environment to affect lens metabolism. –Such as: ageing, mechanical, chemical, operation, inflammation, metabolic Malformation Congenital factors

Risk factors UV Diarrhea Malnutrition Diabetes Smoking Drinking alcohol

Classification On etiology: –Congenital –Senile –Complicated –Metabolic –Drug induced or toxic –Traumatic –After cataract

Classification On location: –Cortical –Nuclear –Subcapsular On degree: –Immature –Intumescent –Mature –Hypermature

Pathogenesis The common route that causing cataract is the oxidation injury by peroxide free radical. Apoptosis—hot spot of research !

Clinical manifestations Symptoms: –Progressive vision decrease –Contrast sensitivity decrease –Refraction changes –Diplopia –Glare –Change of color sensation –Visual field defect

Functionality vision contrast test Positive wave contrast test CSF curve contrast test

Color vision excursion glare visual field loss Vision abnormity

Clinical manifestations Signs: Turbidity of lens

Senile Cataract Now called Age-related Cataract Most commonly seen >50 yrs old >80 yrs old→100% Degenerative changes

Classification Cortical Nuclear Subcapsular

Cortical cataract 4 stages Incipient stage: wedge turbidity

Cortical cataract 4 stages Intumescent stage (immature): iris projection Induce acute angle- closure glaucoma

Cortical cataract 4 stages Mature stage

Cortical cataract 4 stages –Hypermature stage: Morgagni cataract Phacoanaphylactic uveitis Phacolytic glaucoma

Nuclear cataract

Subcapsular cataract Affecting vision early

Congenital cataract Etiology: –Hereditary –Environmental: Virus infection Malnutrition Radiation Drug Systemic disease V D deficiency

Congenital cataract Morphology

Congenital cataract Treatment –observation –Early operation –Amblyopia Treatment

Complicated cataract Caused by other eye diseases –Corneal ulcer –Glaucoma –Uveitis –Retinal detachment –Retinitis pigmentosa –Intraocular tumor –myopia

Old anterior uveitis Complicated cataract glaucoma Complicated cataract （ vogt spot ） Pigmentosa eyeSilicon oil eye Kinds of Complicated cataract

Metabolic cataract Caused by systemic metabolic diseases –Diabetic cataract –Galactosemia cataract –Hand-foot-twitch cataract

Drug induced or toxic cataract Glucocorticosteroid cataract Chlorpromazine cataract Miotic cataract TNT cataract Metal: copper, iron, mercury, silver, zinc

Traumatic cataract Contusive Penetrating Radiative Electric

After cataract Now usually called PCO (posterior capsular opacification) Adult: 30-50% Child: 100% Pathogenesis: Proliferation, migration & metaplasia of lens epi. !

Treatment Drug? NO USE Operation: the only effective therapy –ICCE (intracapsular cataract extraction) –ECCE (extracapsular cataract extraction) –PEA (phacoemulsification) !

ICCEECCE ICCE And ECCE

Treatment IOL (intraocular lens) implantation –AC and PC –Hard and foldable

Treatment IOL (intraocular lens) implantation

Treatment PEA & F-IOL

PEA & F-IOL ( video )

Treatment Correction of aphakia: –Frame glasses –Contact lens –IOL –Laser

Lens Dislocation Etiology: –Congenital –Marfan syndrome –Traumatic –Spontaneous

Clinical Manifestations Subluxation Dislocation

Clinical Manifestations Complications: –Uveitis –Secondary glaucoma –Retinal detachment –Corneal turbidity

Trends Photolysis of cataract Injective IOL Accommodative IOL