1. Cataract
By dr. Omar S. Mahmood
M.B.CH.B F.I.C.M.S ( Opht.)
9/21/2018

2. The crystalline lens
Anatomy of the lens The crystalline lens is a biconvex, avascular transparent structure enclosed by a capsule. The lens consists of: 1- Nucleus: 2- Cortex: 3- The capsule: What is zonules? What is "Accommodation"

5. Ciliary muscle
Innervation: 3rd CN
Function ?
Ciliary process
Attaches to the lens by suspensory ligament (zonular fibers)
Secrete the Aqueous humor into the post. chamber

6. Definition of cataract
Opacification of crystalline lens

8. Epidemiology Cataracts remain the leading cause of blindness.
Age-related cataract is responsible for 48% of world blindness, which represents about 18 million people
Cataracts are also an important cause of low vision in both developed and developing countries.

9. Causes of cataract Old age (commonest) Ocular & systemic diseases DM
Uveitis
Previous ocular surgery
Systemic medication
Steroids
Phenothiazines
Trauma & intraocular foreign bodies
Ionizing radiation
X-ray UV
Congenital
Dominant
Sporadic
Part of a syndrome
Abnormal galactose metabolism
Hypoglycemia
Inherited abnormality
Myotonic dystrophy
Marfan’s syndrom
Rubella
High myopia

10. Age -related cataract It is the Most commonly occurred.
Classified according to:
Morphological Classification
Nuclear
Cortical
Subcapsular
Christmas tree – uncommon
Maturity classification
Immature Cataract
Mature Cataract
Hypermature Cataract

15. Mature Cataract Lens is completely opaque.
Vision reduced to just perception of light
Iris shadow is not seen
Lens appears pearly white
Right eye mature cataract, with obvious white opacity at the centre of pupil

16. Liquefactive/Morgagnian Type
Cortex undergoes auto-lytic liquefaction and turns uniformly milky white.
The nucleus loses support and settles to the bottom.

17. Symptoms A cataract usually develops slowly, so:
Causes no pain.
Cloudiness may affect only a small part of the lens
People may be unaware of any vision loss.
Over time, however, as the cataract grows larger, it:
Clouds more the lens
Distorts the light passing through the lens.
Impairs vision
Reduced visual acuity (near and distant object)
Monocular diplopia.
Altered colours ( white objects appear yellowish)
Not associated with pain, discharge or redness of the eye.
Cataract can improve vision?!

18. Signs
Reduced acuity.
An abnormally dim red reflex is seen when the eye is viewed with an ophthalmoscope.
Reduced contrast sensitivity can be measured by the ophthalmologist.
Only sever dense cataracts causing severely impaired vision cause a white pupil.
After pupils have been dilated, slit lamp examination shows the type of cataract.

19. Gradual loss of vision DDX: Cataract Glaucoma Diabetic retinopathy
Hypertensive retinopathy
Age related macular degeneration
Retinitis pigmentosa
OnTrachoma
chocerciasis (river blindness)
Vitamin A deficiency

20. Treatment SURGERY● there is NO effective medical treatment
Indications of surgery:
1- Visual improvement:is the most common indication,
whether it is mature or immature.
2- Medical indications ?
Types of cataract surgery:
1- Intracapsular cataract extraction (ICCE) ± AC IOL (anterior chamber, intraocular lens):
2- Extracapsular cataract extraction (ECCE) ± PC IOL (posterior chamber intraocular lens):
3- Phacoemulsification:

22. .
Phacoemulsification in cataract surgery involves insertion of a tiny, hollowed tip that uses high frequency (ultrasonic) vibrations to "break up" the eye's cloudy lens (cataract). The same tip is used to suction out the lens

24. Summery Cataract is opacification of crystalline lens
Cataract can be congenital or acquired
Cataract presents with gradual painless loss of vision
Senile cataract is the most common cause
Treatment of cataract is only surgical when indicated

25. Thank You