1. Lecture 3 CATARACTS Lecture 3 CATARACTS

5. Classification of cataracts: Classification of cataracts: By age: congenital, juvenile, age-related (senile) By location opacities in the lens as seen with slit beam: cortical, nuclear, anterior subcapsular, posterior subcapsular By maturity: early, immature, mature, hypermature (Morgagnian cataract) By pattern: cuneiform (typical senile type), zonular, polar, pyramidal (congenital types)

12. DIFFERENTIAL DIAGNOSIS The same sign is progressive (not acute) painless visual loss Sign CATARACTGLAUCOMA MACULAR DEGENERATION Visual acuityis decreased Field of vision is not damagedconstriction of nasal visual field, Bjerrum’s scotoma may be central scotoma Intraocular pressure normal, if increased-secondary phakogenic glaucoma increasednormal Lensopaquetransparent, if opaque– complicated cataract transparent, if opaque– complicated cataract FundusIf is seen, not damaged. If damaged - complicated cataract optic disc changes - dislocation of vessels, pale colour, increased cupping degenerative patches in central area

26. Artificial lens

27. Artiphakia is a condition of eye with artificial lens (IOL). Aphakia is a condition of eye without lens. The visual acuity without correction is very poor – 0,02-0,04. Iridodenesis (iris vibration) is typical. Thick plus glasses are needed for vision: for far distance – sph convex 10,0-12,0 D for near distance – sph convex 13,0-15,0 D. Secondary cataract occurs eventually in about 20 % cases after cataract surgery. It is opacity of natural posterior capsule. It can be treated by YAG laser capsulotomy. Attention! The term «complicated cataract» is used to describe a lens opacity which occurs as a result of some other disease of the eye. Longstanding uveitits, an untreated retinal detachment or an intraocular tumour are all examples of an associated disease.

29. CONGENITAL CATARACTS : I degree – visual acuity is 0,3 and more; the size of opacity is less then 1,5 mm; the surgery may be done at the age of 14-16 years. II degree– visual acuity is 0,05-0,2; the surgery is usually done at the age of 3-4 years. III degree– visual acuity is less then 0,05; the surgery must be done during first year of life.

32. Ectopia lentis (displacement of the lens) may be partial (subluxation) or complete (luxation). Aethiology: trauma, familial ectopia lentis (may be associated with ectopic pupil), associated with other ocular disorders (aniridia and buphtalmos), Marfan’s and Weill-Marchesani syndromes, metabolic (homocystinuria and hyperlysinaemia). Clinical features: iridodenesis (vibration of iris) and not proportional depth of anterior chamber. Marfan’s syndrome: tall person with partial displacement of the lens (subluxation), fragile bones and arachnodactyly.

34. THANK YOU FOR ATTENTION !