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Download MBBS Ophthalmology PPT 22 Complicated Cataract Lecture Notes

Download MBBS (Bachelor of Medicine, Bachelor of Surgery) Ophthalmology PPT 22 Complicated Cataract Lecture Notes

This post was last modified on 07 April 2022

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? At the end of this class students shal be able

to :

? Classify cataract according to aetiology.

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? Understand pathophysiology of metabolic and
complicated cataract.
? Identify distinct morphological subtypes of
metabolic and complicated cataract.

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2


`CATARACTA'(LATIN)MEANING `WATERFALL'

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Definition of cataract

? Any opacity in the lens or its capsule

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Etiological classification of cataract
1. Age related cataract
2. Traumatic cataract

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3. Metabolic cataract
4. Complicated cataract
5. Toxic cataract
6. Radiation induced cataract

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METABOLIC CATARACTS

? Due to endocrine disorders and biochemical

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abnormalities.

? Diabetic cataract
Hyperglycemia

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Excess glucose metabolizes into
sorbitol
(Aldose reductase mediated)

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Osmotic over hydration

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1. Age related cataract in

diabetics

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? Early onset

? Rapid progression

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2. True diabetic cataract.

? Also called `snow flake

cataract' or `snow-storm

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cataract'

? Fluid vacuoles appear

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underneath anterior

and posterior capsules

? Bilateral snowflake-like white

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cortical opacities

Snowflake cataract 7

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Galactosemia

? Multisystem disorder

? Inborn error of galactose

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metabolism

? Anterior and posterior

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subcapsular lamellar

opacities- `oil droplet

cataract'

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Oil droplet cataract

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Myotonic dystrophy

? Fine dust like opacities

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with tiny iridescent spots

in cortex- `christmas tree

cataract'

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? May progress to stellate
opacity at posterior pole

Christmas tree cataract

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Hypocalcaemic cataract

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? May be associated with parathyroid tetany.

? Multicoloured crystals
or
? Small discrete white flecks of cortical opacities

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Wilson's disease

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? `Sunflower cataract' is
rare in such patients.

? `Kayser-Fleischer ring'

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(KF ring) in the cornea
is more common.

Sunflower cataract

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(Photographs- Courtesy :

Kanski's Clinical Ophthalmology)

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Lowe's syndrome

? Lowe's (Oculo-cerebral-renal) syndrome
? Rare inborn error of amino acid metabolism.

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? Ocular features
congenital cataract and glaucoma
? Systemic features
mental retardation
dwarfism

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osteomalacia
muscular hypotonia
frontal prominence.

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COMPLICATED CATARACT

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? Opacification of the lens secondary to

some other intraocular disease.

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? Inflammatory conditions
? Uveal inflammations
(like iridocyclitis, pars planitis, choroiditis)
? Hypopyon corneal ulcer
? Endophthalmitis.

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? Degenerative conditions
? Retinitis pigmentosa
? Myopic chorioretinal degeneration

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? Retinal detachment
Long-standing cases

? Glaucoma (primary or secondary)

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? Intraocular tumours
? Retinoblastoma
? Malignant melanoma

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COMPLICATED CATARACT

? Lens changes typically in front

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of the posterior capsule.
? Irregular in outline
? Variable in density
? Appearance like `breadcrumb'.
? A very characteristic sign is

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Iridescent coloured particles
`polychromatic lustre' of
reds, greens and blues.

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COMPLICATED CATARACT

? Chronic anterior uveitis

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Most common cause
? Polychromatic lustre
at posterior pole
? If persists, anterior and
posterior opacities develop

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Angle closure glaucoma

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Focal infarcts of lens

epithelium

-small grey-white anterior

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subcapsular or capsular

opacities

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`glaukomfecken'

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?Pathological myopia

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Posterior subcapsular opacities

Early onset nuclear sclerosis

?Hereditary fundus dystrophies

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Lebers: total cataract

Stickler syndrome: cortical cataract

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Toxic cataracts

1. Smoking

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2. Alcohol

3. Drug induced cataract

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Corticosteroids

Phenothiazines

Pilocarpine

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Diuretics

Amiodarone

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Allopurinol

Chloroquine

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Other types:
? Infrared (heat) cataract:
`Glass-blower's or Glassworker's cataract'

? Irradiation cataract

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? Ultraviolet radiation cataract

? Electric cataract

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MANAGEMENT OF CATARACT IN ADULTS

? A. Non-surgical measures

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? B. Surgical management

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Non-surgical measures

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1. Treatment of cause of cataract

2. Measures to delay progression

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3. Measures to improve vision in the presence of

incipient and immature cataract

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Surgical management

? Indications

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1. Visual improvement

2. Medical indications :

Lens induced glaucoma

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Retinal diseases like

diabetic retinopathy or retinal detachment

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(treatment of which is hampered by

presence of lens opacities)

3. Cosmetic indications

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Preoperative evaluation

I. General medical examination of the patient

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II. Ocular examination

A. Retinal function tests
B. Search for local source of infection

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C. Anterior segment evaluation by slit-lamp
examination
D. Intraocular pressure (IOP) measurement

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Retinal function tests

? Light perception (PL)

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? Projection of rays (PR)

? Pupillary reaction to light

? Two-light discrimination test

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? Maddox rod test

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Retinal function tests

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? Colour perception

? Entoptic visualisation

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? Laser interferometry

? Objective tests for evaluating retina

like VEP, ERG, EOG, USG

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Preoperative medications and preparations

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? 1. Topical antibiotics
? 2. Preparation of the eye to be operated.
? 3. An informed and detailed consent
? 4. Scrub bath and care of hair.
? 5. To lower IOP

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? 6. To sustain dilated pupil

? Anaesthesia
? LA/GA

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Types and choice of surgical techniques

? Phacoemulsification (MICS)

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? Small incision cataract surgery (SICS)

? Extracapsular cataract extraction (ECCE)

? Intracapsular cataract extraction (ICCE)

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Conclusion

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? Metabolic cataracts are due to endocrine

disorders and/or biochemical abnormalities.

? Complicated cataracts involve opacification

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of the lens secondary to some other

intraocular disease.

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? Many metabolic and complicated cataracts

have distinctive morphologies.

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Thank you

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