causes

DEVELOPMENTAL CATARACT 1. Gestational disturbance - intrauterine infection (ToRCH) - maternal drug intake (C/S, sulphonamide) - irradiation during 1st trimester - nutritional ( Vit D & calcium) 2. Metabolic disorders - DM, galactosemia, hypoglycaemia, hypoparathyroidism 3. Trauma - aniridia, ectopic lentis, PHPV 4. Ocular anomalies

SENILE CATARACT

TRAUMATIC CATARACT 1. penetrating trauma capsule rupture progress rapidly to total opacification 2. Blunt trauma( concusion ) - vossius ring - Rosette shaped cataract - subluxation of the lens 3. Radiation cataract 4. Chemical injuries 5. Metallosis: - sidrosis = iron IOFB - chalcosis = cupper FB 6. Electrical injury

COMPLICATED CATARACT 1. Perforated corneal ulcer. 2. Iridocyclitis. 3. Chorioretinitis. 4. Retinitis pigmentosa. 5. long standing Retinal detachment. 6. Glaucoma. 7. High myopia. 8. Subluxated and dislocated lens. 9. Intraocular tumours.

Types

Morphological changes: 1. Polar 2. Lamellar 3. Complete 4. Coronary 5. Blue dot 6. Nuclear 7. Sutural (stellate) 8. Membranous

1. Cortical i) Cuneiform - Precataractous - Incipient - Immature - Mature - Hypermature ii) Cupuliform 2. Nuclear

Mechanism of development -Interference of nutrition of the lens. -Toxins. Opacity begins on the posterior capsule first (thin and not lined by subcapsular epithelium) polychromatic luster

C/p

Rx

1. Leukocoria 2. Squint & amblyopia 3. Nystagmus 4. Defective vision 1. No treatment if no VA impairment : ant.capsule + blue dot + sutural + coronary cataract 2. Optical Rx : no operation if glasses improve VA up to 6/18 to retain accommodation 3. Surgical (VA < 6/18 with optical correction) - Irrigation-aspiration + posterior capsulotomy + anterior vitrectomy - Lensectomy

Morphological types of developmental cataracts

site POLAR - lens capsule - subcapsular cortex LAMELLAR/ZONULAR specific layers/zones of the lens COMPLETE subtotal (birth) progress to complete cataract profound VA impairment CORONARY near the periphery of lens BLUE DOT scattered all over the lens NUCLEAR may involve embryonic nucleas alone/ with foetal nucleus SUTURAL/STELLATE foetal nucleus MEMBRANOUS

Anterior small, symmetric, non progressive do NOT impair VA

Posterior larger, nearer to the nodal point more VA impairment

a layer of opacification involving the fetal nucleus - surrounding a clear center - surrounded in turn by a clear cortex

- club shaped + broad end towards the center - manifested during puberty

- multiple, small, bluish dots - NO visual disturbance

seldom impair VA

CUNEIFORM CORTICAL Precataractous Incipient - lamellar separation (clefts) - water vacuoles - white, wedge-shaped opacities - near the periphery - pointed end towards the center - cortex : all opacified except zone of superficial cortex

Types of senile cataract CUPULIFORM CORTICAL - posterior subcapsular opacification glares+ poor VA under lightening condition near vision more affected than distant vision

NUCLEAR

VA minimally/not affected

Immature

Mature Hypermature

- lens : greyish - iris shadow - red reflex: dim - VA : not less than CF, highest : 6/12 entire cortec (capsule to nucleus) - VA : HM becomes opaque white - red reflex : absent 1. Usual (shrunken) type : leakage of degenerated cortical material thru lens capsule leaving the capsule wrinkled & shrunken - with iris shadow

2. Morgagnian : further lliquefaction of cortex nucleus sinks inferiorly * Intumescent cortical cataract : lens taking up water swells phakomorphic glaucoma