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C.

R
57/M
Married
Patient Profile

3 yrs PTC, px noted gradual blurring of vision of
the right eye
(-) eye pain
(-) redness
(-) tearing
(-) dicharge

CONSULT

History of Present Illness

Past Medical History
HTN (Amlodipine, 2 yrs)

Past Ocular History
Unremarkable

Family History
Unremarkable
History of Present Illness

Anicteric Sclerae, Pink Palpebral Conjunctivae,
Leukocoria, 2-3 mm EBRTL, (-) redness, (-) discharge
Visual Acuity
OD: HM w/ GLP
OS: 6/6
EOMs
full
IOPs
OD: soft
OS: soft
Fundoscopy
OD: (-) ROR
OS: (+) ROR, CM, DDB, CDR 0.4, AVR 2:3
Eye Examination

SUDDEN GRADUAL TRANSIENT
PAINLESS PAINFUL
Ischemic Optic
Neuropathy
Retinal
Artery/Vein
Occlusion
Acute Angle
Closure
Glaucoma
Corneal Ulcer
Uveitis with
Complications
Cataract
Error of
Refraction
Open Angle
Glaucoma
DM
Retinopathy
Age-related
Macular
Degeneration
Subacute
Angle
Closure
Glaucoma
Uveitis
Optic
Neuritis
Uveitis
Papilledema
Amaurosis
Fugax

Differential Diagnosis

Cataract
57 y/o
Leukocoria
Error of Refraction
Not improved with pinhole
Open Angle Glaucoma
Normal IOP
DM Retinopathy
No DM
Age-related Macular Degeneration
Central vision is not affected
Gradual, Painless

Cataract Senile Mature, OD
Assesment

Definition:
Opacity in the lens
Most common cause:
Aging
Other causes:
trauma
systemic dse (DM)
smoking
heredity
Cataract

Pathogenesis
not completely understood.
cataractous lenses protein aggregates that
scatter light rays and reduce transparency.
Factors:
oxidative damage (from free radical reactions)
ultraviolet light damage
malnutrition
NO medical treatment to retard or reverse
cataract formation.
protective effect from dietary carotenoids (lutein)
Cataract

Mature
All of the lens protein is opaque
Leukocoria
Immature
Some transparent protein
Black opacity against a red orange background
Intumescent
Lens take up water
Hypermature
Cortical proteins have become liquid escape shrunken lens
with wrinkled capsule
Morgagnian
Hypermature cataract in which lens nucleus floats freely in the
capsular bag
Cataract

Most common type
Age-related
Types
Nuclear
Cortical
Subcapsular
Senile Cataract

Nuclear (Hard) Cataract
Hardening of the nucleus d/t compacting &
sclerosing of the lens fiber in the center of the lens
yellow-brown pigments
Myopic shift in refraction
Early onset of BOV (Far vision)

Senile Cataract

Cortical (Soft) Cataract
Hydration of the cortex with development of
subcapsular vacuoles which disrupts regular
arrangement of lens fiber
Opacity begins at periphery (radial spoke-like
opacities)
Late onset of BOV
Senile Cataract

Posterior Subcapsular Cataract
cortex near the central posterior capsule.
Posterior migration of lens epithelium
Near vision is affected early
Associated with DM, trauma, corticosteroid use
(topical or systemic), inflammation, or exposure to
ionizing radiation.
Senile Cataract

Extracapular Cataract
Extraction (ECCE)
Anterior capsule, nucleus &
cortex are removed
Posterior capsule is left
behind to support the
intraocular lens
Complications:
No accomodation, with
astigmatism
Procedure:
Anterior Capsulotomy
Completion of Incision
Removal of Nucleus
Removal of Cortex
Insert IOL
Suturing







Management of Cataract

Phacoemulsification
Latest method
Use of ultrasonic vibrator to
disintegrate nucleus
Sutureless
Procedure:
Capsulorrhexis
Hydrodissection
Sculpting of the Nucleus
Cracking of the Nucleus
Emulsification
Removal of Cortex
Insertion of IOL


Management of Cataract