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Djoko Utomo SpM

Biconvex , avascular , colorless , transparent structure Thick : + 4 mm ; diameter : + 9 mm It is suspended behind the iris by the zonula, which connects it with the cilliary body The Lens capsule is semi permeable membrane admit water and electrolytes

The sole fuction : focus light rays upon the retina The physiologic interplay of the ciliary body, zonule, and lens that result in focusing near object upon the retina is known as

accomodation

As the lens age, its accomodation power is gradually reduced

Consist about 65% water ; 35% protein and trace minerals Pottasium is more concentrated in the lens Ascorbid acis & glutathione are prsent in both the oxidized and reduced forms

Cataract formation is characterized chemically by : - reduction in oxigen uptake - lens edema ; calcium & sodium pottasium, ascorbat acid & protein damaged lamellar fibers Risk Factors :

* Individual : age, sex, ethnic, genetic * Environment : smoking, UV, nutrition, sosioeconomic, education, alcohol, diabetes, dehydration, steroid * Protective : aspirin, hormonal

Cataract-related symptoms are relatively individual and do not correlate absolutely with vision cloudy or blurred vision reduced contrast increased glare (scattered light) changes in color perception (usually a yellowish tinge) Double vision (monocular diplopia) complain of more severe symptoms in bright light (sunshine) or when reading

Acquired cataracts (over 99% of cataracts)

Senile cataract (over 90% of cataracts) Traumatic cataract Metabolic Cataract Toxic Cataract Secondary Cataract

Congenital cataracts

Hereditary cataracts Cataracts due to early embryonic (transplacental) damage

Frequently preceded by the presence of radial water clefts in the lens cortex Morphology :
Nuclear cataract Cortical cataract subcapsular cataract anterior or posterior polar cataract

Severity :

Incipient cataract Immature cataract Mature cataract Hypermature cataract

Nuclear cataract

Nuclear cataract

Cortical cataract

Subcapsularis posterior cataract

Mature cataract

Hypermature cataract

The most common cause of unilateral cataract in young individuals Types of injury :
Direct penetrating injury Cincussion vossius ring Electric shock and lightning Ionizing irradiation

A. A contusion rosette posterior to the anterior lens capsule has developed after severe blunt trauma to the eyeball B. Cataract caused by penetrating trauma C. vossius ring after blunt trauma

Diabetes mellitus Galactosemia Renal insufficiency Mannosidosis Fabry disease Lowe syndrome Wilson disease Myotonic dystrophy Tetany Skin disorders

Diabetic cataract progresses rapidly Diabetic cataract appears as bilateral white punctate or snowflake posterior or anterior opacities

Occur with chronic neurodermatitis and less frequently with scleroderma, poikiloderma, and chromic eczema. Characteristic signs include an anterior crest-shaped thickening of the protruding center of the capsule

Steroid-induced cataract Chlorpromazine-induced cataract Miotic drugs-induced cataract Busulphan-induced cataract Amiodarone-induced cataract

Prolonged topical or systemic therapy with corticosteroids can result in a posterior subcapsular opacity. The exact doseresponse relationship is not known

Chronic anterior uveitis Hereditary fundus dystrophies

Retinitis pigmentosa Lebers congenital amaurosis Gyrate atrophy Wagners and Sticklers syndrome

High myop Acute congestive angle-closure glaucoma

The most common cause of secondary cataract The earliest finding is a polychromatic lustre at the posterior pole of the lens Anterior and posterior subcapsular opacities develop and the lens may become completely opaque

Associated with the subsequent formation of glaucomflecken consisting of small, grey-white, anterior, subcapsular or capsular opacities in the pupillary zone

Indications for cataract surgery

Visual improvement Medical indications Cosmetic indications

Surgical techniques
Extracapsular cataract extraction (ECCE) Small incision cataract surgery (SICS) Phacoemulsification

Operative complications
Rupture of posterior capsule Suprachoroidal haemorrhage

Early postoperative complications

Raised intraocular pressure Iris prolapse Striate keratopathy Wound leak Acute bacterial endophtalmitis

Late postoperative complications

Suture-related problems Malposition of IOL Corneal decompensation Cystoid macular oedema Opacification of the posterior capsule Retinal detachment Epithelial ingrowth Sunset syndrome