Lens Disease

China Medical University NO.4

Affiliated hospital Ophthalmology;
Ophthalmology hospital of China
Medical University

Introduction
Lens disease:
Change of transparency
cataract
Position and morphological
abnormality
dislocation
malformation

Basic knowledge

Anatomy

Equator
Anterior capsule
Posterior capsule
Diameter:9-10mm
Thickness:4-5mm
Lens zonule

Anatomy
Capsule: integritymaintain
transparency
Lens epi. PCO
Lens substance: lens fiber
Nucleus
Cortex

Function
Refraction
Accommodation
Protection: UV filtration

What is accommodation?
The capability that eyes change
refractive condition in order to acquire
clear near sight.

What is cataract?

Turbidity of lens

WHO: turbidity of lens + VA<0.5

What is cataract?

Case: turbid lens, but VA=0.8

Cataract

Cataract is the No. 1 eye disease that

causing blind.
46% blindness is caused by cataract

Etiology
Any factors that change the
intraocular environment to affect lens
metabolism.
Such as: ageing, mechanical, chemical,
operation, inflammation, metabolic

Malformation
Congenital factors

Risk factors

UV
Diarrhea
Malnutrition
Diabetes
Smoking
Drinking alcohol

Classification
On etiology:
Congenital
Senile
Complicated
Metabolic
Drug induced or
toxic
Traumatic
After cataract

Classification
On location:
Cortical
Nuclear
Subcapsular

On degree:

Immature
Intumescent
Mature
Hypermature

Pathogenesis
The common route that causing
cataract is the oxidation injury by
peroxide free radical.

Apoptosishot spot of research

Clinical manifestations
Symptoms:
Progressive vision decrease
Contrast sensitivity decrease
Refraction changes
Diplopia
Glare
Change of color sensation
Visual field defect

contrast

test

Functionality
vision
contrast
test

Positive
wave
contrast
test
CSF

curve

Vision abnormity

Color
vision
excursion

glare

visual field loss

Clinical manifestations
Signs:
Turbidity of lens

Senile Cataract

Now called Age-related Cataract

Most commonly seen
>50 yrs old
>80 yrs old100%
Degenerative changes

Classification
Cortical
Nuclear
Subcapsular

Cortical cataract
4 stages
Incipient stage: wedge turbidity

Cortical cataract
4 stages
Intumescent stage
(immature):
iris projection

Induce acute angleclosure glaucoma

Cortical cataract
4 stages
Mature stage

Cortical cataract
4 stages
Hypermature stage:
Morgagni cataract
Phacoanaphylactic uveitis
Phacolytic glaucoma

Nuclear cataract

Subcapsular cataract
Affecting vision early

Congenital cataract
Etiology:
Hereditary
Environmental:

Virus infection
Malnutrition
Radiation
Drug
Systemic disease
VD deficiency

Congenital cataract
Morphology

Congenital cataract
Treatment
observation
Early operation
Amblyopia
Treatment

Complicated cataract
Caused by other eye diseases
Corneal ulcer
Glaucoma
Uveitis
Retinal detachment
Retinitis pigmentosa
Intraocular tumor
myopia

Kinds of Complicated cataract

Old anterior uveitis Complicated cataract

Pigmentosa eye

Silicon oil eye

glaucoma Complicated
cataract vogt spot

Metabolic cataract
Caused by systemic metabolic diseases
Diabetic cataract
Galactosemia cataract
Hand-foot-twitch cataract

Drug induced or toxic cataract

Glucocorticosteroid cataract
Chlorpromazine cataract
Miotic cataract
TNT cataract
Metal: copper, iron, mercury, silver, zinc

Traumatic cataract

Contusive
Penetrating
Radiative
Electric

After cataract
Now usually called PCO (posterior
capsular opacification)
Adult: 30-50%
Child: 100%
Pathogenesis:
Proliferation, migration & metaplasia of lens
epi.

Treatment
Drug? NO USE
Operation: the only effective therapy
ICCE (intracapsular cataract extraction)
ECCE (extracapsular cataract extraction)
PEA (phacoemulsification)

ICCE And
ECCE

ICCE

ECCE

Treatment
IOL (intraocular lens) implantation
AC and PC
Hard and foldable

Treatment
IOL (intraocular lens) implantation

Treatment
PEA & F-IOL

PEA & F-IOL (video)

Treatment
Correction of aphakia:
Frame glasses
Contact lens
IOL
Laser

Lens Dislocation
Etiology:
Congenital
Marfan syndrome
Traumatic
Spontaneous

Clinical Manifestations
Subluxation
Dislocation

Clinical Manifestations
Complications:

Uveitis
Secondary glaucoma
Retinal detachment
Corneal turbidity

Trends
Photolysis of cataract
Injective IOL
Accommodative IOL