Transcript Approach To A Case Of Cataract [PPT]

Approach to a
Case of Cataract
Sandeep Saxena MS, FRCS (Edin), FRCS (Glasg)
Professor, Ophthalmology, KGMU
Differential diagnosis
Painless, progressive diminution of vision
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Cataract
Primary open angle glaucoma
Diabetic retinopathy
Corneal dystrophies and degenerations
Age related macular degeneration
Retinitis pigmentosa
Cataract
• Opacification of the human crystalline lens
• Major cause of blindness worldwide
• Classification-Etiological
-Morphological
Morphological classification
• Capsular cataract
-Anterior
-Posterior
• Subcapsular cataract
-Anterior
-Posterior
• Cortical cataract
• Nuclear cataract
• Polar cataract
Etiological classification
I. Congenital and Developmental cataract
II. Acquired cataract
• Senile cataract
• Traumatic cataract (blunt, penetrating, radiation,
electric shock, glass blowers, infra-red)
• Complicated cataract (uveitis-induced)
• Metabolic cataract (Diabetes - snowflake, Wilson’s
disease-sunflower)
• Drug induced cataract- corticosteroids, miotics
• Cataract associated with syndromes
• Congenital or Developmental cataract
- Occur due to maternal infection or malnutrition,
perinatal hypoxia – APH, or may be hereditary
- Various morphological forms:
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Blue dot
Sutural
Fusiform or spindle shaped
Embryonal nuclear
Zonular
Coronary
Anterior or posterior polar
Senile cataract
• ‘Age-related cataract’
• By the age of 70 years, over 90% of the
individuals develop senile cataract
• Usually bilateral, but almost always
asymmetrical
Symptoms
• Gradual, painless progressive loss of vision
• Discomfort / glare in daylight – nuclear
cataract; better vision in daylight – cortical
cataract
• Uniocular polyopia
• Coloured halos
• Black spots in front of eyes
• ‘Second sight’
Signs
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Iris shadow
Depth of anterior chamber
Pupillary reflex
Visual acuity
Plain mirror examination under mydriasis
Iris
shadow
A.C.
Depth
Pupillary
reflex
Visual
acuity
Intumescent
Present
Shallow
Greyish white FC to 6/18
Incipient
Present
Normal
Greyish white FC to 6/18
Mature
Absent
Normal
Pearly white
HM to FC
close to face
Hypermature Absent
Morgagnian
Shallow
Milky white
HM +
Hypermature Absent
Calcified
Normal or
deep
Milky
chalky
HM +
Patient workup
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Retinoscopy and best corrected visual acuity
Intraocular pressure
Slit lamp examination
Fundus evaluation – direct & indirect
Macular function tests
Ultrasonography
IOL power calculation
General investigations
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Blood pressure
Blood sugar
Complete haemogram
HIV, Hepatitis B & C
Causes of straining
Foci of infection
Systemic examination
Management
• An un-operated eye is more comfortable than an
operated eye if visual diminution is mild.
• Early cataract :
-Refraction and glasses
-Dark glasses or photochromatic glasses for
nuclear cataract
-Rule out other causes of visual diminution
-If BCVA not to patient’s satisfaction, then
operate.
Surgical techniques
• Intracapsular cataract extraction (ICCE)
• Extracapsular cataract extraction (ECCE)
– Conventional ECCE
– Small Incision Cataract Surgery
– Phacoemulsification
– Lens aspiration in paediatric (soft) cataract
Complications of cataract surgery
• Intraoperative
– Incision related complications
– Posterior capsular rupture
– Zonular dehisence
– Vitreous loss
– Nuclear drop
– Posterior loss of lens fragments
– Injury to the cornea, iris and lens
– Expulsive choroidal haemorrhage
• Early post operative complications
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Hyphaema
Iris prolapse
Striate keratopathy
Postoperative anterior uveitis
Bacterial endophthalmitis
• Late postoperative complications
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Cystoid macular edema
Pseudophakic bullous keraopathy
Retinal detachment
Delayed postoperative endophthalmitis
After cataract
• Soemmering’s ring
• Elschnig’s pearls
Intraocular Lenses
Types
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Anterior chamber IOL
Iris supported lens
Posterior chamber IOL
• Rigid
• Foldable
Calculation of IOL power
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SRK formula
Thank you