22Acquired Cataract

8/10/2019 22Acquired Cataract

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ACQUIRED CATARACT

Morphological1. Classification of age-related cataract

According to maturity

Diabetes

Myotonic dystrophy

Atopic dermatitis

Trauma

2. Other causes of cataracts

3. Surgery

Secondary (complicated)

Large incision extracapsular extraction

Phacoemulsification

Drugs


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Classification of Age-related CataractAccording to Morphology

1. Subcapsular Anterior

Posterior

2. Nuclear

3. Cortical

4. Christmas tree


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Subcapsular cataract

Anterior Posterior


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Nuclear cataract

Exaggeration of normal nuclearageing change

Causes increasing myopia

Increasing nuclear opacification

Initially yellow then brown

Progression


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Cortical cataract

Initially vacuoles and clefts Progressive radial spoke-like opacities

Progression


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Christmas tree cataract

Polychromatic, needle-like opacities May co-exist with other opacities


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Other causes of cataract - diabetes

Juvenile

White punctate or snowflakeposterior or anterior opacities

May mature within few days

Adult

Cortical and subcapsularopacities

May progress more quickly thanin non-diabetics


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Other causes of cataract - myotonic dystrophy

Myotonic facies

Frontal balding 90% of patients after age 20 years

Stellate posterior subcapsular opacity

No visual problem until age 40 years


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Other causes of cataract - atopic dermatitis

Cataract develops in 10%

of cases between 15-30 years Bilateral in 70%

Frequently becomes mature

Anterior subcapsular plaque

(shield cataract) Wrinkles in anterior capsule

C f t ti t t


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Causes of traumatic cataract

Penetration

Concussion

Vossius ring from

imprinting of iris pigment Flower-shaped

Ionizing radiation

Electric shock

Lightning

Other causes


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Secondary (complicated) cataract

Chronic anterior uveitis High myopia

Posterior subcapsular

Hereditary fundus dystrophies Central, anterior subcapsular

opacities

Glaukomflecken

Follows acute angle-closureglaucoma

E t l t t t ti


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Extracapsular cataract extraction

1. Anteriorcapsulotomy

2. Completion ofincision

3. Expression ofnucleus 4. Cortical cleanup

6. Polishing of posteriocapsule, if appropria

5. Care not to aspirateposterior capsule

accidentally

E t l t t t ti ( t )


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8. Grasping of IOL ancoating with viscoelasubstance

Extracapsular cataract extraction ( cont. )

7. Injection ofviscoelastic

substance

9. Insertion of inferiorhaptic and optic

11. Placement of hapticsinto capsular bag

10. Insertion of superi

haptic

12. Dialling of IOL inthorizontal position

and not into ciliarysulcus

Ph l ifi ti


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Phacoemulsification

1. Capsulorrhexis 2. Hydrodissection

3. Sculpting of nucleus 4. Cracking of nucleu

5. Emulsification ofeach quadrant

6. Cortical cleanup a

insertion of IOL

22Acquired Cataract

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