cataract lecturer
TRANSCRIPT
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C A T A R A C T
Dr. T. Budi Sulistya, Sp.MDr. Anny Sulistiyowati, Sp.M
Dr. Sony Agung Santoso, Sp.M
Department of OphthalmologyFaculty of Medicine Brawijaya ni!ersity
Saiful Anwar "ospital
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# Bicon!e$
# A!ascular
# Transparent
# Thic%ness& ' mm,diameter ( mm
# Ant & a)ueous humo
# *ost & !itreous# *osition& suspensory
ligament +onula-
inn
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PHYSIOLOGY
/ens transparency & control water 0electrolyte
Dehydrated
1 22
Amino Acid
3a4
5l
> "A 06itreous< "A 06itreous
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BIOCHEMISTRY
# 789 water
# :89 *rotein, mineral, glutathione,
*otassium, Ascor;ic acid, etc.# 3utrition&
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"yperglicemic Osmotic ↑ Swelling
Opaci=cation
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PATHOLOGY
# Ad!ance age
# Trauma# >n?ammation
# Meta;olic disorder
# 5orticosteroid# @adiation
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Age Related Cataract
5ommon
3uclear, 5ortical, *osterior Su;
5apsular 5ataract +*S5-
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STAGES OF SENILECATARACT
# Stadium >3S>*>3T
# Stadium >MMAT@
# Stadium MAT@
# Stadium "*@ MAT@
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RISK FACTOR
# Age
# Dia;etes mellitus
# Drugs& corticosteroid, phenothiaine,chlorpromaine
# ltra!iolet radiation
# Smo%ing
# Al%ohol
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DIAGNOSIS &
EXAMINATIONC. 6isual distur;ance&
depends on& opacity
location.
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EXAMINATION
C. 6isual acuity& natural, ;est corrected
. Anterior segment
:. *upilary dilatation
'. Funduscopic e!aluation &
E $amine with
ophthalmoscope E Blac%
spot o!er orange ;ac%ground +insipient Eimmature-
E 3egati!e +mature-
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Additioal te!t
C. >ntraocular pressure
. 1eratometry and ;iometry
:. @etinometry
'. ltrasonography
8. Blood pressure7. Blood sugar
. "emostasis
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MANAGEMEN
TNo S"rgical
C. Spectacle lens
. Magni=cation G !isual aids
:. Appropriate illumination
S"rgical
@educed !isual funcion
5omplication & Secondary
glaucoma
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Indication of Surgery
C.6isual >mpairment
# @esponsi;le for the patientHs disa;ility
in desired acti!ity +dri!ing, reading,
occupational needs-
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# 6isual disa;ility increases due to glare or
dim illumination
# *atient complains of monocular diplopia or
polyopia
# 6isual disparity e$ists ;etween two eyes
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. Other indications&
/ens induced diseases & phacomorphic
glaucoma, phacolytic glaucoma
5oncomitant ocular disease that
re)uires clear media& re)uired to
ade)uately diagnose dia;etic
retinopathy
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#$ Stadi"% INSIPIENT
6isual acuity can ;e normal Opacity starts as a line at lens edge
Iheel appearance
5entral one stillclear
May ;e stationer
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$ Stadi"% IMMAT'RE
/ens a;sor;s water ;ulging glaucoma
# 6A& 8G7 CG7J
# Fundus re?e$ +4-# Opacity not
homogen
# >ris shadow test +4-
# >ndication for
surgery +4-
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# 6isual acuity CG7J /* +4-
# "omogen opacity
# Fundus re?e$ +-
# >ris shadow test +-
# O;!ious indication for surgery
($ Stadi"% MAT'RE
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)$ Stadi"% HIPERMAT'RE
Degeeratio o* le! corte+ adca,!"le
S-r".e cataract / le! !-ri.! ad t-i! d"e
to lo!! o* 0ater
Morgagia Cataract / corte+ !o*te! ad
li1"e2e! "cle"! !i.!
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S"rgical Proced"re
# $tra 5apsuler 5ataract $traction 55
3uclear $pressionG$traction
*hacoemulsi=cation
# >ntra 5apsuler 5ataract $traction >55
E
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EXTRA CAPS'LAR
E+tra ca,!"lar
>ncision KCJ mm corneoscleral
Anterior capsulotomy
3ucleus $pressed from capsular ;ag
@esidual corte$ remo!ed
*osterior capsule is intact
/arge incision& suture 22
For all %inds of cataract
Manual Small >ncisi 5ataract Surgery
+MS>5S-
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P-acoe%"l!i2catio
# E : mm
# 5lear cornea
# 5apsulotomy& 5ontinuous
5ur!elinear 5apsulore%sis
555
# ltrasonic
# 3o sutures
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INTRA CAPS'LAR
# >55
# /arge incision# /ens 0 5apsule intoto
# "igher ris% of !itreous loss
# For mature 0 hypermature cataract
# 5an not ;e done for congenital 0 ju!enile cat.
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INTRAOC'LAR LENS
# More *hysiological
More co%*orta3le
# *MMA, Silicone, Acrylic
# >nside capsular ;ag
# 6A 7G7
# *seudopha%ia
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COMPLICATIONS# ndophthalmi
tis
# Iound lea%
# >ris prolapse
# !eitis
# >ncreased >O*
# 5orneal
edema
# Bullous %eratopaty
# Dislocated >O/
# 6itreous /ost
# 5M
# @D
# 5horoidal
hemorrhage
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POST S'RGICAL REHA4ILITATION
# *atients complaint
# 6A
# Anterior segment
# Sign of in?ammation
# >O*
# Iound healing.# *ersonal hygiene
# Spectacle correctionGreading
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COMM'NITY OPHTHALMOLOGY
# Blindness& C.8 9, cataract C 9
# "andling& Dept of "ealth
3
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4ac.log Cataract
# 5ataract& C 9 CJ.JJJ
# Surgical capacity& KJ.JJJGyear
#Bac%log & C:J.JJJGyear
# ANected ;y& unawareness community
high cost of surgery
ophthalmologist LL
reach surgical capacity
LL
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# 5ommunity ophthalmology& elimination
cataract&
*romotion
*re!ention
5ure
@eha;ilitation
Ophthalmologist
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