Dr. Abdelmonem HamedFellow of Baylor of College of Medicine, USA

Professor of ophthalmology, Benha University, ARE

LENS

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حامد المنعم عبد ادبنها جامعة ، العين وجراحة طب استاذ

بأمريكا بيلور طب كلية زميل

LENS

2

حامد المنعم عبد اد ، العين وجراحة طب استاذ

بنها جامعةبأمريكا بيلور طب كلية زميل

Part 2

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SENILE CATARACT

SENILE CATARACTDefinition:

Gradual,progressive lens opacity, affecting elderly,

who is not suffering from local or systemic disease.

Bilateral,

SENILE CATARACTDefinition:

Gradual,progressive lens opacity, affecting elderly,

who is not suffering from local or systemic disease.

Bilateral,

SENILE CATARACTDefinition:

Gradual,progressive lens opacity, affecting elderly,

who is not suffering from local or systemic disease.

Bilateral,

SENILE CATARACTDefinition:

Gradual,progressive lens opacity, affecting old age people,

who are not suffering from local or systemic disease.

Bilateral,

SENILE CATARACTDefinition:

Gradual,progressive lens opacity, affecting old age people,

who are not suffering from local or systemic disease.

Bilateral,

SENILE CATARACT

Incidence: Age: ˃ 50 years Sex: males = females. Bilateral: It affects both eyes

Etiology: Disturbed capsular permeability. Disturbed Ph. around lens Disrubance of important metabolites ( ↓

vit. C & glutathione) Disturbance of endocrine hormones. Exposure to UV rays .

SENILE CATARACT 4D & 1E

Pathogenesis: Change in water content :

hydration of cortex ; changes in the permeability of lens

capsule water drops go inside cortex which becomes opaque.

sclerosis of nucleus

SENILE CATARACT

V.S i

SENILE CATARACT

how cataract is formed?

Accumulation of lactic acid ↓ pH activation of dormant enzymes (proteases) breakdown of lens proteins & accumulation of amino acids lens opacity (cataract)

Types:1. Cortical2. Nuclear3. corticonuclear

SENILE CATARACT

SENILE CATARACT

I. torchlightII. SlilampIII. Red reflex

Methods of examination:

Senile cortical cataract

Stages of senile cortical cataract

1. Immature cataract Incipient (sectorial opacities

at the periphery). Intumescent.

2.  Mature cataract (totally opaque)

3. Hypermature cataract (loses water & shrink)

Immature cataract

Showing Lens is not totally opaque wedge – shaped opacities

appear in the periphery of the lens

progress gradually

Immature cataract

Symptoms:1. Gradual diminution of

vision, as the visual axis is not involved

2. Uni-ocular diplopia, due to sectorial change in the refractive index.

3. Colored halos are seen around light due to light scattering.

من كلهاالمريض

Immature cataract

Signs:Oblique

illumination: Iris shadow

Red reflex: black sectors

against reddish background

من كلهاالطبيب

Immature cataract

Signs:Oblique

illumination: Iris shadow

Red reflex: black sectors

against reddish background

عن كلهاالطبيب

What is the iris shadow? black crescent due to presence of clear interval

between iris and lens opacity.

Intumescent cataract

Hydration of the lens

swelling of the lens shallow AC pupillary block (phacomorphic glaucoma ) Colored halos

Mature cataract

Signs: Entire cortex is opaque. vision is hand movement Iris shadow is absent. R.R. is absent

وبالتالى

Hypermature cataract1. Entire cortex is opaque vision is HM R.R. is

absent2. The lens shrink (thick wrinkled

capsule + cholesterol deposition)

1. Iris shadow may be present. 2. Tremulous iris3. A.C. deep

3. IOP: may be elevated (Phacolytic glaucoma)

وبالتالى

Hypermature cataractComplications Subluxation or dislocation of lens, due

to degeneration of zonules. leakage of lens protein

Phacolytic glaucoma, lens protin is ingested by the phagocytes. Obstruction of angle of AC

Phacotoxic uveitis Morgagnian cataract:

liquefaction of lens matter into a milky fluid, nucleus sinks down by gravity

How to differentiate Immature and Mature Cataract

IMMATURE CATARACT

1. VA is reduced to counting finger.

2. Lens is partially opaque

3. Iris shadow is present

4. Fundus may be visible.

MATURE CATARACT

1. VA reduced to HM or PL

2. Lens is totally opaque

3. No iris shadow4. No fundus details

Prof . Dr. Abdelmonem Hamed

V.S

Senile nuclear cataractDefinition

sclerosis of the central nuclear fibers

EtiologyUV photo – oxidation of amino

acids Formation of brown pigment deposition of abnormal lipoproteins. reduction in glutathione formation. calcium concentration

Senile nuclear cataractDefinition

sclerosis of the central nuclear fibers

EtiologyUV photo – oxidation of amino

acids Formation of brown pigment deposition of abnormal lipoproteins. reduction in glutathione formation. calcium concentration

Senile nuclear cataractDefinition

sclerosis of the central nuclear fibers

EtiologyUV photo – oxidation of amino

acids Formation of brown pigment deposition of abnormal lipoproteins. reduction in glutathione formation. calcium concentration

Senile nuclear cataractDefinition

sclerosis of the central nuclear fibers

EtiologyUV photo – oxidation of amino

acids Formation of brown pigment deposition of abnormal lipoproteins. reduction in glutathione formation. calcium concentration

Incidence: > 40 years of age

Clinical grades (1+ to 4+): due to deposition of melanin pigment derived from amino acids in

the lens The nucleus becomes yellowish, brown,

red & then black Black cataract (cataracta nigra)

Senile nuclear cataract

i

The sclerosis gradually spreads towards the cortex,

then extends up to the capsule , then the entire lens functions as a nucleus (Mature cataract ).

Senile nuclear cataract

PS. Hypermaturity does not occur as the process is very slow

i

Symptom: ↓ VA due to progressive

myopia and central opacity.

Signs: Red reflex : hazy to

black Slit-lamp examination:

nuclear cataract.

Senile nuclear cataract

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Thank you