Adult Cataract: Cortical or Soft Cataract
Adult Cataract: Cortical or Soft Cataract
Adult Cataract: Cortical or Soft Cataract
Age Related
Cataract
The lens becomes thicker and heavier and the protein fibers begin to break down
The proteins form clumps that distort light as it penetrates the lens and reaches the retina
Nuclear sclerosis: Age-related change in the density of the crystalline lens nucleus that occurs in all elderly caused by compression of older lens fibers in the
new formation. It is a normal condensation process in the lens nucleus
nucleus by
Immature Cataract
Lens is partially opaque
Mature Cataract
Lens is completely opaque
SYMPTOMS
1) Painless gradual diminution of vision: due to
a) Lenticular opacity
b) Refractive error induced : due to the changes in refractive index of lens
Cortical cataract index hypermetropia
Nuclear cataract index myopia. , a previously ,ie presbyopic patient may be able to read again
without the aid of spectacles. This known as 'second sight'.
2) Seeing fixed black spots in the field of vision
3) Monocular diplopia or polyopia due to irregular refraction by the lens.
Vision steadily diminishes until only light perception (LP) remains in the mature stage of cataract
refraction.
Indumescent
If the lens takes up water
SIGNS
Cortical or soft cataract:
hydration followed by coagulation of proteins appears primarily in the cortex of the lens.
Incipient stage: Wedge shaped spokes of opacity striae) extend from the periphery of the cortex, to the
center. The areas between them are clear.
Immature stage: The process of opacification advanced further. The lens appears greyish. Clear lens
are still present in the cortex and therefore iris shadow is present
Progressive sometimes rapid hydration of the cortical layers may cause swelling of the lens, thus making
the AC shallow (intumescent cataract) leading to increase IOP.
Mature stage: Eventually the entire cortex becomes opaque and white. The cataract is said to ripe or
mature no iris shadow is seen. The vision is now reduced to HM or PL
Slit lamp findings reveal that lens is completely opacified; ROR (red
orange reflex) cannot be seen. This is visualized with pupils fully dilated
In performing cataract surgery, it is important for the surgeon to prevent
ENDOTHELIAL TOUCH. The corneal endothelium is a single layer for cells
which do not regenerate. It touched, scratched or manipulated during
surgery, it will decompensate and opacify. You might have removed the
cataract but there is still opacification due to poor surgical technique.
Subscapular
Nuclear
Cortical
- Uncommon
- Polychromatic (glows when you check on slitlamp exam), needle-like deposits in the deep
cortex and nucleus.
- Shape is similar to Christmas tree.
Presenile Cataract
Mean age of cataract development at 65 y.o. (according to the American Academy of Ophthalmology and the Philippine Board of Ophthalmology)
Presence of systemic disorders may cause earlier onset of cataract formation
DIABETES MELLITUS
Aside from cataract, can affect refractive
index of lens and its amplitude of
accommodation,
Prevention: good sugar control
can affect refractive index and affect, can
affect amplitude of accommodation
cataract starts 50+ y.o.
MYOTONIC DYSTROPHY
Visually innocuous, fine cortical
Evolves into visually disabling stellate
posterior subcapsular
Iridescent opacities in the 3rd decade.
Cataract by the 5th decade.
Develops slowly, takes about 2 decades for
cataract to develop.
ATOPIC DERMATITIS
in 10% of patients with severe dermatitis,
cataract develop.
a) shield-likedense anterior subcapsular
plaque
b) posteriorsubcapsular
NEUROFIBROOMATOSIS TYPE 2
Posterior subcapsular or posterior cortical
opacities.
Traumatic Cataract
Trauma is the most common cause of unilateral cataract in young individuals secondary to physical trauma due to their active lifestyle and risk taking behaviors.
Bilateral cataracts are not as common but are possible depending on the extent of injury
is most commonly due to a foreign body injury to the lens or blunt trauma to the eyeball. Air rifle pellets are a frequent cause; less frequent causes include arrows, rocks, contusions, overexposure to
heat ("glassblower's cataract"), and ionizing radiation. Most traumatic cataracts are preventable. In industry, the best safety measure is a good pair of safety goggles
Traumatic "star-shaped" cataract in the posterior lens. This is usually due to ocular contusion and is only detectable through a well-dilated pupil
Traumatic cataract with wrinkled anterior capsule
Imprint of iris pigment on anterior surface of lens
ELECTRIC SHOCK OR LIGHTNING
IONIZING RADIATION
DIRECT PENETRATING
CONCUSSION
Tumor Treatment
INFRARED RADIATION
Drug-induced
Cataract
Corticosteroids administered over a long period of time, either systemically or in drop form, can cause lens opacities. Other drugs associated with cataract include phenothiazines,
amiodarone, and strong miotic drops such as phospholine iodide, used in the treatment of glaucoma.
STEROIDS
CHLORPROMAZINE
BUSULPHAN (MYERAN)
AMIODARONE
GOLD
in treatment of cardiac
arrhythmias, causes
inconsequential anterior
subcapsular opacities
in treatment of rheumatoid
arthritis, innocuous anterior
capsular opacities in 50% of
pts of >3yrs treatment
ALLOPURINOL
increases the risk of
cataracts in the elderly if
dose exceeds 400g or
duration of >3yrs Treatment
Secondary
Cataract
Closure glaucoma
Lens-induced glaucoma can present in two
forms: phacomorphic and phacolytic
Phacomorphic glaucoma increased IOP d/t
tumescent lens covering the pupil; aqueous
cant drain to the pupil
Phacolytic glaucoma lens appear to be
mature but there is problem with the lens
proteins such that they escape onto the
anterior chamber and clog up the trabecular
meshwork
For both cases, treatment remains to be
cataract removal
small, grey-white, anterior subcapsular or
capsular opacities within the pupillary area
(glaukomflecken)