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    Cataract

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    Amit Martin
    Cataracts are a clouding of the lens in the eye that causes blurred or dimmed vision and can lead to blindness if left untreated. Age is the most common cause of cataracts, and they are responsible for 48% of blindness worldwide. Surgical removal of the clouded lens and replacement with an intraocular lens is the most common treatment for cataracts when vision impairment cannot be corrected with glasses or contact lenses.

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    Cataract

    Uploaded by

    Amit Martin
    419 views45 pages
    Cataracts are a clouding of the lens in the eye that causes blurred or dimmed vision and can lead to blindness if left untreated. Age is the most common cause of cataracts, and they are responsible for 48% of blindness worldwide. Surgical removal of the clouded lens and replacement with an intraocular lens is the most common treatment for cataracts when vision impairment cannot be corrected with glasses or contact lenses.

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    Cataracts are a clouding of the lens in the eye that causes blurred or dimmed vision and can lead to blindness if left untreated. Age is the most common cause of cataracts, and they are responsible for 48% of blindness worldwide. Surgical removal of the clouded lens and replacement with an intraocular lens is the most common treatment for cataracts when vision impairment cannot be corrected with glasses or contact lenses.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    419 views45 pages

    Cataract

    Uploaded by

    Amit Martin
    Cataracts are a clouding of the lens in the eye that causes blurred or dimmed vision and can lead to blindness if left untreated. Age is the most common cause of cataracts, and they are responsible for 48% of blindness worldwide. Surgical removal of the clouded lens and replacement with an intraocular lens is the most common treatment for cataracts when vision impairment cannot be corrected with glasses or contact lenses.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 45

    CATARACT

    DEFINITION
    • A cataract is a clouding or opacity that develops in the
    crystalline lens of the eye or in its envelope, varying in
    degree from slight to capacity and obstructing the passage
    of light.
    or
    • It is a clouding or opaqueness of the crystalline lens which
    leads gradual painless blurring and eventual loss of vision

    • The term cataract is derived from the Greek word


    cataractos, which describes rapidly running water or
    falling water.
    Epidemiology
    1. Cataracts remain the
    leading cause of blindness.
    2. Age-related cataract
    is responsible for 48%
    of world blindness,
    which represents
    about 18 million
    people.
    3. Cataracts are also an
    important cause of low
    vision in both developed
    and developing countries.
    Causes of cataract
    • Old age (commonest)>65 Year • Congenital
    • Ocular & systemic diseases – Part of a syndrome
    – DM – Abnormal galactose
    – Uveitis metabolism
    –Previous ocular surgery – Hypoglycemia
    • Systemic medication • Inherited abnormality
    – Steroids – Myotonic
    – Phenothiazines dystrophy
    • Trauma & intraocular foreign – Marfan’s syndrom
    bodies – Rubella
    • Ionizing radiation – High myopia
    – X-ray
    – UV

    8
    Types of cataracts
    The lens is composed of layers, like an onion. The outermost is the
    capsule. The layer inside the capsule is the cortex, and the innermost
    layer is the nucleus. A cataract may develop in any of these areas.
    Cataracts are named for their location in the lens:

    A nuclear cataract is located in the center of the lens. The nucleus


    tends to darken with age, changing from clear to yellow and
    sometimes brown.

    A cortical cataract affects the layer of the lens surrounding the


    nucleus. The cataract looks like a wedge or a spoke.

    A posterior capsular cataract is found in the back outer layer of the


    lens. This type often develops more rapidly.
    PATHOPHYSIOLOGY
    Any physical or chemical cause
    ↓
    Disturbs the intracellular and extracellular equilbrium of water and
    electrolytes
    ↓
    Deranges the colloid system in lens fibres
    ↓
    Aberrant fibres are formed from germinal epithelium of lens
    ↓
    Epithelial cell necrosis
    ↓
    Focal
    opacification of lens epithelium
    (glau
    comflecken)

    ↓
    Opa
    Opacification of lens takeplace by 3 biochemical changes.

    1. Hydration 2.Denaturation of 3.Slow


    lens protein
    sclerosis
    c c
    c

    Abnormalities of lens proteins & Disorganisation of lens fibres

    c
    Loss of transparency of lens
    c

    Cataract
    Cataract
    Divided to :
    • Acquired cataract
    Age – related cataract
    Metabolic cataract
    Radiation or electric cataract
    Traumatic cataract
    Toxic cataract
    Secondary cataract
    AGE OF ONSET:

    1. CONGENITAL
    2. INFANTILE
    3. JUVINILE
    4. PRE-SENILE
    5. SENILE
    CONGENITAL CATARACT
    INFANTILE AND JUVINILE CATARACT
    Age -related cataract
    It is the Most commonly occurred.
    Classified according to:
    Morphological Classification
    •Capsular cataract
    •Sub capsular cataract
    •Cortical cataract
    •Supra nuclear cataract
    •Nuclear cataract
    •Polar cataract
    Nuclear cataract
    • Most common type
    • Age-related
    • Occur in the center of the
    lens.
    • It involves the nucleus of
    the crystalline lens. The
    nucleus becomes diffusely
    cloudy and obstructs the
    light rays.
    Cortical cataract
    • Occur on the outer edge of the lens (cortex).
    • Begins as whitish, wedge-shaped opacities.
    • The lens fibers of the cortex are mainly affected. There is
    hydration due to accumulation of water droplets in between the
    fibers and the protein are first denaturated and then are
    coagulated forming opacity.
    CAPSULAR CATARACT
    • It involves the capsule and may be anterior
    capsule or posterior capsule.

    Subcapsular cataract

    •It involves superficial part of the cortex(just below the


    capsule) and includes anterior sub capsule or posterior
    sub capsule.
    MATURITY:
    1. Immature catarct
    2. Mature cataract
    3. Hypermature cataract
    MATURE AND IMMATURE CATARACT
    Mature Cataract
    • Lens is completely opaque.
    • Vision reduced to just perception of light
    • Iris shadow is not seen
    • Lens appears pearly white

    Right eye mature cataract, with obvious white


    opacity at the centre of pupil
    IMMATURE CATARACT
    Hypermature Cataract
    • Shrunken and wrinkled anterior capsule due to leakage of water
    out of the lense.

    •This may take any of two forms:


    1.Liquefactive/Morgagnian Type
    2.Sclerotic Cataract
    Liquefactive/Morgagnian Type
    • Cortex undergoes auto-lytic liquefaction and turns uniformly
    milky white.
    • The nucleus loses support and settles to the bottom.
    Sclerotic Cataract

    • The fluid from the cortex gets absorbed


    and the lens becomes shrunken.
    • There may be deposition of calcific
    material on the lens capsule.
    • Iridodonesis: Anterior chamber
    deepens and iris becomes tremulous.
    • The zonules become weak, increasing
    the risk of subluxation / dislocation
    of lens.
    SUBJECTIVE CLASSIFICATION:
    • Grade 0: clear lens
    • Grade 1: swollen fibres and sub capsular
    opacities
    • Grade 2: nuclear cataract and visible lens
    fibres
    • Grade 3: strong nuclear cataract with
    perinuclear area opacity
    • Grade 4: total opacity
    Subjective classification
    Clinical Manifestations
    • Gradual painless • Photophobia(light
    burning sensitivity)
    • Loss of vision due to
    lens opacity • Blurred or
    • Increased glare in distorted images
    bright light • Light scattering
    • Decreased color • Leukokoria or
    perception
    • Decreased visual white pupil
    acuity • Reduced light
    • Poor vision at transmission
    night • Contrast sensitivity is also
    lost
    Blurred vision due to scattering of light on the
    retina
    Glared view(trouble driving at night)
    Change in colour vision(dimness)
    1. H isto ry co llectio n
    2. Visual acuity test
    3. Dilated eye exam
    4. Tonometry
    Cataracts are diagnosed through a comprehensive eye examination
    This examination may include:

    Patient history to determine if vision difficulties are limiting daily activities and
    other general health concerns affecting vision.

    Visual acuity measurement to determine to what extent a cataract may be limiting


    clear distance and near vision.

    Refraction to determine the need for changes in an eyeglass or contact lens


    prescription.

    Evaluation of the lens under high magnification and illumination to determine the
    extent and location of any cataracts.

    Evaluation of the retina of the eye through a dilated pupil.

    Measurement of pressure within the eye.

    Supplemental testing for color vision and glare sensitivity.


    Treatment
    • Glasses: Cataract alters the refractive power of the natural lens
    so glasses may allow good vision to be maintained.
    • Surgical removal: when visual acuity can't be improved with
    glasses.

    • Surgical techniques

    – Phacoemulsification method.

    – Extracapsular cataract extraction.

    – Intra capsular cataract extraction.

    – Intraocular lens implantation


    .

    Phacoemulsification in cataract surgery involves


    insertion of a tiny, hollowed tip that uses high frequency
    (ultrasonic) vibrations to "break up" the eye's cloudy lens
    (cataract). The same tip is used to suction out the lens
    Intra-capsular Cataract Extraction
    Intracapsular Cataract Extraction. From the late
    1800s until the 1970s, the technique of choice for
    cataract extraction was intracapsular cataract extraction
    (ICCE).The entire lens (ie, nucleus, cortex,
    and capsule) is removed, and fine sutures close the
    incision .

    ICCE is infrequently performed today; however, it is


    indicated when there is a need to remove the entire lens,
    such as with a subluxated cataract (ie, partially or
    completely dislocated lens).
    Extra-capsular Cataract Extraction
    (ECCE)
    Extracapsular Surgery. Extracapsular
    cataract extraction (ECCE) achieves the
    intactness of smaller incisional wounds (less
    trauma to the eye) and maintenance of the
    posterior capsule of the lens, reducing
    postoperative complications, particularly
    aphakic retinal detachment and cystoid macular
    edema.
    Postoperative care after cataract
    surgery
    • Steroid drops(inflammation)
    •
    • Antibiotic drops (infection)

    Avoid
    • Very strenuous exertion (rise
    the pressure in the eyeball)
    • Ocular trauma.
    Complications of cataract surgery
    • Infective endophthalmitis
    – Rare but can cause permanent severe reduction of vision.
    – Most cases within two weeks of surgery.
    – Typically patients present with a short history of a
    reduction in their vision and a red painful eye.
    – This is an ophthalmic emergency.
    – Low grade infection with pathogen such as
    Propionibacterium species can lead patients to present
    several weeks after initial surgery with a refractory uveitis

    • Suprachoroidal haemorrhage.
    – Severe intraoperative bleeding can
    lead to serious and permanent
    reduction in vision.
    • Uveitis

    • Ocular perforation.

    • Postoperative refractive error

    • Posterior capsular rupture and

    • vitreous loss
    Nursing diagnosis
    • Disturbed Sensory Perception related to opacity of lens.

    • Anxiety related to lack of knowledge about post operative


    care.

    • Risk for infection related to surgical incision and self care


    after surgery.

    • Risk for injury related to blurred vision or sensory deficit while


    operated eye is patched.

    • Acute pain related to trauma to the incision and increased IOP

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