Disease of lensDisease of lens

Anatomy Anatomy lens capsule + lens fibelens capsule + lens fibe

CharacterCharacter transparenttransparent

avascular avascular

nourishment come from aqueous humornourishment come from aqueous humor

LensLens

CataractCataract

General description of cataractGeneral description of cataract

DefinitionDefinition When there are changes of When there are changes of aqueous humor componentaqueous humor component

osmotic character of lens capsuleosmotic character of lens capsule

metabolic disturbancemetabolic disturbance

caused by various factorscaused by various factors

lens protein lens protein degenerationdegeneration

transparent lens becomes opaquetransparent lens becomes opaque

called cataractcalled cataract

According to According to

CauseCause age-related traumatic complicated age-related traumatic complicated

Age occurredAge occurred congenital acquired congenital acquired

Site of opacitySite of opacity nuclear cortical capsular subcapsular nuclear cortical capsular subcapsular

Shape of opacityShape of opacity punctate coronary lamellar punctate coronary lamellar

Degree of opacityDegree of opacity incipient immature mature hypermature incipient immature mature hypermature

ClassificationClassification

Clinical findingsClinical findings

Progressive blurred vision Progressive blurred vision

Contrast sensitivity changeContrast sensitivity change

Increase in the refractive indexIncrease in the refractive index

Monocular diplopia or polyopiaMonocular diplopia or polyopia

DazzleDazzle

Change of color sensationChange of color sensation

Defect of visual fieldDefect of visual field

Age-related cataract (senile Age-related cataract (senile

cataract)cataract)

Clinical findingsClinical findings

progressive blurred visionprogressive blurred vision

3 categories3 categories

cortical cataractcortical cataract

nuclear cataract nuclear cataract

subcapsular cataract subcapsular cataract

Cortical cataractCortical cataract

4 stages4 stages

incipient stageincipient stage

intumescent stage or immature stageintumescent stage or immature stage

mature stagemature stage

hypermature stagehypermature stage

Incipient stageIncipient stage

cuneiform opacity in peripheralcuneiform opacity in peripheral

tip towards to centretip towards to centre

pupillary area not affected pupillary area not affected

difficult to find without mydriasisdifficult to find without mydriasis

no blurred vision take placeno blurred vision take place

Intumescent stageIntumescent stage

uneven milk-white opacityuneven milk-white opacity

vision decrease obviouslyvision decrease obviously

fundus difficult to be seenfundus difficult to be seen

swollen cortex ---push iris forwardswollen cortex ---push iris forward

---shallow anterior chamber------shallow anterior chamber---

glaucomaglaucoma

be careful to mydriasisbe careful to mydriasis

maturemature stagestage

entire lens appear as grey-white opacityentire lens appear as grey-white opacity

fundus can not to be seenfundus can not to be seen

vision decrease to FC or HMvision decrease to FC or HM

swollen cortex decrease---normal anterior chamberswollen cortex decrease---normal anterior chamber

Hypermature stage—Morgagni cataractHypermature stage—Morgagni cataract

cortex fibers decomposed cortex fibers decomposed

entire lens reduced capsule shrankentire lens reduced capsule shrank

nucleus fallen downnucleus fallen down

anterior chamber become deeper anterior chamber become deeper

iridodonesisiridodonesis

vision increasevision increase

lens-induced uveitislens-induced uveitis

Phacolytic glaucomaPhacolytic glaucoma

nuclear cataractnuclear cataract

develop slowlydevelop slowly

from embryonic nucleus to adult’s nucleusfrom embryonic nucleus to adult’s nucleus

grey-yellowish in centre grey-yellowish in centre

less affect vision in early stageless affect vision in early stage

Posterior subcapsular cataractPosterior subcapsular cataract

at subcapsular cortex in posterior pole of lens at subcapsular cortex in posterior pole of lens

appear as plate shapeappear as plate shape

blurred vision take place in early stageblurred vision take place in early stage

Congenital cataractCongenital cataract

EtiologyEtiologyGenetic factor Genetic factor

autosomal dominant inheritanceautosomal dominant inheritance

Environmental factorEnvironmental factor

viral infection rubellaviral infection rubella

nourishment disturbance Vit Dnourishment disturbance Vit D

Morphology Morphology

anterior polar cataractanterior polar cataract

posterior polar cataractposterior polar cataract

perinuclear or zonular cataractperinuclear or zonular cataract

coronary cataractcoronary cataract

total cataracttotal cataract

Congenital cataractCongenital cataract

Complicated cataractComplicated cataract

Induced by ocular inflammation or

degenerative disorders

Anterior segment disorder---cortex opaque

Posterior segment disorder---nucleus opaque

Metabolic cataractMetabolic cataract

diabetic cataractdiabetic cataract

galactose cataractgalactose cataract

tetany cataracttetany cataract

Diabetic cataractDiabetic cataract

Combine with senile cataractCombine with senile cataract

Single diabetic cataract Single diabetic cataract

Tetany cataractTetany cataract

Hypocalcemia Hypocalcemia

After extraction of parathyroid After extraction of parathyroid

Drug-induced or toxic cataractDrug-induced or toxic cataract

Glucocorticosteroid cataractGlucocorticosteroid cataract

Chlorpromazine cataractChlorpromazine cataract

Miotic cataractMiotic cataract

Trinitrotoluence cataractTrinitrotoluence cataract

Metal-induced cataractMetal-induced cataract

Traumatic cataractTraumatic cataract

Contusive cataractContusive cataract

Penetrating cataractPenetrating cataract

Radiative cataractRadiative cataract

Electric cataractElectric cataract

After cataractAfter cataract

After extracapsular cataract extraction After extracapsular cataract extraction

or aspiration of lens or aspiration of lens

Symptom blurred visionSymptom blurred vision

Treatment YAG laserTreatment YAG laser

Dislocated lensDislocated lens

Hereditary lens dislocation

Traumatic lens dislocation

partial dislocation partial dislocation

completely dislocation completely dislocation

Surgery of cataractSurgery of cataract

OccasionOccasion

ExaminationExamination

Method Method

Surgery proceduresSurgery procedures

Intracapsular cataract extraction Extracapsular Intracapsular cataract extraction Extracapsular

cataract extraction + IOL implantation cataract extraction + IOL implantation

ECCE + IOLECCE + IOL

Phacoemulsifaction + IOL implantationPhacoemulsifaction + IOL implantation

PHACO + IOLPHACO + IOL

Intracapsular cataract extractionIntracapsular cataract extraction

白内障现代囊外摘除术 +人工晶体植入术 ECCE+IOL

PHACO + IOLPHACO + IOL

SUMMARY

CATARACTCATARACT

I.I.Classification of cataractClassification of cataract

※※ Congenital cataractCongenital cataract

※※ Senile cataractSenile cataract

※※ Traumatic cataractTraumatic cataract

※※ Secondary cataractSecondary cataract

※※ Complicated Complicated cataractcataract

((一一 ) ) Cortical Cortical cataractcataract 1. incipient stage 2. premature stage 3. mature stage 4. hypermature stage

(( 二二 ) ) Neuclear Neuclear cataractcataract

II.II.Diagnosis of cataractDiagnosis of cataract

(1) age(1) age

(2) gradual decrease of vision(2) gradual decrease of vision

(3) lens opacity(3) lens opacity

III.III.Treatment of cataractTreatment of cataract

operation methods:operation methods:

•Intracapsular cataract extraction (ICCE)

•Extracapsular cataract extraction (ECCE)

•PhacoemusificationPhacoemusification

ECCE+IOLECCE+IOL

Thank You ！