Aetiology
Congenital cataracts occur in about 3 in 10 000 live births. Two-thirds of cases are bilateral and the cause can be identified
in about half of those affected. The most common cause is genetic mutation, usually autosomal dominant (AD); other causes
include chromosomal abnormalities, metabolic disorders and intrauterine infections.
unilateral cataracts are usually sporadic, without a family history or systemic disease, and affected infants are usually full-
term and healthy.
-Inheritance
Isolated hereditary cataracts account for about 25% of cases. The mode is most frequently AD but may be autosomal
recessive (AR) or X-linked (X-L).
Isolated inherited congenital cataracts carry a better visual prognosis than those with coexisting ocular and systemic
abnormalities.
Morphology:
The morphology of congenital cataract is important because it may indicate a likely etiology, mode of inheritance and effects
on vision.
1- Nuclear opacities are confined to the embryonic or foetal nuclei of the lens.
2- Lamellar opacities affect a particular lamella of the lens both anteriorly and posteriorly .
3- Coronary (supranuclear) cataract lies in the deep cortex and surrounds the nucleus like a crown .
4- Blue dot opacities (cataracta punctata caerulea ).
5- Sutural in which the opacity follows the anterior or posterior Y suture.
6- Anterior polar may be flat or project as a conical opacity into the anterior chamber (pyramidal cataract) . bilateral in one-
third of cases and visually insignificant.
7- Posterior polar cataract may be occasionally associated with persistent hyaloid remnants , posterior lenticonus and 🔷 Cataract is defined as opacification of the crystalline lens
The term cataract comes from the Greek word katarraktes (downrushing; waterfall) because earlier it was
persistent hyperplastic primary vitreous.
8- Central ‘oil droplet’ opacities are characteristic of galactosaemia. thought that the cataract was a congealed fluid from the brain that had flowed in front of the lens.
9- Membranous cataract is rare. It occurs when the lenticular material partially or completely reabsorbs leaving behind account for about 40% of global blindness
residual chalky-white lens matter sandwiched between the anterior and posterior capsule
🔹 Risk factors:
1- Age occurring in almost every ageing population
🔹
Systemic metabolic associations 2-sunlight, smoking, alcohol, dehydration, radiation, corticosteroid use, and diabetes mellitus.
Galactoasemia Pathogenesis:
Pathogenesis: is an autosomal recessive AR condition characterized by severe impairment of galactose utilization caused by How these factors cause cataracts is unclear, although a common pathway appears to be protein denaturation,
absence of the enzyme galactose-1-phosphate uridyl transferase (GPUT). e.g. Metabolic disturbance (hyperglycaemia in diabetes mellitus) leads to alteration of the refractive index of
Treatment the lens secondary to fluids accumulation.
Timing is crucial and the main considerations are as follows:
🔹
1- Bilateral dense cataracts require early surgery when the child is 4–6 weeks of age to prevent the development of
stimulus deprivation amblyopia. If the severity is asymmetrical, the eye with the denser cataract should be addressed first. Clinical presentations:
2- Bilateral partial cataracts may not require surgery until later if at all. monitor lens opacities and visual function and 1-Symptoms
intervene later if vision deteriorates. Gradual painless dimimution of vision: plus other visual complains like :contrast sensitivity, colour
3- Unilateral dense cataract merits urgent surgery (possibly within days) followed by aggressive antiamblyopia therapy. appreciation,and glare.
The timing of intervention should be balanced by the suggestion that early intervention (<4 weeks) may result in an Change in refraction: typically, myopic shift in nuclear sclerosis or changing astigmatism.
increased risk of subsequent secondary glaucoma. If the cataract is detected after 16 weeks of age then the visual
prognosis is particularly poor. Congenital 1% 2- Signs
• Reduced visual acuity measured on a Snellen chart and
4- Partial unilateral cataract can usually be observed or treated non surgically with pupillary dilatation and possibly part near vision chart.
time contralateral occlusion to prevent amblyopia. • An abnormally dim red reflex is seen when the retina is viewed
5- Surgery involves anterior capsulorhexis, aspiration of lens matter, capsulorhexis of the posterior capsule, limited with an ophthalmoscope at arms length.
anterior vitrectomy and IOL implantation, if appropriate. It is important to correct associated refractive errors. • Only very dense cataracts causing severely impaired vision
cause a white pupil.
🔷Postoperative complications: • After pupils have been dilated, slit lamp examination shows
whether the cataract is cortical, nuclear or posterior subcapsular
Cataract surgery in children carries a higher incidence of complications than in adults.
1-Posterior capsular opacification is nearly universal if the posterior capsule is retained intro and allows fundus examination.
🔹
in a child under the age of 6 years. It is also of more significance in young children
because of its amblyogenic effect Time of onset
2-Secondary membranes may form across the pupil, particularly in microphthalmic eyes - Acquired 99%( Senile,
or those with associated chronic uveitis. complicated, traumatic)
3- Proliferation of lens epithelium is universal but usually visually inconsequential, - Congenital 1%
since it does not involve the visual axis. It becomes encapsulated within the remnants of
the anterior and posterior capsules.
4- Glaucoma eventually develops in about 20% of eyes.
5- Retinal detachment is an uncommon and usually late complication.
🔹 Maturity of cataract
-Immature: opacification is incomplete.
-Mature: opacification is total
-Hypermature: lysis of the cortex results in
visual rehabilitation: shrinkage, seen clinically as wrinkling of the
Classification of cataract capsule.
The main problem after catract extraction in children is amblyopia. With regard to optical correction Cataract can be classified, according to Time of onset,
for the aphakic child, the two main considerations are age and laterality of aphakia. - Morgagnian: liquefaction of the cortex
morphology, grade of opacification, and maturity. allows the harder nucleus to drop inferiorly
1- Spectacles are useful for older children with bilateral aphakia.
2- Contact lenses provide a superior optical solution for both unilateral and bilateral aphakia. (but still within the capsule
Tolerance is usually reasonable until the age of about 2 years, although after this period problems
with compliance may develop as the child becomes more active and independent.
3- IOL implantation : Awareness of the rate of myopic shift which occurs in the developing eye,
allows the calculation of an IOL power targeted at initial hypermetropia (correctable with spectacles)
🔹 morphology can be divided into
-Subcapsular cataract
which will ideally decay towards emmetropia later in life. However, final refraction is variable and -Nuclear cataract
emmetropia in adulthood cannot be guaranteed. -Cortical cataract
4- Occlusion to treat or prevent amblyopia is essential. Atropine penalization may also be -Christmas tree cataract
considered NB: Nuclear cataract starts as an exaggeration of the normal ageing
changes involving the lens nucleus. It is often associated with myopia due to
an increase in the refractive index of the nucleus, Some elderly patients may
consequently be able to read without spectacles again ('second sight of the
aged’).
🔹A)Diabetes mellitus cataract
Hyperglycaemia → ↑glucose in the aqueous humour, which diffuses into the lens. Here glucose is
metabolized into sorbitol, which accumulates within the lens, resulting in secondary osmotic over
hydration. In mild degree, this may affect the refractive index of the lens with consequent fluctuation of 🔷 intraoperative complications
1-Rupture of the posterior lens capsule
refraction in line with the plasma glucose level, hyperglycaemia resulting in myopia and vice versa.
1- Classic diabetic cataract, which is rare, consists of snowflake cortical opacities, occurring in the Capsular rupture may be accompanied by vitreous loss, posterior migration of lens
young diabetic. Such a cataract may resolve spontaneously or mature within a few days. material, and rarely expulsive haemorrhage.
Sequelae to vitreous loss, particularly if inappropriately managed, include chronic cystoid
🔹
2- Age-related cataract occurs earlier in diabetes mellitus. Nuclear opacities are common.
B)Myotonic dystrophy Cataract in systemic macular oedema, retinal detachment, endophthalmitis, updrawn pupil, uveitis, glaucoma
Myotonic dystrophy is characterized by delayed muscular relaxation after cessation of voluntary and posterior dislocation of the IOL.
effort (myotonia). About 90% of patients develop visually innocuous, fine cortical iridescent opacities in
diseasesd 2- Posterior loss of lens fragments into the vitreous cavity after zonular dehiscence or
the 3rd decade which evolve into visually disabling stellate posterior subcapsular opacities , by the 5th posterior capsule rupture is rare but potentially serious as it may result in glaucoma,
chronic uveitis, retinal detachment and chronic cystoid macular oedema.
🔹
decade that may progress to maturity; occasionally cataract may predate myotonia.
3- Posterior dislocation of IOL
C) Atopic dermatitis Dislocation of an IOL into the vitreous cavity is a rare but serious complication particularly
About 10% of patients with severe atopic dermatitis develop cataracts in the 2nd–4th decades; these if accompanied by loss of lens material ..
🔹
are often bilateral and may mature quickly. 4- Suprachoroidal haemorrhage
D) Neurofibromatosis type 2 involves a bleed into the suprachoroidal space from a ruptured long or short posterior
NF2 is associated with cataract in about 60% of patients. It tends to develop prior to the age of 30 years. ciliary artery. If sufficiently severe it may result in extrusion of intraocular contents
(‘expulsive’ haemorrhage).
Glaucoma Contributing factors include: advanced age, and vitrous loss, systemic
A secondary (complicated) cataract develops as a result of some other primary ocular cardiovascular disease
🔹
disease.
1-Chronic anterior uveitis
Chronic anterior uveitis is the most common cause. The incidence is related to the 🔷
🔹 Acute postoperative endophthalmitis (at least 0.1%):
Risk factors may include:
duration and activity of intraocular inflammation that results in prolonged breakdown of
the blood–aqueous and/or blood–vitreous barrier. The use of steroids, topically and operative complications such as posterior capsule rupture,
systemically. Cataract appears to progress more rapidly in the presence of posterior prolonged procedure time, combined procedure (e.g. with vitrectomy), wound leak on the first day,
delaying postoperative topical antibiotics until the day after surgery, topical anaesthesia, adnexal
🔹2-Acute congestive angle-closure
synechiae.
Acute congestive angle-closure may cause small, grey-white, anterior, subcapsular or Secondary cataract complications
🔹
disease and diabetes.
Pathogens:
About 90% of isolates are Gram-positive and 10%
capsular opacities within the pupillary area (glaukomflecken) . They represent focal
Gram-negative. Staphylococcus epidermidis is the most common.
🔹
infarcts of the lens epithelium.
1- Symptoms are pain and visual loss.
3-High myopia
2- Signs
is associated with posterior subcapsular lens opacities and early-onset nuclear sclerosis,
• Eyelid swelling, chemosis, conjunctival injection and discharge.
🔹
which may increase the myopic refractive error.
• A relative afferent pupillary defect is common.
4-Hereditary fundus dystrophies • Corneal haze
such as retinitis pigmentosa may be associated with posterior subcapsular lens opacities • Fibrinous exudate and hypopyon
.Cataract surgery may occasionally improve visual acuity even in the presence of severe
retinal changes. Acquired 99% 🔹 • Vitritis with an impaired view of the fundus
Management : Vitreous tapping for C/S to confirm the diagnosis and intravitreal antibiotics with
core vitrectomy.
1-Steroids : Both systemic and topical are cataractogenic .
2- Chlorpromazine
3- Busulphan which used in treatment of chronic myeloid
leukaemia.
🔷 Delayed-onset postoperative Endophthalmitis:
Delayed-onset endophthalmitis following cataract surgery develops when an organism of low virulence
4- Amiodarone which used in treatment of cardiac Drug induced cataract becomes trapped within the capsular bag ('saccular endophthalmitis’). It has an onset ranging from 4 weeks
arrhythmias . to years (mean of 9 months) postoperatively.
🔷postoperative complications
5- Gold which used in treatment of rheumatoid arthritis. It may rarely be precipitated by Nd:YAG laser capsulotomy, which releases the organism into the vitreous.
6- Allopurinol which used in treatment of hyperuricaemia and 1- Presentation: painless mild progressive visual deterioration which may be associated with floaters.
chronic gout. 2- Signs:
• Low-grade anterior uveitis, sometimes with mutton-fat keratic precipitates . The inflammation initially
🔹 Trauma is the most common cause of unilateral cataract in young
responds well to topical steroids, but recurs when treatment is stopped and eventually becomes steroid
🔹 Phacomorphic glaucoma: The large cataractous lens may cause anterior bowing of the iris with 2ry
angle closure. Presentation is as acute or chronic angle closure with high IOP, shallow AC, and fixed semi- dilated
individuals and may include the following.
1- Penetrating trauma .
resistant .
• Vitritis is common but hypopyon infrequent.
• An enlarging capsular plaque composed of organisms sequestrated in residual cortex within the peripheral
2- Blunt trauma :may cause a characteristic flower-shaped opacity
pupil. Distinguish it from 1ry angle closure glaucoma (PACG) by the presence of an ipsilateral swollen capsular bag is characteristic .
3- Electric shock and lightning strike: are very rare causes that may result
🔹 Traumatic cataract
cataractous lens and a contralateral open angle with a deep AC. • Gonioscopy under mydriasis may identify an equatorial plaque.
in anterior and posterior iridescent opacities
phacolytic glaucoma: The hypermature cataract loses soluble lens proteins through the intact anterior 3-Treatment if persistent:
4- Infrared radiation: if intense as in glass blowers, may rarely cause true
capsule, causing trabecular obstruction and subsequent 2ry open angle glaucoma. Note raised IOP, lens protein exfoliation of the anterior lens capsule ○- Intravitreal antibiotics alone are usually unsuccessful in resolving the infection.
in a deep AC (may form a pseudohypopyon), open angles, and hypermature cataract. 5- Ionizing radiation : for ocular tumours may cause posterior subcapsular ○- Removal of the capsular bag, residual cortex and IOL, requiring pars plana vitrectomy. Secondary IOL
opacities ,that may develop months or years later.
🔷 Posterior capsular opacification
🔹
Indications for surgery
1-Visual improvement: It is the most common indication for cataract surgery. Operation is indicated
Visually significant posterior capsular opacification (PCO) is the most common late
complication of uncomplicated cataract surgery. Apart from reducing visual acuity, PCO
🔹
when the opacity causing difficulty in performing essential daily activities.
2- Medical: the cataract is affecting the health of the eye, for example, phacolytic or phacomorphic
glaucoma.
may impair contrast sensitivity, cause difficulties with glare or give rise to monocular
diplopia.
Management : YAG laser capsulotomy
Cataract surgery to improve the clarity of the ocular media may be required to exam fundal pathology
Management of age-related
🔹
(e.g. diabetic retinopathy) requiring monitoring or treatment.
Cataract extraction:
Intracapsular catract extraction (ICCE)
cataract
Extracapsular catract extraction (ECCE)
Phacoemulsification ( small self-sealed wound and less astigmatism) by fatema okoff
I/A
NB IOL calculation is mandatory before cataract surgery.
Congenital cataracts occur in about 3 in 10 000 live births. Two-thirds of cases are bilateral and the cause can be identified
in about half of those affected. The most common cause is genetic mutation, usually autosomal dominant (AD); other causes
include chromosomal abnormalities, metabolic disorders and intrauterine infections.
unilateral cataracts are usually sporadic, without a family history or systemic disease, and affected infants are usually full-
term and healthy.
-Inheritance
Isolated hereditary cataracts account for about 25% of cases. The mode is most frequently AD but may be autosomal
recessive (AR) or X-linked (X-L).
Isolated inherited congenital cataracts carry a better visual prognosis than those with coexisting ocular and systemic
abnormalities.
Morphology:
The morphology of congenital cataract is important because it may indicate a likely etiology, mode of inheritance and effects
on vision.
1- Nuclear opacities are confined to the embryonic or foetal nuclei of the lens.
2- Lamellar opacities affect a particular lamella of the lens both anteriorly and posteriorly .
3- Coronary (supranuclear) cataract lies in the deep cortex and surrounds the nucleus like a crown .
4- Blue dot opacities (cataracta punctata caerulea ).
5- Sutural in which the opacity follows the anterior or posterior Y suture.
6- Anterior polar may be flat or project as a conical opacity into the anterior chamber (pyramidal cataract) . bilateral in one-
third of cases and visually insignificant.
7- Posterior polar cataract may be occasionally associated with persistent hyaloid remnants , posterior lenticonus and 🔷 Cataract is defined as opacification of the crystalline lens
The term cataract comes from the Greek word katarraktes (downrushing; waterfall) because earlier it was
persistent hyperplastic primary vitreous.
8- Central ‘oil droplet’ opacities are characteristic of galactosaemia. thought that the cataract was a congealed fluid from the brain that had flowed in front of the lens.
9- Membranous cataract is rare. It occurs when the lenticular material partially or completely reabsorbs leaving behind account for about 40% of global blindness
residual chalky-white lens matter sandwiched between the anterior and posterior capsule
🔹 Risk factors:
1- Age occurring in almost every ageing population
🔹
Systemic metabolic associations 2-sunlight, smoking, alcohol, dehydration, radiation, corticosteroid use, and diabetes mellitus.
Galactoasemia Pathogenesis:
Pathogenesis: is an autosomal recessive AR condition characterized by severe impairment of galactose utilization caused by How these factors cause cataracts is unclear, although a common pathway appears to be protein denaturation,
absence of the enzyme galactose-1-phosphate uridyl transferase (GPUT). e.g. Metabolic disturbance (hyperglycaemia in diabetes mellitus) leads to alteration of the refractive index of
Treatment the lens secondary to fluids accumulation.
Timing is crucial and the main considerations are as follows:
🔹
1- Bilateral dense cataracts require early surgery when the child is 4–6 weeks of age to prevent the development of
stimulus deprivation amblyopia. If the severity is asymmetrical, the eye with the denser cataract should be addressed first. Clinical presentations:
2- Bilateral partial cataracts may not require surgery until later if at all. monitor lens opacities and visual function and 1-Symptoms
intervene later if vision deteriorates. Gradual painless dimimution of vision: plus other visual complains like :contrast sensitivity, colour
3- Unilateral dense cataract merits urgent surgery (possibly within days) followed by aggressive antiamblyopia therapy. appreciation,and glare.
The timing of intervention should be balanced by the suggestion that early intervention (<4 weeks) may result in an Change in refraction: typically, myopic shift in nuclear sclerosis or changing astigmatism.
increased risk of subsequent secondary glaucoma. If the cataract is detected after 16 weeks of age then the visual
prognosis is particularly poor. Congenital 1% 2- Signs
• Reduced visual acuity measured on a Snellen chart and
4- Partial unilateral cataract can usually be observed or treated non surgically with pupillary dilatation and possibly part near vision chart.
time contralateral occlusion to prevent amblyopia. • An abnormally dim red reflex is seen when the retina is viewed
5- Surgery involves anterior capsulorhexis, aspiration of lens matter, capsulorhexis of the posterior capsule, limited with an ophthalmoscope at arms length.
anterior vitrectomy and IOL implantation, if appropriate. It is important to correct associated refractive errors. • Only very dense cataracts causing severely impaired vision
cause a white pupil.
🔷Postoperative complications: • After pupils have been dilated, slit lamp examination shows
whether the cataract is cortical, nuclear or posterior subcapsular
Cataract surgery in children carries a higher incidence of complications than in adults.
1-Posterior capsular opacification is nearly universal if the posterior capsule is retained intro and allows fundus examination.
🔹
in a child under the age of 6 years. It is also of more significance in young children
because of its amblyogenic effect Time of onset
2-Secondary membranes may form across the pupil, particularly in microphthalmic eyes - Acquired 99%( Senile,
or those with associated chronic uveitis. complicated, traumatic)
3- Proliferation of lens epithelium is universal but usually visually inconsequential, - Congenital 1%
since it does not involve the visual axis. It becomes encapsulated within the remnants of
the anterior and posterior capsules.
4- Glaucoma eventually develops in about 20% of eyes.
5- Retinal detachment is an uncommon and usually late complication.
🔹 Maturity of cataract
-Immature: opacification is incomplete.
-Mature: opacification is total
-Hypermature: lysis of the cortex results in
visual rehabilitation: shrinkage, seen clinically as wrinkling of the
Classification of cataract capsule.
The main problem after catract extraction in children is amblyopia. With regard to optical correction Cataract can be classified, according to Time of onset,
for the aphakic child, the two main considerations are age and laterality of aphakia. - Morgagnian: liquefaction of the cortex
morphology, grade of opacification, and maturity. allows the harder nucleus to drop inferiorly
1- Spectacles are useful for older children with bilateral aphakia.
2- Contact lenses provide a superior optical solution for both unilateral and bilateral aphakia. (but still within the capsule
Tolerance is usually reasonable until the age of about 2 years, although after this period problems
with compliance may develop as the child becomes more active and independent.
3- IOL implantation : Awareness of the rate of myopic shift which occurs in the developing eye,
allows the calculation of an IOL power targeted at initial hypermetropia (correctable with spectacles)
🔹 morphology can be divided into
-Subcapsular cataract
which will ideally decay towards emmetropia later in life. However, final refraction is variable and -Nuclear cataract
emmetropia in adulthood cannot be guaranteed. -Cortical cataract
4- Occlusion to treat or prevent amblyopia is essential. Atropine penalization may also be -Christmas tree cataract
considered NB: Nuclear cataract starts as an exaggeration of the normal ageing
changes involving the lens nucleus. It is often associated with myopia due to
an increase in the refractive index of the nucleus, Some elderly patients may
consequently be able to read without spectacles again ('second sight of the
aged’).
🔹A)Diabetes mellitus cataract
Hyperglycaemia → ↑glucose in the aqueous humour, which diffuses into the lens. Here glucose is
metabolized into sorbitol, which accumulates within the lens, resulting in secondary osmotic over
hydration. In mild degree, this may affect the refractive index of the lens with consequent fluctuation of 🔷 intraoperative complications
1-Rupture of the posterior lens capsule
refraction in line with the plasma glucose level, hyperglycaemia resulting in myopia and vice versa.
1- Classic diabetic cataract, which is rare, consists of snowflake cortical opacities, occurring in the Capsular rupture may be accompanied by vitreous loss, posterior migration of lens
young diabetic. Such a cataract may resolve spontaneously or mature within a few days. material, and rarely expulsive haemorrhage.
Sequelae to vitreous loss, particularly if inappropriately managed, include chronic cystoid
🔹
2- Age-related cataract occurs earlier in diabetes mellitus. Nuclear opacities are common.
B)Myotonic dystrophy Cataract in systemic macular oedema, retinal detachment, endophthalmitis, updrawn pupil, uveitis, glaucoma
Myotonic dystrophy is characterized by delayed muscular relaxation after cessation of voluntary and posterior dislocation of the IOL.
effort (myotonia). About 90% of patients develop visually innocuous, fine cortical iridescent opacities in
diseasesd 2- Posterior loss of lens fragments into the vitreous cavity after zonular dehiscence or
the 3rd decade which evolve into visually disabling stellate posterior subcapsular opacities , by the 5th posterior capsule rupture is rare but potentially serious as it may result in glaucoma,
chronic uveitis, retinal detachment and chronic cystoid macular oedema.
🔹
decade that may progress to maturity; occasionally cataract may predate myotonia.
3- Posterior dislocation of IOL
C) Atopic dermatitis Dislocation of an IOL into the vitreous cavity is a rare but serious complication particularly
About 10% of patients with severe atopic dermatitis develop cataracts in the 2nd–4th decades; these if accompanied by loss of lens material ..
🔹
are often bilateral and may mature quickly. 4- Suprachoroidal haemorrhage
D) Neurofibromatosis type 2 involves a bleed into the suprachoroidal space from a ruptured long or short posterior
NF2 is associated with cataract in about 60% of patients. It tends to develop prior to the age of 30 years. ciliary artery. If sufficiently severe it may result in extrusion of intraocular contents
(‘expulsive’ haemorrhage).
Glaucoma Contributing factors include: advanced age, and vitrous loss, systemic
A secondary (complicated) cataract develops as a result of some other primary ocular cardiovascular disease
🔹
disease.
1-Chronic anterior uveitis
Chronic anterior uveitis is the most common cause. The incidence is related to the 🔷
🔹 Acute postoperative endophthalmitis (at least 0.1%):
Risk factors may include:
duration and activity of intraocular inflammation that results in prolonged breakdown of
the blood–aqueous and/or blood–vitreous barrier. The use of steroids, topically and operative complications such as posterior capsule rupture,
systemically. Cataract appears to progress more rapidly in the presence of posterior prolonged procedure time, combined procedure (e.g. with vitrectomy), wound leak on the first day,
delaying postoperative topical antibiotics until the day after surgery, topical anaesthesia, adnexal
🔹2-Acute congestive angle-closure
synechiae.
Acute congestive angle-closure may cause small, grey-white, anterior, subcapsular or Secondary cataract complications
🔹
disease and diabetes.
Pathogens:
About 90% of isolates are Gram-positive and 10%
capsular opacities within the pupillary area (glaukomflecken) . They represent focal
Gram-negative. Staphylococcus epidermidis is the most common.
🔹
infarcts of the lens epithelium.
1- Symptoms are pain and visual loss.
3-High myopia
2- Signs
is associated with posterior subcapsular lens opacities and early-onset nuclear sclerosis,
• Eyelid swelling, chemosis, conjunctival injection and discharge.
🔹
which may increase the myopic refractive error.
• A relative afferent pupillary defect is common.
4-Hereditary fundus dystrophies • Corneal haze
such as retinitis pigmentosa may be associated with posterior subcapsular lens opacities • Fibrinous exudate and hypopyon
.Cataract surgery may occasionally improve visual acuity even in the presence of severe
retinal changes. Acquired 99% 🔹 • Vitritis with an impaired view of the fundus
Management : Vitreous tapping for C/S to confirm the diagnosis and intravitreal antibiotics with
core vitrectomy.
1-Steroids : Both systemic and topical are cataractogenic .
2- Chlorpromazine
3- Busulphan which used in treatment of chronic myeloid
leukaemia.
🔷 Delayed-onset postoperative Endophthalmitis:
Delayed-onset endophthalmitis following cataract surgery develops when an organism of low virulence
4- Amiodarone which used in treatment of cardiac Drug induced cataract becomes trapped within the capsular bag ('saccular endophthalmitis’). It has an onset ranging from 4 weeks
arrhythmias . to years (mean of 9 months) postoperatively.
🔷postoperative complications
5- Gold which used in treatment of rheumatoid arthritis. It may rarely be precipitated by Nd:YAG laser capsulotomy, which releases the organism into the vitreous.
6- Allopurinol which used in treatment of hyperuricaemia and 1- Presentation: painless mild progressive visual deterioration which may be associated with floaters.
chronic gout. 2- Signs:
• Low-grade anterior uveitis, sometimes with mutton-fat keratic precipitates . The inflammation initially
🔹 Trauma is the most common cause of unilateral cataract in young
responds well to topical steroids, but recurs when treatment is stopped and eventually becomes steroid
🔹 Phacomorphic glaucoma: The large cataractous lens may cause anterior bowing of the iris with 2ry
angle closure. Presentation is as acute or chronic angle closure with high IOP, shallow AC, and fixed semi- dilated
individuals and may include the following.
1- Penetrating trauma .
resistant .
• Vitritis is common but hypopyon infrequent.
• An enlarging capsular plaque composed of organisms sequestrated in residual cortex within the peripheral
2- Blunt trauma :may cause a characteristic flower-shaped opacity
pupil. Distinguish it from 1ry angle closure glaucoma (PACG) by the presence of an ipsilateral swollen capsular bag is characteristic .
3- Electric shock and lightning strike: are very rare causes that may result
🔹 Traumatic cataract
cataractous lens and a contralateral open angle with a deep AC. • Gonioscopy under mydriasis may identify an equatorial plaque.
in anterior and posterior iridescent opacities
phacolytic glaucoma: The hypermature cataract loses soluble lens proteins through the intact anterior 3-Treatment if persistent:
4- Infrared radiation: if intense as in glass blowers, may rarely cause true
capsule, causing trabecular obstruction and subsequent 2ry open angle glaucoma. Note raised IOP, lens protein exfoliation of the anterior lens capsule ○- Intravitreal antibiotics alone are usually unsuccessful in resolving the infection.
in a deep AC (may form a pseudohypopyon), open angles, and hypermature cataract. 5- Ionizing radiation : for ocular tumours may cause posterior subcapsular ○- Removal of the capsular bag, residual cortex and IOL, requiring pars plana vitrectomy. Secondary IOL
opacities ,that may develop months or years later.
🔷 Posterior capsular opacification
🔹
Indications for surgery
1-Visual improvement: It is the most common indication for cataract surgery. Operation is indicated
Visually significant posterior capsular opacification (PCO) is the most common late
complication of uncomplicated cataract surgery. Apart from reducing visual acuity, PCO
🔹
when the opacity causing difficulty in performing essential daily activities.
2- Medical: the cataract is affecting the health of the eye, for example, phacolytic or phacomorphic
glaucoma.
may impair contrast sensitivity, cause difficulties with glare or give rise to monocular
diplopia.
Management : YAG laser capsulotomy
Cataract surgery to improve the clarity of the ocular media may be required to exam fundal pathology
Management of age-related
🔹
(e.g. diabetic retinopathy) requiring monitoring or treatment.
Cataract extraction:
Intracapsular catract extraction (ICCE)
cataract
Extracapsular catract extraction (ECCE)
Phacoemulsification ( small self-sealed wound and less astigmatism) by fatema okoff
I/A
NB IOL calculation is mandatory before cataract surgery.
