Lens

Lu Yong
Department of ophthalmology
First Teaching Hospital of Zhengzhou University
Anatomy
 Shape
 a biconvex lens and capable of changing shape
 colorless
 transparent
 avascular
 size
4mm thick and 9mm in
diameter
 position
 behind the iris and
the pupil
 In front of the vitreous
 suspended by suspensary ligament
Lens
Anatomy
 structure
 capsule:an elastic transparent basement membrane
admit water and electrolytes pass through
the lens fibers are enveloped in it
epithelium : this single cell layer located anteriorly and
extending to the equator
 fibers:continuously produced by epthelium
the nucleus:old fibers ,harder at the centre
the cortex: new fibers,softer, at the periphery
With age,the lens gradually becomes larger, harder
and less elastic
Physiology
 composition
 water -64% The water content of the lens decreases with age.
 protein -35% the highest protein content in any body tissue
 soluble protein

 insoluble protein:With age, the percent of it increases

 1%- A trace of minerals are present (Potassium, Ascorbic acid and

Glutathione)
The lens has complex metabolic process. It`s nourishment
comes from aqueous humor.When there are changes of
aqueous or capsule or metabolism,the transparent lens becomes
opaque.
Physiology
 Function
 one of important refractive medias
 focus light rays upon the retina
 filter a part of ultraviolet rays ,it is beneficial to
the retina
Cataract
 Cataract –transparent lens becomes opaque
Cataract
 Epidemiology
 Cataract is a common ocular disease and one of the main
causes of blindness.It is estimated that 30 to 45 million people
in the world are blind,with cataract accounting for as much as
45% of this blindness.
 The prevalence of cataract varies widely with striking regional
differences.It is more common in areas where people eyes
expose to sunlight greatly.
 The prevalence rises with age and is higher in females.
 WHO defines blindness as best corrected visual acuity less
than 20/400(0.05) or visual field restricted to 10°or less.
Classification
 Senile cataract-age related cataract
 Complicated cataract-due to ocular inflammation or
degeneration affects lens metabolism
 Congenital cataract-a result of developmental disturbance of
lens during the process of development of fetus
 Traumatic cataract-eye trauma cause lens opacities
 Metabolic cataract-metabolic disturbance
 Toxic cataract-many drugs and chemicals have been
shown to induce cataracts
 After-cataract-after cataract surgery,remained cortex and
epithelial cells exfoliated to form opacity
Senile cataract
Senile cataract is by far the most common type. It often occurred
over the age of 40. With aging,it`s incidence increases.we call it
“age related cataract”
 Etiology
It is a lens disorder formed on the basis of decreasing
of lens metabolic function with aging of whole body and plus many
other factors.
It has relation to
 Heredity
 Ultraviolet rays-plateau (expanse of level land high above sea-level)
long periods of strong sunlight
 Systematic disorders-diabetes
 Nourishment condition
map
Senile cataract
 Clinical findings
 Symptom:progressively blurred vision is the
only symptom
 Types:according to the place of opacity
appear first
 Cortical cataract
 Nuclear cataract
 Posterior subcapsular cataract
Senile cataract-cortical cataract
There are 4 stages in its developing
 Incipient stage (beginning;in an early stage)
 The lens is only slightly opaque
 These spoke-like opacities
begin in the lens periphery
 Pupillary area isn`t affected
 No blurred vision takes place
Senile cataract-cortical cataract
 Intumescent stage (immature stage)
 Lens opacity develop gradually,the fibers absorb
water,the lens edema,the cortex become swollen.
 The anterior chamber is shallow .
It is easy to induce
onset of glaucoma.
 Visual acuity
decrease.
Senile cataract –cortical cataract
 Mature stage
 The lens is completely opaque,
 The color is greywhite.
 The depth of the anterior
chamber restores to
normal. Because the
swollen decreases.
 The vision is
obviously decreased
to FC or HM
Senile cataract-cortical cataract
 Hypermature stage
 The degenerated cortex has been decomposed to
form milklike substance.
 The lens nucleus
fall down.
 The capsule wrinkled
and shrunk.
Due to water
escaping from lens.
Senile cataract-nuclear cataract
 The nucleus becomes harder(sclerotic) and
increasingly pigmented with age.
 At beginning, nucleus appears yellowish,its color
becomes more and more dark with development

 It generally produce
more blurring of
distance vision than
near vision
Senile cataract-
posterior subcapsular cataract
 Golden yellow or white particles,mixed with
small vacuoles in them occur at shallow layer
of subcapsular cortex in posterior pole lens.
 The opaque area situates in the area of visual
axis,so blurred vision takes place in early
stage
Congenital cataract
 It is a result of developmental disturbance of lens
during the process of development of fetus
 Etiology
 Genetic factor-autosomal dominant inheritance
 Damage of fetal lens caused by systemic disorders of
mother or fetus-viral infections,nourishment and
metabolic disturbance of mother
Congenital cataract
 Commonly are as follows:
 polar cataract,nuclear cataract,lamellar
cataract,complete cataract,coronary cataract
axiality cataract
Complicated cataract
 It is a lens opacity induced by ocular
inflammation or degeneration disorder
Uveitis,glaucoma,too low IOP,retinal
pigmentary degeneration
Traumatic cataract
It may be caused by mechanical
injury,physical forces(radiation,electrical
current,heat and cold),and osmotic influences

Penetrating cataract
Metabolic cataract
 Diabetic cataract
 Hypocalcemic cataract
Toxic cataract and After cataract
 Many drugs and chemicals have been shown
to induce cataract-
 After cataract surgery,remained cortex and
epithelial cells exfoliated onto lens posterior
capsule proliferate to form opacity
Management of cataract
 Medical management
 No medical treatment has been proven conclusively
to delay,prevent,or reverse the development of
cataract
 Indication for surgery
 The most common indication for cataract surgery is
the patient`s desire for improved visual function.
 When visual acuity impairment interferes with the
patient`s normal activities,the surgery of cataract well
be performed.
Lens surgery
 Microsurgical techniques is employed for all
cataract surgery.
 There are 3 principal types of lens extraction
 Intracapsular cataract extraction(ICCE)
 It involves complete removal of the lens within its capsule.

through a larger (12mm length)

superior limbal incision
 The larger incision may increase the risk of wound-related
problems.
Lens surgery
 Extracapsular cataract extraction(ECCE)
 It involves removal of the lens nucleus and cortex
through an opening in the anterior capsule, leaving the
posterior capsule in place.
 A superior limbal incision is made,it is shorter than
ICCE
 The anterior portion of the capsule is ruptured and
removed
 The nucleus is extracted
 The cortex is either irrigated or aspirated from the eye
leaving the posterior capsule behind.
ECCE and IOL
IOL
Lens surgery
 Phacoemulsification(Phaco)
 It is a relatively new technique.In recent years, it has
become popular.
 It is a method of extracting the nucleus through a
small incision(3mm).
 The nucleus is extracted by ultrasonic vibration.
 This technique results in a lower incidence of wound-
related complications, faster healing, and more rapid
visual rehabilitation than procedures requiring larger
incisions.
Phaco
ICCE vs ECCE vs Phaco
TYPE ADVANTAGES DISADVANTAGES
ICCE Removes all lens Larger incision
material, no posterior Cystoid macular edema
capsular opacity Vitreous complications
Endophthalmodonesis
Increased incidence of RD
ECCE Smaller incision Posterior capsule opacity
No vitreous complications
Less endophthalmodonesis
Less CME,RD
Allows implants pcIOL
Phaco Smallest incision Demanding technique
Less induced astigmatism Complications while learning
Fastest technique
Visual rehabilitation
 Removal of the lens causes a marked
reduction of the refractive power of the
eye,we call it aphakia
 Aphakia may be corrected by three methods
include spectacles(glasses),contact lens or
intraocular lens(IOL) to increase its refractive
power
 IOL is the best among them and now is widely
used in the world
 Correction of Aphakia
TYPE ADVANTAGES DISADVANTAGES
Spectacles Safety Magnification of image size
Cheaper (20%-35%)
Convenience Spherical aberration
Contact lens Less image magnification Difficult insertion and removal
(7%~12%) Need for disinfection and
cleaning systems
Toxic and inflammatory phenomena
Intraocular lens Least image magnification
(1%~2%)
Least optical distortion
Less aniseikonia