LENS

AND
CATARACT

Calumpad, Ann Krizel Zyra T.

Castillo, Grace
 LENS

Function:
An essential refractive media
Focuses the light on the retina
total refractive power
Adds 10-20diopters to the corneas 43
diopters RP
 LENS
Shape:
Biconvex, transparent structure
Posterior surface has a radius of
6mm, with greater curvature than
that of the anterior surface which
has a radius of 10mm
LENS
Weight:
An adult lens weighs about
220mg
Approximately 4mm thick
Increases with age to five times
its weight at birth
 LENS
Position and suspension
Lies in the posterior chamber of
the eye between the posterior
surface of the iris and the vitreous
body in a saucer-shaped
depression of the vitreous
body called the hyaloid fossa
Embryology and growth
Purely an epithelial structure
No nerves and blood vessels
Purely an ectodermal structure
Differentiates from an anterior layer of
epithelial cells into central geometric
lens fibers and an acellular hyaline
capsule
 LENS
Direction of growth is cetrifugal
Younger cells are always on the surface and the
oldest ones are in the center of the lens
Metabolism and aging of the lens
Nourished by the diffusion from the aqueous humour
Epithelium maintains and permit ion equilibrium for
transportation of nutrients, mineral s and water for
preservation of integrity, transparency and optical
function of the lens
Lens
 LENS
Water content of the lens decreases with age
Protein increases.
Lens becomes harder, less elastic and less
transparent
Unavoidable over the age of 65
Central portion of the lens becomes
sclerosed and slightly yellowish with age
CATARACT
Opacity in the lens
Age-related cataract
65-74 y/o
PATHOGENESIS

cataractous lenses

protein aggregates that scatter light rays

Reduce transparency
 yellow or brown discoloration

Additional findings may

include vesicles between lens
fibers or migration and
enlargement of epithelial cells
FACTORS

oxidative damage (from free

radical reactions)
ultraviolet light damage
malnutrition
SYMPTOMS
1. Blurring of vision
2. Glare (Photophobia)
3.Image blur
4. Distortion
5. Altered color perception
 CLASSIFICATION
IMMATURE CATARACT
has some transparent regions

MATURE CATARACT
is one in which all of the lens substance is opaque

HYPERMATURE CATARACT
cortical proteins become liquid. This liquid may escape
through the intact capsule, leaving a shrunken lens with
a wrinkled capsule
morgagnian cataract
AGE RELATED CATARACT

NUCLEAR

CORTICAL

POSTERIOR SUBSCAPULAR
NUCLEAR CATARACT
The normal condensation process in
the lens nucleus: nuclear sclerosis.

The earliest symptom may be

improved near vision without glasses
(second sight).

Most nuclear cataracts are bilateral

 CORTICAL CATARACTS
opacities in the lens cortex. Changes in the
hydration of lens fibers create clefts in a radial
pattern around the equatorial region. They also
tend to be bilateral, but they are often
asymmetric.

Visual function is variably affected, depending

on how near the opacities are to the visual axis.
POSTERIOR SUBCAPSULAR
CATARACTS
Common symptoms include glare
and reduced vision under bright
lighting conditions

This lens opacity can also result

from trauma, corticosteroid use
(topical or systemic),
inflammation, or exposure to
ionizing radiation
 CHILDHOOD CATARACT
congenital (infantile) cataracts, which
are present at birth or appear shortly
thereafter

acquired cataracts, which occur later

and are usually related to a specific
cause. Either type may be unilateral or
bilateral.
Results from prenatal exposure to
radiation (1st trimester)
Drugs taken by the mother prenatally
(corticosteroids, sulfonamides)
Maternal malnutrition
Intrauterine infection (rubella, herpes,
mumps, toxoplasmosis)
TRAUMATIC CATARACT

Most commonly d/t foreign

body injury to the lens or blunt
trauma to the eyeball
CATARACT SECONDARY TO
INTRAOCULAR DISEASE
(COMPLICATED CATARACT)

begins: posterior subcapsular area-

entire lens structure.

chronic or recurrent uveitis,

glaucoma, retinitis pigmentosa,
and retinal detachment.
CATARACT ASSOCIATED WITH
SYSTEMIC DISEASE

Bilateral cataracts occur in many

systemic disorders including diabetes
mellitus, hypocalcemia (of any cause),
myotonic dystrophy, atopic dermatitis,
galactosemia, and Down, Lowe
(oculo-cerebro-renal), and Werner
syndromes
 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.
Cataract Surgery
 CATARACT SURGERY

No medical treatment for

cataract
Surgery is the definitive
treatment
INDICATIONS
Visual improvement
Medical indications
Phacolytic glaucoma
Hypermature cataract leading to
leakage of proteins leading to
inflammatory reaction and open
angle glaucoma from increased IOP
due to blockage of trabecular pores
INDICATIONS
Phacomorphic glaucoma
Swelling of the lens (intumescent lens)
leads to angle closure glaucoma
(secondary)
Diabetic nephropathy
Cosmetic indications
To restore black pupil in a mature cataract
with no light perception
 Cataract Surgery
Extracapsular Cataract Extraction
Preserves the posterior portion of the lens capsule
Incision is made at the limbus either superiorly or
temporally
An opening is formed in the anterior capsule and
the nucleus and cortex of the lens are removed
An intraocular lens can then be placed in the empty
capsular bag supported by the intact posterior
capsule
 CATARACT SURGERY
Phacoemulsification
Now the most common form of extracapsular
cataract extraction in developed countries
Utilizes a handheld ultrasonic vibrator to
disintegrate the hard nucleus that the nuclear
material and cortex can be aspirated through a
3mm small incision.
This incision will also be the site of insertion of
foldable intraocular lenses
 CATARACT SURGERY
Manual Sutureless Small Incision
Cataract Surgery
Traditional nuclear expression form of
extracapsular cataract extraction

The nucleus is removed intact but

utilizing a small incision
Cortex is removed by manual aspiration
ADVANTAGE: SMALL INCISION
SURGERY
More controlled operating conditions
Avoidance of suturing
Rapid wound healing with lesser
degrees of corneal distortion
Reduced postoperative intraocular
inflammation
More rapid visual rehabilitation
 COMPLICATION
Posterior capsular tear
Rf: previous trauma
Dense cataract
Unstable lens
Small pupil
Post-operative complications:
Secondary opacification of the posterior
capsule
PARS PLANA LENSECTOMY
OR PHACOFRAGMENTATION
Lens is removed via the pars plana in
conjuction with posterior vitrectomy using
automated lens and vitreous cutters
May be performed to facilitate vitero-retinal
surgery or to remove completely dislocated
lens or a partially dislocated lens that is not
amenable to phacoemulsification
Depends on severity of cataract
 INTRAOCULAR LENSES
Newest posterior chamber lenses are made of
flexible materials such as silicone and acrylic
polymers
Allows implant to be folded, decreasing the
required incision size
There are lens designes that incorporate
multifocal optics or partially restore
accomodation
Goal: to provide patients with good vision for
both near and distance without glasses
 POST-OPERATIVE CARE
Small incision
Shortened postoperative recovery period
Patient is ambulatory on the day of surgery but
is advised to move cautiously and avoid
straining or heavy lifting for about a month
May be patched on the day of surgery, metal
shield is often suggested for several days after
surgery
Temporary glasses can be used for few days
Recovery 4-8 weeks after surgery patient can
see well through intraocular lens
COMPLICATIONS OF ADULT
CATARACT SURGERY
Has a very low 2-5% rate of
complication that results in permanent
impairment of vision
Most serious complication:
Intraocular infection (endophthalmitis,
0.1%
Intraocular hemorrhage (<0.5%)
COMPLICATIONS OF ADULT
CATARACT SURGERY
Other complications:
Retinal detachment
Cystoid macular edema
Glaucoma
Corneal edema
Ptosis
Most common: posterior capsule
opacification
POSTERIOR CAPSULE
OPACIFICATION
after cataract posterior capsule
opacification after an extracapsular
cataract extraction
But due to more advance surgeries,
this complication is now not a
common complication
 POSTERIOR CAPSULE
OPACIFICATION
This may be due to a proliferating
epithelium following cataract surgery
which leads to frank opacification.
These cells may contract which may lead
to wrinkling of the posterior capsule
resulting in visual distortion and
decreased visual acuity
CATARACT SURGERY IN THE
YOUNG
Less dense cataracts than in adults and may
usually be removed by irrigation-aspiration
technique without the need for
phacoemulsification
Correction consists of spectacles but most
childhood operations are followed by
contact lens correction
 PROGNOSIS
Cataract in children requiring surgery is not as
good as that with age-related vcataract surgery.
Associated amblyopia and occasional anomalies
of the optic nerve or retina limit the degree of
useful vision
Prognosis for improvement of visual acuity is
worst following surgery for unilateral congenital
cataracts and best for incomplete bilateral
congenital cataracts that are slowly progressive
Glaucoma is a common long term complication
THANK YOU