INTRODUCTION

• CATARACT" IS DERIVED FROM THE LATIN CATARACTA,

MEANING "WATERFALL",
• WITH THE CONDITION POSSIBLY THEREFORE NAMED
AFTER THE WHITE APPEARANCE OF RAPIDLY RUNNING
WATER.
 DEFINITION

IT IS A CLOUDING OR OPAQUENESS OF THE

CRYSTALLINE LENS WHICH LEADS GRADUAL PAINLESS
BLURRING AND EVENTUAL LOSS OF VISION
 INCIDENC
E
• A CAUSE OF BLINDNESS AND IS
CONVENTIONALLY TREATED WITH SURGERY
• VISION LOSS OCCURS BECAUSE OPACIFICATION
OF THE LENS OBSTRUCTS LIGHT FROM
PASSING AND BEING FOCUSED ON THE RETINA
• 3RD LEADING CAUSE OF PREVENTABLE
BLINDNESS
 CLASSIFICATION
ETIOLOGICAL CLASSIFICATION
 CONGENITAL & DEVELOPMENTAL CATARACT
 ACQUIRED CATARACT
• SENILE CATARACT
• TRAUMATIC CATARACT
• . COMPLICATED CATARACT
• METABOLIC CATARACT
• RADIATION CATARACT
• ELECTRIC CATARACT
• TOXIC CATARACT
• DERMATOGENIC CATRACT
• CATARACT ASSOCIATED WITH OSSEOUS DISEASE
• CATRACT ASSOCIATED WITH SYSTEMIC SYNDROMES
MORPHOLOGICAL CLASSIFICATION:
• CAPSULAR CATARACT - ANTERIOR CAPSULAR CATARACT &
POSTERIOR CAPSULAR CATARACT
• SUBCAPSULAR CATARACT: ANTERIOR SUBCAPSULAR CATARACT
& POSTERIOR SUBCAPSULAR CATARACT
• CORTICAL CATARACT
• NUCLEAR CATARACT
• POLAR CATRACT
 RESPECT TO MATURITY

• MATURE CATARACT
• IMMATURE CATRACT
• HYPER MATURE CATARACT
• INCIPIENT CATARACT
 CONGENITAL CATARACTS& DEVELOPMENTAL
CATARACT

• CONGENITAL CATARACTS REFERS TO A LENS OPACITY

WHICH IS PRESENT AT BIRTH.
• DEVELOPMENTAL CATARACT IS CATARACT WITH
ONSET AFTER BIRTH TILL PUBERTY
 SENILE CATARACT

• SENILE CATARACT IS AN AGE-RELATED, VISION-IMPAIRING

DISEASE CHARACTERIZED BY GRADUAL PROGRESSIVE
CLOUDING AND THICKENING OF THE LENS OR ITS CAPSULE OF
THE EYE.
• ABSENCE OF SECONDARY CAUSE
• IT IS THE WORLD'S LEADING CAUSE OF TREATABLE BLINDNESS
• TRAUMATIC CATARACT IS A CLOUDING OF THE LENS THAT
MAY OCCUR AFTER EITHER BLUNT OR PENETRATING OCULAR
TRAUMA THAT DISRUPTS THE LENS FIBERS.

• A COMPLICATED CATARACT IS OPACIFICATION OF THE

NATURAL LENS OF THE EYE DUE TO INFLAMMATORY
CONDITIONS OF THE EYE OR UVEITIS.

• METABOLIC CATARACT IS LOSS OF LENS TRANSPARENCY

CAUSED BY AN INSULT TO THE NUCLEAR OR LENTICULAR
FIBRES DUE TO AN UNDERLYING METABOLIC DISORDER.
• CATARACTS INDUCED BY IONIZING RADIATION (E.G., X-RAYS
AND GAMMA RAYS) USUALLY ARE OBSERVED IN THE POSTERIOR
REGION OF THE LENS. INCREASING THE DOSE OF IONIZING
RADIATION CAUSES INCREASING OPACIFICATION OF THE LENS,
WHICH APPEARS AFTER A DECREASING LATENCY PERIOD.

• ELECTRICAL CATARACTS MAY OCCUR FOLLOWING CONTACT

WITH HIGH TENSION CONDUCTOR1, LIGHTNING2 OR ELECTRIC
SHOCK THERAPY.

• TOXIC OR DRUG INDUCED CATARACT SEEN AS A RESULT OF

THE DRUGS USED EITHER TOPICALLY OR SYSTEMICALLY
• CATARACT CONTINUES TO BE ASSOCIATED WITH A NUMBER OF
SYSTEMIC DISEASES AND SYNDROMES SUCH AS
ATHEROSCLEROSIS, DIABETES MELLITUS, ATOPY, JUVENILE
RHEUMATOID ARTHRITIS,

• OSTEOPOROSIS IS ASSOCIATED WITH THE PRESENCE OF

CATARACTS. COMMON PATHOPHYSIOLOGICAL ASSOCIATION
• CATARACTS AFFECTING THE CENTER OF THE LENS (NUCLEAR
CATARACT)
• CATARACTS THAT AFFECT THE BACK OF THE LENS
(POSTERIOR SUBCAPSULAR CATARACTS

• CAPSULAR CATARACT ONE CONSISTING OF AN OPACITY OF

THE CAPSULE OF THE LENS.
• POLAR CATARACT, A DISTINCTIVE SUBTYPE OF LENS
OPACITY, PRESENTS AS AN AREA OF DEGENERATIVE AND
MALFORMED LENS FIBERS THAT FORM AN OPACITY IN THE
CENTRAL POSTERIOR SUBCAPSULAR AREA OF THE LENS.
• A CORTICAL CATARACT IS TYPE OF CATARACT OCCURS IN THE
LENS CORTEX, WHICH IS THE PART OF THE LENS THAT SURROUNDS
THE CENTRAL NUCLEUS

• IMMATURE CATARACT (INCIPIENT CATARACT) AN

INCOMPLETE CATARACT; THE LENS IS ONLY SLIGHTLY OPAQUE
AND THE CORTEX CLEAR.

• IF THE LENS IS TOTALLY OPAQUE IT IS TERMED A "MATURE"

CATARACT. MOST MATURE CATARACTS ARE WHITE IN COLOR.
 CAUSES
CONGENITAL AND DEVELOPMENTAL CATRACT
• IDIOPATHIC
• HERIDITY
• INTRAUTERINE INFECTIONS
• INTRAUTERINE EXPOSURE TO CERTAIN DRUGS AND RADATION
• MATERNAL MALNUTRITION
• BIRTH TRAUMA
• CONGENITAL DISEASE
 ADULT CATARACT
• HEREDITARY FACTORS
• AGING
• LOSS OF LENS TRANSPARENCY
• DECREASED OXYGEN UPTAKE
• DENATURATION OF PROTEINS IN LENS
• ACCUMULATION OF A YELLOW BROWN PIGMENT DUE TO THE
BREAK DOWN OF LENS PROTEIN
• DIETARY FACTORS
• UV RADIATION
TRAUMA
BLUNT TRAUMA
ASSOCIATED OCULAR CONDITIONS
RETINITIS PIGMENTOSA
• RETINAL DETACHMENT AND RETINAL SURGERY
• INFECTION
• ELECTRICAL SHOCK
TOXIC FACTORS
CORTICOSTEROIDS
CIGARETTE SMOKING
• REDUCED LEVELS OF ANTIOXIDANTS
• POOR NUTRITION
• OBESITY
Systemic diseases and syndromes

Diabetes mellitus
Down syndrome
Renal disorders
Musculoskeletal disorders
Due to etiological factors
 Clinical features
• DIPLOPIA
• AMBLYOPIA
• SQUINT
• NYSTAGMUS
• BRUNESCENCE – COLOR SHIFT FROM YELLOW TO
BROWN
• REDUCED LIGHT TRANSMISSION
• COLOR OF PUPIL WILL BE YELLOWISH, GRAY OR WHITE
• DEVELOP IN BOTH EYES
• COLOUR OF LENS
IN MATURE CATARACT-GRAYISH WHITE
MATURE CATARACT –PEARLY WHITE
HYPERMATURE CATARACT –MILKY WHITE
• NUCLEAR SCLEROSIS
• SNOWFLAKE APPEARANCE
• CLOUDED, BLURRED OR DIM VISION
• INCREASING DIFFICULTY WITH VISION AT NIGHT
• SENSITIVITY TO LIGHT AND GLARE
• FADING OR YELLOWING OF COLORS
 DIAGNOSTIC FINDINGS
• VISUAL ACUITY MEASUREMENTS
• SNELLEN VISUAL ACUITY TEST
• OPHTHALMOSCOPY
• SLIT LAMP MICROSCOPIC EXAMINATION
• RETINOSCOPY
• TONOMETRY
• ULTRASOUND
 PREVENTION

• AVOID THE RISK FACTORS – UV RAYS, X RAYS,

SMOKING
• WEAR SUNGLASSES
• REGULAR INTAKE OF ANTIOXIDANTS (VITAMINS
A,C AND E) WOULD PROTECT AGAINST RISKS
• PREVENT ACCIDENTS
• TREAT UNDERLYING DISORDERS PROPERLY
 MANAGEMENT
• NON SURGICAL TREATMENT WILL NOT
CURE CATARACT
• SURGERY IS PERFORMED AS
OUTPATIENT BASIS USUALLY TAKES
LESS THAN 1 HOUR AND DISCHARGED IN
30 MINUTES
• WHEN BOTH EYES HAVE CATARACTS – ONE EYE IS TREATED
FIRST, AFTER SEVERAL WEEKS THE OTHER CATARACTS IS BEEN
MANAGED.

• THIS WILL HELP ONE EYE TO HEAL PROPERLY AND THE DOCTOR
CAN CHECK THE SURGICAL PROCEDURE IS EFFECTIVE OR NOT

• THE DOCTOR CAN ALSO CHECK THE PRESENCE OF ANY

COMPLICATIONS DUE TO SURGERY.
 PHACOEMULSIFICATION

• MOST WIDELY USED CATARACT SURGERY

• THROUGH A VERY SMALL INCISION IN THE
SURFACE OF THE EYE
• AN ULTRASOUND PROBE IS THEN INSERTED
• THIS USES ULTRASONIC VIBRATIONS TO
DISSOLVE (PHACOEMULSIFY) THE CLOUDED
LENS
• THESE TINY FRAGMENTED PIECES ARE THEN
SUCTIONED OUT THROUGH THE SAME
 EXTRA CAPSULAR CATARACT
EXTRACTION
• ONLY USES IN VERY ADVANCED CATARACTS WHERE THE LENS IS
TOO DENSE TO DISSOLVE INTO FRAGMENTS
• THIS TECHNIQUE REQUIRES A LARGER INCISION SO THAT THE
CATARACT CAN BE REMOVED IN ONE PIECE WITHOUT BEING
FRAGMENTED INSIDE THE EYE
• THE POSTERIOR CAPSULE IS LEFT INTACT.
• AN ARTIFICIAL LENS IS PLACE IN THE SAME CAPSULAR BAG
• AN EYE PATCH AFTER THE SURGERY IS NEEDED.
 INTRACAPSULAR CATARACT
EXTRACTION
• THIS SURGICAL TECHNIQUE REQUIRES AN EVEN
LARGER WOUND THAN EXTRACAPSULAR
SURGERY

• IN THIS THE ENTIRE LENS AND THE

SURROUNDING CAPSULE IS REMOVED

• INTRA OCULAR LENS IS PLACED IN FRONT OF THE

IRIS.
 LENS REPLACEMENT

• AFTER REMOVAL OF THE CRYSTALLINE LENS, THE

PATIENT IS REFERRED TO AS APHAKIC (WITHOUT LENS)
• IOL(INTRA OCCULAR LENS) -IT IS PERMANENTLY
PLACED, NO MAINTENANCE OR HANDLING AND
NEITHER FELT BY THE PATIENT NOR NOTICED BY
OTHERS
• MADE OF SILICONE OR ACRYLIC MATERIAL
• MONOFOCAL LENS
RECENT ADVANCES IN CATARACT SURGERIES
• MICRO INCISIONAL SURGERY
• LASER ASSISTED CATARACT SURGERY
 PREOPERATIVE CARE

• EYE EXAMINATION BY SURGEON TO CONFIRM THE

PRESENCE OF CATARACT AND TO DETERMINE THE
PATIENT IS SUITABLE CANDIDATE FOR SURGERY

• EYES SHOULD HAVE NORMAL PRESSURE. IF

INCREASED PRESSURE IS THERE IT SHOULD BE
CONTROLLED WITH MEDICATION BEFORE SURGERY

• IN SOME CASES A COMBINED CATARACT –

GLAUCOMA PROCEDURE (PHACO
TRABECULECTOMY) CAN BE PLANNED
• PUPIL SHOULD BE ADEQUATELY DILATED
• RETINAL DETACHMENT SHOULD BE RULED
• NPO – 6- 8 HOURS BEFORE IN SELECTED CASES
• PRE OPERATIVE ANTIBIOTIC EYE DROPS
NSAIDS EYE DROPS
• MYDRIATICS – PHENYLEPHRINE HCL ACID
• EVERY 10 MIN FOR FOUR DOSES ATLEAST 1 HOUR BEFORE SURGERY
• CYCLOPLEGICS (PARALYSES THE CILIARY MUSCLES THUS LOSING THE
ACCOMMODATION OF LENS) - TROPICAMIDE, ATROPINE,
CYCLOPENTOLATE HCL
 POST OPERATIVE CARE
• DISCHARGED WITHIN FEW HOURS
• EYE PATCH SHOULD BE DONE – THE DRESSING IS REMOVED
A DAY AFTER SURGERY
• POSITION THE PATIENT ON BACK OR UP OPERATED SIDE TO
PREVENT PRESSURE IN OPERATED EYE
• EYE PROTECTIVE SHIELDS SHOULD BE PROVIDED FOR 2-3
WEEKS FOR AVOIDING ACCIDENTAL INJURY
• PROPER FOLLOW UP – 4-5 VISIT IN A PERIOD OF 5 TO 6 WEEKS
• TELL THE PATIENT TO AVOID SITUATION THAT IOP CAN
INCREASES (SNEEZING, COUGHING, VOMITING, STRAINING,
OR SUDDEN BENDING)
 INSTRUCT THE PATIENT
• AVOID TOUCHING THE OPERATIVE EYE
• TAKE CARE TO PREVENT SOAP OR WATER FROM ENTERING
THE OPERATIVE EYE DURING FACE OR HAIR WASHING
• AVOID HEAVY LIFTING
• EXERCISE IN MODERATION
• WASH HANDS BEFORE INSTILLING EYE MEDICATIONS
• WEAR SUNGLASSES TO PREVENT BRIGHT LIGHTS
• WAIT 2 -3 MIN BETWEEN ADMINISTRATION OF DIFFERENT EYE
MEDICATIONS (ANTIBIOTICS AND CORTICOSTEROIDS)
• ADMINISTER EYE OINTMENTS LAST
• AVOID SMOKING, DRIVING
COMPLICATIONS OF CATARACT SURGERY

IMMEDIATE PREOPERATIVE COMPLICATIONS

• RETROBULBAR HEMORRHAGE – CAN RESULT
DUE TO ANESTHESIA INJECTION
• EFFECTS – INCREASED IOP, LID TIGHTNESS, AND
SUBCONJUNCTIVAL HEMORRHAGE
MANAGEMENT
• CANTHOTOMY – SLITTING OF CANTHUS TO
REDUCE THE IOP
• PUNCTURE OF ANTERIOR CHAMBER
INTRAOPERATIVE
COMPLICATIONS
• RUPTURE OF POSTERIOR CAPSULE
AND SUPRACHOROIDAL
HEMORRHAGE
• MANAGEMENT IS VITRECTOMY
 POST OPERATIVE
COMPLICATIONS
EARLY
• ACUTE BACTERIAL ENDOPHTHALMITIS – ANTIBIOTIC
THERAPY
• TOXIC ANTERIOR SEGMENT SYNDROME (TASS) – NON
INFECTIOUS INFLAMMATION CAUSED BY TOXIC AGENT
USED TO STERILIZE SURGICAL INSTRUMENTS
LATE
• SUTURE RELATED PROBLEMS
• MALPOSITION OF IOL
• OPACIFICATION OF POSTERIOR CAPSULE