Understanding Cataract: Classification, Diagnosis, and Symptoms
Cataract is a common cause of vision loss worldwide classified into etiological and morphological categories. Senile cataract is age-related, while congenital cataract can be due to various factors. Symptoms include gradual loss of vision, glare, halos, and polyopia. Proper differential diagnosis is essential to distinguish cataract from other eye conditions.
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Approach to a Case of Cataract Sandeep Saxena MS, FRCS (Edin), FRCS (Glasg) Professor, Ophthalmology, KGMU
Differential diagnosis Painless, progressive diminution of vision Cataract Primary open angle glaucoma Diabetic retinopathy Corneal dystrophies and degenerations Age related macular degeneration Retinitis pigmentosa
Cataract Opacification of the human crystalline lens Major cause of blindness worldwide Classification- -Etiological -Morphological
Morphological classification Capsular cataract -Anterior -Posterior Subcapsular cataract -Anterior -Posterior Cortical cataract Nuclear cataract Polar cataract
Etiological classification I. Congenital and Developmental cataract II. Acquired cataract Senile cataract Traumatic cataract (blunt, penetrating, radiation, electric shock, glass blowers, infra-red) Complicated cataract (uveitis-induced) Metabolic cataract (Diabetes - snowflake, Wilson s disease-sunflower) Drug induced cataract- corticosteroids, miotics Cataract associated with syndromes
Congenital or Developmental cataract - Occur due to maternal infection or malnutrition, perinatal hypoxia APH, or may be hereditary - Various morphological forms: Blue dot Sutural Fusiform or spindle shaped Embryonal nuclear Zonular Coronary Anterior or posterior polar
Senile cataract Age-related cataract By the age of 70 years, over 90% of the individuals develop senile cataract Usually bilateral, but almost always asymmetrical
Symptoms Gradual, painless progressive loss of vision Discomfort / glare in daylight nuclear cataract; better vision in daylight cortical cataract Uniocular polyopia Coloured halos Black spots in front of eyes Second sight
Signs Iris shadow Depth of anterior chamber Pupillary reflex Visual acuity Plain mirror examination under mydriasis
Iris shadow A.C. Depth Pupillary reflex Visual acuity Present Shallow Greyish white FC to 6/18 Intumescent Present Normal Greyish white FC to 6/18 Incipient Absent Normal Pearly white HM to FC close to face Mature Absent Shallow Milky white HM + Hypermature Morgagnian Absent Normal or deep Milky chalky HM + Hypermature Calcified
Patient workup Retinoscopy and best corrected visual acuity Intraocular pressure Slit lamp examination Fundus evaluation direct & indirect Macular function tests Ultrasonography IOL power calculation
General investigations Blood pressure Blood sugar Complete haemogram HIV, Hepatitis B & C Causes of straining Foci of infection Systemic examination
Management An un-operated eye is more comfortable than an operated eye if visual diminution is mild. Early cataract : -Refraction and glasses -Dark glasses or photochromatic glasses for nuclear cataract -Rule out other causes of visual diminution -If BCVA not to patient s satisfaction, then operate.
Surgical techniques Intracapsular cataract extraction (ICCE) Extracapsular cataract extraction (ECCE) Conventional ECCE Small Incision Cataract Surgery Phacoemulsification Lens aspiration in paediatric (soft) cataract
Complications of cataract surgery Intraoperative Incision related complications Posterior capsular rupture Zonular dehisence Vitreous loss Nuclear drop Posterior loss of lens fragments Injury to the cornea, iris and lens Expulsive choroidal haemorrhage
Early post operative complications Hyphaema Iris prolapse Striate keratopathy Postoperative anterior uveitis Bacterial endophthalmitis Late postoperative complications Cystoid macular edema Pseudophakic bullous keraopathy Retinal detachment Delayed postoperative endophthalmitis After cataract Soemmering s ring Elschnig s pearls
Intraocular Lenses Types Anterior chamber IOL Iris supported lens Posterior chamber IOL Rigid Foldable Calculation of IOL power SRK formula
