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Lens Disease
China Medical University NO.4Affiliated hospital Ophthalmology;
Ophthalmology hospital of ChinaMedical University
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Introduction Lens disease:
Change of transparency
cataract Position and morphological
abnormality
dislocation
malformation
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Basic knowledge
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Anatomy
Capsule: integritymaintaintransparency
Lens epi. PCO Lens substance: lens fiber
Nucleus
Cortex
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Function
Refraction
Accommodation
Protection: UV filtration
What is accommodation?
The capability that eyes changerefractive condition in order to acquireclear near sight.
!
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What is cataract?
Turbidity of lens
WHO: turbidity of lens + VA
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What is cataract?
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Case: turbid lens, but VA=0.8
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Cataract
Cataract is the No. 1 eye disease that
causing blind. 46% blindness is caused by cataract
!
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Etiology
Any factors that change theintraocular environment to affectlens metabolism. Such as: ageing, mechanical,
chemical, operation, inflammation,metabolic
Malformation Congenital factors
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Risk factors
UV
Diarrhea
Malnutrition
Diabetes
Smoking
Drinking alcohol
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Classification
On etiology:
Congenital
Senile
Complicated
Metabolic
Drug induced or
toxic Traumatic
After cataract
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Classification
On location: Cortical
Nuclear
Subcapsular
On degree: Immature
Intumescent
Mature
Hypermature
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Pathogenesis
The common route that causingcataract is the oxidation injury byperoxide free radical.
Apoptosishot spot of research
!
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Clinical manifestations
Symptoms:
Progressive vision decrease
Contrast sensitivity decrease
Refraction changes Diplopia
Glare
Change of color sensation Visual field defect
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Functionality
vision
contrast
test
Positive
wave
contrast
test
CSF curve
contrast test
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Color
vision
excursion
glare visual field loss
Vision abnormity
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Clinical manifestations
Signs:
Turbidity of lens
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Senile Cataract
Now calledAge-related Cataract
Most commonly seen
>50 yrs old >80 yrs old100%
Degenerative changes
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Classification
Cortical
Nuclear
Subcapsular
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Cortical cataract
4 stages
Incipient stage: wedge turbidity
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Cortical cataract
4 stages
Intumescent stage
(immature): iris projection
Induce acute angle-closure glaucoma
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Cortical cataract
4 stages
Mature stage
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Cortical cataract
4 stages Hypermature stage:
Morgagni cataract
Phacoanaphylactic uveitis
Phacolytic glaucoma
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Nuclear cataract
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Subcapsular cataract
Affecting vision early
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Congenital cataract
Etiology:
Hereditary
Environmental: Virus infection
Malnutrition
Radiation
Drug
Systemic disease
VD deficiency
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Congenital cataract
Morphology
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Congenital cataract
Treatment
observation Early operation
AmblyopiaTreatment
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Complicated cataract
Caused by other eye diseases
Corneal ulcer
Glaucoma Uveitis
Retinal detachment
Retinitis pigmentosa
Intraocular tumor
myopia
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Old anterior uveitis Complicated cataract
glaucoma Complicatedcataractvogt spot
Pigmentosa eye Silicon oil eye
Kinds of Complicated cataract
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Metabolic cataract
Caused by systemic metabolic diseases Diabetic cataract
Galactosemia cataract
Hand-foot-twitch cataract
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Drug induced or toxic cataract
Glucocorticosteroid cataract
Chlorpromazine cataract
Miotic cataract
TNT cataract
Metal: copper, iron, mercury, silver, zinc
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Traumatic cataract
Contusive
Penetrating
Radiative Electric
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After cataract
Now usually called PCO (posteriorcapsular opacification)
Adult: 30-50%
Child: 100%
Pathogenesis:
Proliferation, migration & metaplasia of lens
epi.!
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Treatment
Drug? NO USE
Operation: the only effective therapy
ICCE (intracapsular cataract extraction)
ECCE (extracapsular cataract extraction)
PEA (phacoemulsification)
!
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ICCE ECCE
ICCE And ECCE
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Treatment
IOL (intraocular lens) implantation
AC and PC
Hard and foldable
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Treatment
IOL (intraocular lens) implantation
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Treatment
PEA & F-IOL
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PEA & F-IOL (video)
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Treatment
Correction of aphakia:
Frame glasses
Contact lens
IOL
Laser
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Lens Dislocation
Etiology:
Congenital
Marfan syndrome
Traumatic
Spontaneous
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Clinical Manifestations
Subluxation
Dislocation
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Clinical Manifestations
Complications: Uveitis
Secondary glaucoma
Retinal detachment Corneal turbidity
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Trends
Photolysis of cataract
Injective IOL
Accommodative IOL