eye

1. Cataract associated with
systemic diseases and
management of Cataract

2. Complicated Cataract
Cataract associated with ocular diseases:
Complicated Cataract : is due to disturbance
of the nutrition of lens due to inflammatory
or degenerative disease of anterior and /or
posterior segment of the eye like
iridocyclitis, cilitis, pars planitis, choroiditis,
myopic degeneration, retinitis pigmentosa,
retinal detachment, other retinal
pigmentory dystrophies etc.

3. Complicated Cataract
 Cataract has characteristic breadcrumb
appearance and rainbow display of
colours (polychromatic lustre).
 Vision is usually affected even in early
stages as opacity is near the nodal point
of the eye.

4. Complicated Cataract
 Prognosis depends on the causative
condition.
 All cases of cataract without obvious
cause should be carefully looked for
keratic precipitates or evidences of pars
planitis.

5. Cataract associated with systemic
disease
 Diabetic Cataract:
Early onset of senile cataract and cataract
develops rapidly.
True diabetic cataract is rare condition, occurring
typically in young people with acute diabetes
(with gross imbalance of water balance of the
body). Fluid droplets (vacuoles) appear under
the anterior and posterior subcapsular cortex,
manifesting as myopia, producing diffuse
opacity. These changes are reversible.

6. Diabetic Cataract
 The lens rapidly becomes cataractous with
dense, white anterior and posterior
subcapsular cortical cataract resembling
snowstorm “snowflake Cataract”.
 If diabetes is controlled appropriately, the
rapid progression to mature cataract may
be arrested.

7. Cataract associated with systemic
disease
 Parathyroid Tetany
 Myotonic Dystrophy
 Galactosaemia
 Down Syndrome
 Atopic Cataract

8. Objective Examination
 The state of the nucleus (grading of
nuclear sclerosis)
 The state of the cortex
 The presence or absence of signs of
inflammation
 Pupillary glow by transillumination
 B- Scan ultrasonography

9. Functional Tests
 Pupillary reaction
 Projection of light
 Macular function test – two pinholes test
and Maddox rod test
 Entoptic view of the retina : Auto-
ophthalmoscopy
 Electro-retinographic record, particularly of
macula.

10. Pre-operative evaluation
 Thorough ocular examination to exclude
any ocular disease like abnormalities of
lids, lacrimal sac, conjunctiva (including
conjunctival infections), cornea, uveal
inflammation, glaucoma, posterior
segment inflammatory/ degenerative
condition etc.

11. Pre-operative evaluation
 Systemic examination to exclude
hypertension, cardiovascular disorder,
cerebro-vascular disease, chronic
obstructive air way disorder etc. If any
disorder is present, it should be
adequately controlled before surgery
 ENT and Dental checkup to exclude septic
focus

12. Treatment of cataract
 Medical treatment: No medical treatment
is effective once the lens opacity has
developed.

13. Treatment of cataract
 Surgical Treatment:
Indication for surgery:
1. Cataract – when routine work becomes
difficult due to reduced vision (attributable to
cataract)
2. Subluxated or dislocated lens
3. Lens induced complications like phacolytic
uveitis / glaucoma, phacoanaphylactic
endophthalmitis, phacomorphic glaucoma.

14. Treatment of cataract
 Surgical Treatment:
Options
I. Intracapsular lens extraction (ICCE):
Method of intracapsular cataract extraction
(ICCE), now becoming obsolete, by which
the entire lens including the capsule is
removed by rupturing zonular ligaments.

15. Surgical Treatment of Cataract
II. Extracapsular Cataract Extraction (ECCE):
Methods –
1. Conventional ECCE
2. ECCE by small incision cataract surgery
(SICS)
3. Lensectomy
4. Phacoemulsification

16. Steps of ECCE
1. Anaesthesia
a. General Anaesthesia : In children,
psychiatric patients, senile dementia
b. Local anaesthesia: Retrobulbar block,
peribulbar block, along with or without
facial block , topical anaesthesia

17. Steps of ECCE
2. Cleaning of lids with 5% betadine solution
and instillation of betadine solution in
conjunctival sac
3. Draping
4. Superior Rectus suture in case of
conventional ECCE and SICS
5. Conjunctival flap in case of SICS

18. Steps of ECCE
6. Scleral tunnel incision or Corneo-scleral
section or corneal or corneal tunnel
incision
7. Anterior chamber entry
8. Injection of ocular viscosurgical device
(OVD) in anterior chamber (HPMC or
Sodium Hyaluronate)
9. Capsulotomy ( can opener or continuous
curvilinear capsulorrhexis, CCC)

19. Steps of ECCE
10. Hydrodissection and Hydrodelineation
11. Nucleus delivery (in conventional ECCE
and SICS) / Phacoemulsification of
nucleus (in phacoemulsification, machine ,
through titanium needle provides energy
for emulsification of nucleus, needle
vibrates at an speed of 20,000 Hz and
pulverizes the nucleus)

20. Steps of ECCE
12. Cortical clean up by aspiration and
irrigation (BSS or Ringer lactate is used as
irrigating fluid)
13. Filling of lens capsule (capsular bag)
with OVD
14. Insertion of posterior chamber IOL (in
the bag, in case of complications in the
ciliary sulcus)

21. Steps of ECCE
15. Removal of OVD from anterior chamber
16. Closure of wound of entry (corneoscleral
wound requires sutures 10-0 silk or nylon),
phaco and SICS incisions are self sealing.

22. Complications of Cataract Surgery
I. Due to local anesthesia: Retrobulbar
haemorrhage, globe perforataion,
oculocardiac reflex etc.
II. Intra-operative complications :
detachment of descemet’s membrane,
damage to corneal endothelium,
zonular dialysis, posterior capsular
rupture

23. Complications of cataract Surgery
III. Early post-operative complications:
wound leak and complications related to it
(iris prolapse, flat anterior chamber),
secondary glaucoma, postoperative
infection, lens matter induced uveitis etc.

24. Complications of Cataract Surgery
IV. Late post-operative complications:
cystoid macular edema, posterior capsular
opacification, corneal endothelial
decompensation causing corneal edema,
retinal detachment, displacement of IOL
etc.