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Lens Disease

Lens Disease. China Medical University NO.4 Affiliated hospital Ophthalmology; Ophthalmology hospital of China Medical University. Introduction. Lens disease: Change of transparency cataract Position and morphological abnormality dislocation malformation. Basic knowledge. Anatomy.

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Lens Disease

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  1. Lens Disease China Medical University NO.4 Affiliated hospital Ophthalmology; Ophthalmology hospital of China Medical University

  2. Introduction • Lens disease: • Change of transparency • cataract • Position and morphological abnormality • dislocation • malformation

  3. Basic knowledge

  4. Anatomy • Equator • Anterior capsule • Posterior capsule • Diameter:9-10mm • Thickness:4-5mm • Lens zonule

  5. Anatomy • Capsule: integrity—maintain transparency • Lens epi. — PCO • Lens substance: lens fiber • Nucleus • Cortex

  6. ! Function • Refraction • Accommodation • Protection: UV filtration • What is accommodation? • The capability that eyes change refractive condition in order to acquire clear near sight.

  7. What is cataract? • Turbidity of lens • WHO: turbidity of lens + VA<0.5

  8. What is cataract?

  9. Case: turbid lens, but VA=0.8

  10. ! Cataract • Cataract is the No. 1 eye disease that causing blind. • 46% blindness is caused by cataract

  11. Etiology • Any factors that change the intraocular environment to affect lens metabolism. • Such as: ageing, mechanical, chemical, operation, inflammation, metabolic • Malformation • Congenital factors

  12. Risk factors • UV • Diarrhea • Malnutrition • Diabetes • Smoking • Drinking alcohol

  13. Classification • On etiology: • Congenital • Senile • Complicated • Metabolic • Drug induced or toxic • Traumatic • After cataract

  14. Classification • On location: • Cortical • Nuclear • Subcapsular • On degree: • Immature • Intumescent • Mature • Hypermature

  15. ! Pathogenesis • The common route that causing cataract is the oxidation injury by peroxide free radical. • Apoptosis—hot spot of research

  16. Clinical manifestations • Symptoms: • Progressive vision decrease • Contrast sensitivity decrease • Refraction changes • Diplopia • Glare • Change of color sensation • Visual field defect

  17. contrast test Functionality vision contrast test Positive wave contrast test CSF curve

  18. Vision abnormity Color vision excursion glare visual field loss

  19. Clinical manifestations • Signs: Turbidity of lens

  20. Senile Cataract • Now called Age-related Cataract • Most commonly seen • >50 yrs old • >80 yrs old→100% • Degenerative changes

  21. Classification • Cortical • Nuclear • Subcapsular

  22. Cortical cataract • 4 stages Incipient stage: wedge turbidity

  23. Cortical cataract • 4 stages Intumescent stage (immature): • iris projection • Induce acute angle-closure glaucoma

  24. Cortical cataract • 4 stages Mature stage

  25. Cortical cataract • 4 stages • Hypermature stage: • Morgagni cataract • Phacoanaphylactic uveitis • Phacolytic glaucoma

  26. Nuclear cataract

  27. Subcapsular cataract • Affecting vision early

  28. Congenital cataract • Etiology: • Hereditary • Environmental: • Virus infection • Malnutrition • Radiation • Drug • Systemic disease • VD deficiency

  29. Congenital cataract • Morphology

  30. Congenital cataract • Treatment • observation • Early operation • Amblyopia Treatment

  31. Complicated cataract • Caused by other eye diseases • Corneal ulcer • Glaucoma • Uveitis • Retinal detachment • Retinitis pigmentosa • Intraocular tumor • myopia

  32. Kinds of Complicated cataract Old anterior uveitis Complicated cataract glaucoma Complicated cataract（vogt spot） Pigmentosa eye Silicon oil eye

  33. Metabolic cataract • Caused by systemic metabolic diseases • Diabetic cataract • Galactosemia cataract • Hand-foot-twitch cataract

  34. Drug induced or toxic cataract • Glucocorticosteroid cataract • Chlorpromazine cataract • Miotic cataract • TNT cataract • Metal: copper, iron, mercury, silver, zinc

  35. Traumatic cataract • Contusive • Penetrating • Radiative • Electric

  36. ! After cataract • Now usually called PCO (posterior capsular opacification) • Adult: 30-50% • Child: 100% • Pathogenesis: Proliferation, migration & metaplasia of lens epi.

  37. Treatment Drug? NO USE Operation: the only effective therapy ICCE (intracapsular cataract extraction) ECCE (extracapsular cataract extraction) PEA (phacoemulsification) !

  38. ICCE And ECCE ICCE ECCE

  39. Treatment • IOL (intraocular lens) implantation • AC and PC • Hard and foldable

  40. Treatment • IOL (intraocular lens) implantation

  41. Treatment • PEA & F-IOL

  42. PEA & F-IOL (video)

  43. Treatment • Correction of aphakia: • Frame glasses • Contact lens • IOL • Laser

  44. Lens Dislocation • Etiology: • Congenital • Marfan syndrome • Traumatic • Spontaneous

  45. Clinical Manifestations • Subluxation • Dislocation

  46. Clinical Manifestations • Complications: • Uveitis • Secondary glaucoma • Retinal detachment • Corneal turbidity

  47. Trends • Photolysis of cataract • Injective IOL • Accommodative IOL

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