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

Anatomy
Capsule: integritymaintain transparency Lens epi. PCO Lens substance: lens fiber
Nucleus Cortex

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

What is cataract?

Turbidity of lens
WHO: turbidity of lens + VA<0.5

What is cataract?

Case: turbid lens, but VA=0.8

Cataract

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

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

Malformation Congenital factors

Risk factors
UV Diarrhea Malnutrition Diabetes Smoking Drinking alcohol

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

Classification
On location:
Cortical Nuclear Subcapsular

On degree:
Immature Intumescent Mature Hypermature

Pathogenesis
The common route that causing cataract is the oxidation injury by peroxide free radical.

!
Apoptosishot spot of research

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

contrast

test

Functionality vision contrast test

Positive wave contrast test CSF

curve

Vision abnormity

Color vision excursion

glare

visual field loss

Clinical manifestations
Signs:
Turbidity of lens

Senile Cataract
Now called Age-related Cataract Most commonly seen >50 yrs old >80 yrs old100% Degenerative changes

Classification
Cortical Nuclear

Subcapsular

Cortical cataract
4 stages
Incipient stage: wedge turbidity

Cortical cataract
4 stages
Intumescent stage (immature):
iris projection

Induce acute angleclosure glaucoma

Cortical cataract
4 stages
Mature stage

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

Nuclear cataract

Subcapsular cataract
Affecting vision early

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

Congenital cataract
Morphology

Congenital cataract
Treatment
observation Early operation Amblyopia Treatment

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

Kinds of Complicated cataract

Old anterior uveitis Complicated cataract

Pigmentosa eye

Silicon oil eye

glaucoma Complicated cataract vogt spot

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

Drug induced or toxic cataract

Glucocorticosteroid cataract Chlorpromazine cataract Miotic cataract TNT cataract Metal: copper, iron, mercury, silver, zinc

Traumatic cataract
Contusive Penetrating Radiative Electric

After cataract
Now usually called PCO (posterior capsular opacification) Adult: 30-50% Child: 100% Pathogenesis:

Proliferation, migration & metaplasia of lens epi.

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

ICCE And ECCE

ICCE

ECCE

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

Treatment
IOL (intraocular lens) implantation

Treatment
PEA & F-IOL

PEA & F-IOL (video)

Treatment
Correction of aphakia:
Frame glasses Contact lens IOL Laser

Lens Dislocation
Etiology:
Congenital Marfan syndrome Traumatic Spontaneous

Clinical Manifestations
Subluxation Dislocation

Clinical Manifestations
Complications:
Uveitis Secondary glaucoma Retinal detachment Corneal turbidity

Trends
Photolysis of cataract Injective IOL

Accommodative IOL