cataract case

Lens

Lens

A 13 years-old boy complains of diminution of vision in his left eye, He cant read words over the board. This condition started since two years after blunt trauma to this eye by foot ball, but increase slowly over the past months. He dos not wear glasses. His best corrected vision is 6/6 right eye and 6/60 left eye. His examination is significant dense lens opacity in his left eye, small corneal opacity in left eye, bilateral reactive pupils, normal IOP and normal right fundus. History of squint surgery in left eye 9 years ago.

OSPE Z

Cataract Overview

Diagnosis

Left traumatic cataract

Causes of chronic painless visual loss Z

• Cataract

• Glaucoma

• Age-related macular degeneration

• Refractive error

• Retinitis pigmentosa

• Diabetic retinopathy

• Which part of lense is left inside eye after cataract surgery

• = posterior capsule

Chronic Visual Loss

History

• Age
• Onset
• Duration
• Severity of visual loss compared to baseline
• Monocular vs. binocular ?
• Any associated symptoms

Examination

• Visual acuity assessment
• Visual fields
• Pupillary reactions
• Penlight or slit lamp examination
• Intraocular pressure
• Ophthalomoscopy
  • red reflex
  • assessment of clarity of media
  • direct inspection of the fundus

Types & Age Groups

Type	Age Group	Laterality	Notes
Senile	Old age	Bilateral	Most common in elderly
Traumatic	Young	Unilateral	Often due to injury
Congenital	Infants/Children	Uni/Bilateral	Present at birth

Anatomy

• Lens Location: Posterior segment of the eye
• Attachment: Suspensory ligament (zonules of Zinn)

Pathogenesis

• Causes: Protein degeneration, cellular apoptosis leading to cataract formation

Treatment

Age/Condition	Management
< 18 months	Treat cataract (conservative or surgery)
> 18 months	Cataract operation + intraocular lens (IOL)
Postoperative	Correct aphakia: contact lens, IOL implant, glasses (glasses not suitable for unilateral cases)
Traumatic cataract	Treated similarly to senile (older) patients

Essential Investigations

1. Biometry (for IOL power calculation)
2. Ocular ultrasound (especially if fundus view is obscured)

Clinical features

• lens
• Age
• Visual acuity
• Ocular examination
• investigation
• Tension

Treatment

Surgical Management

Since the child is over 18 months and has significant visual impairment (6/60 in the affected eye), the definitive treatment is cataract surgery:

• Lens aspiration / Phacoemulsification (depending on cataract hardness)

• Posterior chamber intraocular lens (IOL) implantation

  • Usually placed within the capsular bag (posterior capsule left intact if possible)

• Posterior capsulotomy may be performed in children (manually or with Nd:YAG laser postoperatively) to prevent posterior capsule opacification