Podcast
Questions and Answers
What are the characteristic visual disturbances associated with incipient cataract?
What are the characteristic visual disturbances associated with incipient cataract?
Incipient cataract leads to difficulties in night vision, mono-ocular diplopia, and haloes around light.
How does immature cataract differ from mature cataract in terms of visual acuity?
How does immature cataract differ from mature cataract in terms of visual acuity?
Immature cataract has visual acuity of counting fingers or better, while mature cataract usually presents as hand motion or worse.
What common feature is absent in mature cataracts that is present in immature cataracts?
What common feature is absent in mature cataracts that is present in immature cataracts?
In mature cataracts, the iris shadow is absent, whereas it is present in immature cataracts.
Describe the changes in color and opacity between immature and mature cataracts.
Describe the changes in color and opacity between immature and mature cataracts.
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What are the indications for cataract surgery?
What are the indications for cataract surgery?
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What is the approximate dioptric power of the eye?
What is the approximate dioptric power of the eye?
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List two congenital causes of visual impairment.
List two congenital causes of visual impairment.
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What is one symptom associated with lenticular myopia?
What is one symptom associated with lenticular myopia?
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What is monocular diplopia and one possible sign of it?
What is monocular diplopia and one possible sign of it?
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What is the primary optical correction method for visual impairments?
What is the primary optical correction method for visual impairments?
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What type of cataract is characterized by yellowing due to nuclear sclerosis?
What type of cataract is characterized by yellowing due to nuclear sclerosis?
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Which type of cataract affects near vision more than far vision and is often seen in bright conditions?
Which type of cataract affects near vision more than far vision and is often seen in bright conditions?
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What is a common characteristic of cortical cataracts?
What is a common characteristic of cortical cataracts?
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What are the advantages of using ECCE over ICCE in cataract surgery?
What are the advantages of using ECCE over ICCE in cataract surgery?
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How does phacoemulsification benefit postoperative recovery in cataract surgery?
How does phacoemulsification benefit postoperative recovery in cataract surgery?
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What are some common complications of cataract surgery during the postoperative period?
What are some common complications of cataract surgery during the postoperative period?
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In the context of ocular surgery, what is the role of A-Scan ultrasound and keratometry?
In the context of ocular surgery, what is the role of A-Scan ultrasound and keratometry?
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What local anesthesia options are available for patients undergoing cataract surgery?
What local anesthesia options are available for patients undergoing cataract surgery?
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What is the primary role of the crystalline lens in the eye?
What is the primary role of the crystalline lens in the eye?
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Describe the anatomical position of the crystalline lens in relation to the iris.
Describe the anatomical position of the crystalline lens in relation to the iris.
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What are the different nuclei of the lens, and how are they formed?
What are the different nuclei of the lens, and how are they formed?
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How are the anterior and posterior capsules of the lens different in structure?
How are the anterior and posterior capsules of the lens different in structure?
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Explain the significance of the lens sutures.
Explain the significance of the lens sutures.
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What role does the ciliary body play in relation to the crystalline lens?
What role does the ciliary body play in relation to the crystalline lens?
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Discuss the refractive index difference between the lens cortex and nucleus.
Discuss the refractive index difference between the lens cortex and nucleus.
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What embryological structures lead to the formation of the crystalline lens?
What embryological structures lead to the formation of the crystalline lens?
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What clinical manifestations might indicate the presence of incipient cataract?
What clinical manifestations might indicate the presence of incipient cataract?
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How would you differentiate between immature and mature cataracts based on iris shadow?
How would you differentiate between immature and mature cataracts based on iris shadow?
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In what way does color change between immature and mature cataracts aid in diagnosis?
In what way does color change between immature and mature cataracts aid in diagnosis?
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What are the potential complications that may arise from a hypermature cataract?
What are the potential complications that may arise from a hypermature cataract?
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What is the significance of identifying symptoms like polyopia in assessing cataract progression?
What is the significance of identifying symptoms like polyopia in assessing cataract progression?
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What are the primary advantages of performing ECCE compared to ICCE during cataract surgery?
What are the primary advantages of performing ECCE compared to ICCE during cataract surgery?
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Explain the role of the posterior capsule during cataract surgery.
Explain the role of the posterior capsule during cataract surgery.
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Identify and describe two intraoperative complications that can arise during cataract surgery.
Identify and describe two intraoperative complications that can arise during cataract surgery.
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What is phacoemulsification, and how does it improve postoperative recovery for cataract patients?
What is phacoemulsification, and how does it improve postoperative recovery for cataract patients?
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List two common postoperative complications associated with cataract surgery and their implications.
List two common postoperative complications associated with cataract surgery and their implications.
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What dioptric power does the eye achieve inside the eye?
What dioptric power does the eye achieve inside the eye?
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Identify one cause of visual impairment related to congenital factors.
Identify one cause of visual impairment related to congenital factors.
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Name one method for the optical correction of visual impairments.
Name one method for the optical correction of visual impairments.
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What type of cataract is characterized by an increase in refractive index of the lens nucleus?
What type of cataract is characterized by an increase in refractive index of the lens nucleus?
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How does posterior subcapsular cataract primarily affect vision?
How does posterior subcapsular cataract primarily affect vision?
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What is a common visual effect of nuclear cataract on presbyopes?
What is a common visual effect of nuclear cataract on presbyopes?
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Which type of traumatic injury can lead to a specific form of cataract known as 'glass blowers cataract'?
Which type of traumatic injury can lead to a specific form of cataract known as 'glass blowers cataract'?
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What possibly indicates the presence of a large globe in relation to congenital glaucoma?
What possibly indicates the presence of a large globe in relation to congenital glaucoma?
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What anatomical feature divides the eyeball into anterior and posterior segments?
What anatomical feature divides the eyeball into anterior and posterior segments?
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What is the significance of the lens sutures in the crystalline lens?
What is the significance of the lens sutures in the crystalline lens?
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Describe the difference in thickness between the anterior and posterior capsules of the crystalline lens.
Describe the difference in thickness between the anterior and posterior capsules of the crystalline lens.
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Why does the posterior pole of the lens represent its thinnest area?
Why does the posterior pole of the lens represent its thinnest area?
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What type of cells contribute to the formation of new cortical fibers throughout life in the lens?
What type of cells contribute to the formation of new cortical fibers throughout life in the lens?
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What embryological structure leads to the formation of the lens vesicle?
What embryological structure leads to the formation of the lens vesicle?
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What are the three nuclei of the crystalline lens, and when is each formed?
What are the three nuclei of the crystalline lens, and when is each formed?
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How does the refractive index differ between the lens cortex and nucleus?
How does the refractive index differ between the lens cortex and nucleus?
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What visual defect is predominantly associated with incipient cataract?
What visual defect is predominantly associated with incipient cataract?
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Which characteristic differentiates immature cataract from mature cataract?
Which characteristic differentiates immature cataract from mature cataract?
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Which of the following describes the visual acuity of a mature cataract?
Which of the following describes the visual acuity of a mature cataract?
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What symptom commonly indicates the progression to a hypermature cataract?
What symptom commonly indicates the progression to a hypermature cataract?
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Which of the following conditions may result from advanced cataract stages?
Which of the following conditions may result from advanced cataract stages?
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Which statement accurately describes the advantages of ECCE over ICCE in cataract surgery?
Which statement accurately describes the advantages of ECCE over ICCE in cataract surgery?
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What is the primary benefit of performing phacoemulsification during cataract surgery?
What is the primary benefit of performing phacoemulsification during cataract surgery?
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Which of the following is a complication associated with cataract surgery during the intraoperative period?
Which of the following is a complication associated with cataract surgery during the intraoperative period?
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Which two methods are combined to determine IOL power calculation?
Which two methods are combined to determine IOL power calculation?
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Which complication is often encountered postoperatively in cataract surgery patients?
Which complication is often encountered postoperatively in cataract surgery patients?
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What is the approximate dioptric power of the eye outside the eye?
What is the approximate dioptric power of the eye outside the eye?
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Which factor is NOT associated with acquired visual impairment?
Which factor is NOT associated with acquired visual impairment?
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Which of the following types of cataract affects vision primarily in bright lighting conditions?
Which of the following types of cataract affects vision primarily in bright lighting conditions?
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What is a common consequence of nuclear sclerosis in nuclear cataract?
What is a common consequence of nuclear sclerosis in nuclear cataract?
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Which of the following does NOT describe a symptom of lenticular myopia?
Which of the following does NOT describe a symptom of lenticular myopia?
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In which condition might an individual experience color changes in their vision due to cataract?
In which condition might an individual experience color changes in their vision due to cataract?
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Which of the following types of cataract is commonly associated with aging?
Which of the following types of cataract is commonly associated with aging?
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What is the effect of electric injury on the lens?
What is the effect of electric injury on the lens?
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What is the main structural difference between the anterior and posterior capsules of the crystalline lens?
What is the main structural difference between the anterior and posterior capsules of the crystalline lens?
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Which statement accurately describes the lens and its components?
Which statement accurately describes the lens and its components?
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What is the primary role of the ciliary processes in relation to the crystalline lens?
What is the primary role of the ciliary processes in relation to the crystalline lens?
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What is the significance of the lens sutures in the crystalline lens?
What is the significance of the lens sutures in the crystalline lens?
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What embryological component ultimately leads to the formation of the adult lens?
What embryological component ultimately leads to the formation of the adult lens?
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Which characteristic of the lens indicates it is the thinnest at the posterior pole?
Which characteristic of the lens indicates it is the thinnest at the posterior pole?
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What does the continuous proliferation of the anterior subcapsular epithelium contribute to?
What does the continuous proliferation of the anterior subcapsular epithelium contribute to?
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Which of the following statements about the refractive power of the lens is true?
Which of the following statements about the refractive power of the lens is true?
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What visual symptom is most commonly associated with incipient cataract?
What visual symptom is most commonly associated with incipient cataract?
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In which type of cataract is the iris shadow absent?
In which type of cataract is the iris shadow absent?
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What color change is typically observed in mature cataracts?
What color change is typically observed in mature cataracts?
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What is a primary advantage of using ECCE over ICCE in cataract surgery?
What is a primary advantage of using ECCE over ICCE in cataract surgery?
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What is one of the common complications associated with hypermature cataracts?
What is one of the common complications associated with hypermature cataracts?
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Which complication is most commonly associated with postoperative cataract surgery?
Which complication is most commonly associated with postoperative cataract surgery?
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What visual acuity is associated with immature cataract?
What visual acuity is associated with immature cataract?
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During cataract surgery, the use of phacoemulsification primarily leads to what outcome?
During cataract surgery, the use of phacoemulsification primarily leads to what outcome?
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What is the purpose of performing IOL power calculation before surgery?
What is the purpose of performing IOL power calculation before surgery?
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What distinguishes phacoemulsification from conventional cataract surgery techniques?
What distinguishes phacoemulsification from conventional cataract surgery techniques?
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What is the effect of posterior subcapsular cataract on vision?
What is the effect of posterior subcapsular cataract on vision?
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Which of the following is NOT an acquired cause of visual impairment?
Which of the following is NOT an acquired cause of visual impairment?
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What dioptric power is typically observed outside the eye?
What dioptric power is typically observed outside the eye?
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Which signs might indicate the presence of monocular diplopia?
Which signs might indicate the presence of monocular diplopia?
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Which type of cataract is specifically known to become brown or black at late stages?
Which type of cataract is specifically known to become brown or black at late stages?
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What is the primary method used for optical correction of visual impairments?
What is the primary method used for optical correction of visual impairments?
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What is a common refractive error associated with lenticular myopia?
What is a common refractive error associated with lenticular myopia?
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Which traumatic injury is specifically related to 'glass blowers cataract'?
Which traumatic injury is specifically related to 'glass blowers cataract'?
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What is the primary function of the crystalline lens in the eye?
What is the primary function of the crystalline lens in the eye?
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Which feature differentiates the anterior and posterior capsules of the lens?
Which feature differentiates the anterior and posterior capsules of the lens?
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What is the structure that forms the thinnest area of the lens?
What is the structure that forms the thinnest area of the lens?
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Which statement regarding lens fibers is correct?
Which statement regarding lens fibers is correct?
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What embryological origin does the lens arise from?
What embryological origin does the lens arise from?
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How does the refractive index of the lens nucleus compare to the cortex?
How does the refractive index of the lens nucleus compare to the cortex?
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What is the role of suspensory ligaments in relation to the crystalline lens?
What is the role of suspensory ligaments in relation to the crystalline lens?
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What structural feature is found at the center of both the anterior and posterior capsules of the lens?
What structural feature is found at the center of both the anterior and posterior capsules of the lens?
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Study Notes
Anatomy
- The crystalline lens is a clear, biconvex structure located behind the iris.
- It divides the eyeball into anterior and posterior segments.
- Connected to the ciliary processes by suspensory ligaments.
- Covered by an anterior and posterior capsule, joining at the equator.
- Anterior capsule is thicker, lined by anterior subcapsular epithelium.
- Posterior capsule is not lined by epithelium.
- The center of the anterior capsule is the anterior pole, and the posterior capsule is the posterior pole.
- The line connecting these poles is the lens axis.
- The lens cortex is formed from anterior subcapsular epithelium, and represents soft fibers inner to the anterior and posterior capsules.
- The epithelium continually forms new cortical fibers throughout life.
- Lens fibers form sutures; anterior sutures have an erect (Y) shape, posterior sutures have an inverted (Y) shape.
- The lens has three nuclei: embryonic, foetal/infantile, adult.
Embryology
- Develops embryologically from the surface ectoderm, forming a lens placode.
- Then separates to form a lens vesicle.
- The lens nucleus at birth is the embryonic nucleus.
- This is partly formed by migration of the posterior subcapsular epithelium.
- The lens lacks blood vessels and nerve endings.
- Initially vascularized during early embryonic life by the posterior hyaloid artery.
- With development, the posterior hyaloid artery obliterates, forming the tunica vasculosa lentis.
Function
- Refraction: accounts for about one-third of the eye's refractive power.
- Dimensions of an adult lens: approximately 10mm diameter and 4mm thick.
- Radius of curvature: anterior surface (10mm), posterior surface (6mm).
- Refractive index: cortex (1.38), nucleus (1.42).
- Dioptric power: inside the eye (16-18 Diopters), outside the eye (70 Diopters).
- Accommodation: allows the eye to focus on near objects.
- Protection: protects the retina from harmful ultraviolet (UV) rays.
Lens Displacement
- Etiology: Congenital (connective tissue diseases) or acquired (trauma, hypermature cataract, anterior uveal tumor, large globe).
- Symptoms: Visual impairment (lenticular myopia, changing astigmatism, prismatic effect, monocular diplopia).
- Signs: Deep anterior chamber, tremulous iris, possible visualization of lens edge or zonules.
- Management: Optical correction (glasses or contact lenses), surgical removal.
Aphakia
- Definition: Absence of the lens from the pupillary area.
- Etiology: Congenital, surgical, loss through perforated corneal ulcer, or posterior dislocation.
- Symptoms: Strong hypermetropia (increase in refractive error).
- Loss of accomodation: ability to focus on near objects is lost.
- Optical conditions: Increase in image size.
- Clinical picture: Decreased visual acuity, deep anterior chamber, tremulous iris, jet black pupil, absence of Purkinje images.
Management (glasses, contact lenses, IOL implantation)
- Glasses: For bilateral cases (thick, heavy, decrease field of vision, increase image size).
- Contact lenses: Unilateral or bilateral (used with care, increase size of image).
- IOL implantation: Primary or secondary; posterior chamber, anterior chamber, scleral fixation.
- Investigations for power determination: A-scan US, IOL Master.
Cataract
- Definition: Opacification of the lens.
- Classification: Congenital and Developmental (Lamellar, Polar, Blue Dot, Coronary) or Acquired (Senile, Traumatic, Complicated, Toxic).
- Causes: Congenital/Developmental (trauma, metabolic disorders, ocular anomalies, infections, drugs, irradiation, nutritional).
- Causes: Acquired (senile, traumatic, complicated, toxic).
- Clinical presentations: Leucocoria, squint/amblyopia, nystagmus, and diminution of vision (mild, moderate or severe).
- Types: Nuclear, Posterior Subcapsular, Cortical (precataractous changes, incipient, immature, mature, hypermature).
Acquired Cataract
- Causes: Toxins or drugs (steroid induced).
- Types: Toxic (secondary to ocular or systemic disease), Complicated (weakness of accommodation, change/change in refractive index).
Traumatic Cataract
- Blunt trauma: Rosette-shaped cataract, Vossious ring, lens displacement.
- Penetrating trauma: Direct impact, Lenticulo-corneal touch, trauma to lens capsule, chemical injuries (alkalis > acids), radiation injury (ultraviolet, microwave, ionizing, infrared), electric injury (coagulation of lens proteins, IOFB-iron/copper lead to sidrosis, chalcosis, sunflower's cataract).
IOL Calculation
- Using A-scan US + Keratometry
- Types of Anesthesia: Local, General
- Types of Procedures: ICCE, ECCE
Intraoperative and Postoperative Complications
- Intraoperative: Vitreous loss, Expulsive hemorrhage.
- Postoperative: Posterior capsule opacification (PCO), Endophthalmitis, Corneal edema, Astigmatism, Iris prolapse, IOL decentration, RD, CME.
Phacoemulsification
- A surgical technique.
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