236B Systemic Final-Cataract-Dr. Walker

Front 1

What are the possible causes for cataract

Back 1

1. Uveitis, RP
2. corticosteroids
3. Diabetes, myotonic dystrophy, atopic dermatitis
4. Down syndrome
5. Many are idiopathic

Front 2

Lens development
1. 3rd wk
2. 6th wk
3. 7th mon

Back 2

1. 3rd wk
● differentiate from surface ECTODERM

2. 6th wk
● separated from ectoderm
● form Lens Vesicle
● develop Embryonic lens nucleus

3. 7th mon
● "Tunica vasculosa lentis (hyaloid) disappears
3. 7th mon

Front 3

Lens anterior epithelium
1. in which region is responsible for production of ner fibers

Back 3

Epithelial region near the equator

Front 4

Lens
-Zone of discontinuity

Back 4

Alternating light & dark bands/ lines seen with SLE ( Most visible at 30-40age)

-different indices of refraction

Front 5

Lens
-zone of disjunction

Back 5

Relatively "Clear" or "Darker" region seen under the Ant. lens capsure

-composed of the NEWEST, YOUNGEST fibers

Front 6

Time of development
1. Embryonic nucleus
2. Fetal nucleus
3. Juvenile nucleus (Infantile)
4. Adult nucleus
5. Cortex

Back 6

1. Embryonic nucleus- 7 wk
2. Fetal nucleus- 8 mon
3. Juvenile nucleus (Infantile)- early~mid teens
4. Adult nucleus-late teens to mid-20s
5. Cortex- mid 20s throughout life

Front 7

What are the anatomical regions of lens that present at birth

Back 7

embryonic nucleus
fetal nucleus
Y suture
capsule

Front 8

Name the clinical features of the lens from Center to Anterior capsule

Back 8

Embryonic nucleus
Fetal nucleus
Y suture
Juvenile nucleus (infantile)
Adult nucleus
Cortex
"Zone of disjunction"
Capsule

Front 9

What lens anomalies is this?

Back 9

Mittendorf dot
● remnant of hyaloid system (small, white, circular)
● at INF+NAL on Post. lens capsure
● not clinically impt to affect vision

Front 10

Vogt's Reflex line

Back 10

Remnant of hyaloid
Faint, gray thing line
Reversed C-shaped line
Post. lens surface
Not clinically impt to affect vision

Front 11

Coloboma
1. definition
2. appearance

Back 11

1. Definition
● incomlete lens development

2. appearance
● Notch in the edge

Front 12

Define "Ectopia lentis"

Back 12

aka "Lens luxation"

Marfan's: UPWARD
Homocystinuria: DOWNWARD

● DO NOT dilate if lens is loose, can fall into AC --> pupillary block glaucoma

Front 13

Lenticonus
1. usually one eye or both eye
2. Alport's syndrome
3. Lowe's syndrome
4. vision problem

Back 13

1. usually UNILATERAL

2. Alport's (deafness, renal failure, white retinal flecks): ANT. con

3. Lowe's ( glaucoma, mental ret.): POST. con

4. Vision
● Irregular astigmatism
● myopia
● decrease acuity

Front 14

Define "Spherophakia" , associated with

Back 14

●lens with a SHORT radius of curvature

●associated with microphakia, extreme myopia, tend to subluxate and dislocate anteriorly
●associated w/ " Marchesani syndrome" (short stature, stubby fingers and toes)

Front 15

Define "Congenital Cataract"

Back 15

present AT birth, or within 3 month after birth

Front 16

Congenital Cataract
1. Cause

Back 16

1. Cause
● MOST are Idiopathic
● 25% are inherited and part of a syndrome

2. BILATERAL = inherited = autosomal Dominant

Front 17

Cataractogenic agents for Congenital Cataracts

Back 17

●Ionizing radiation- risk at 1st trimester
●Drugs- risk at 1st trimester (steroids, antibiotics)
●Metabolic disease of mother- diabetes, hypocalcaemia
●Maternal malnutrition-amino acid, niacin, thiamine, riboflavin deficiencies
●Intrauterine infection- toxoplasmosis, rubella, CMV, syphilis

Front 18

Review Types of Congenital Cataracts in Esther's final study guide on p. 35

Back 18

Embryonic nuclear cataract
cataracta centralis pulveralenta
etc

Front 19

Congenital cataracts that are Bilateral

Back 19

Embryonic nuclear cataract-autosomal dominant
Sutural cataract- X-lnked
Zonulae-Lamellar cataract-abnormal Ca metabolism

Front 20

Stellate/ stalagmite/coraliform

Back 20

放射狀

Front 21

what type of congenital cataract is this?

Back 21

Anterior polar cataract
●cotton-ball like opacity
●ANT. sub-capsule
●made of hyaline, Ca, cholesterol, degenerating lens fibers
● sharp edge
● associated w/ "Persistent pupillary membrane"

Front 22

Effect on vision:

ANT. polar vs Post. polar cataract

Back 22

Ant little visual decrease

Post. GREATER vision decrease b/c closer to nodal point

Front 23

Most common congenital cataract is

Back 23

Zonule /Lamellar

Front 24

Which congenital cataract accounts for 30% of all cases

Back 24

Sutural cataract

Front 25

What type of congenital cataract is it?

Back 25

Zonular-lamellar cataract
● bilateral
●circular zone with clear center surrounding nucleus
● associated with ABNORMAL Ca++ metabolism

Front 26

what type of cataract is it?

Back 26

Total/Diffuse cataract
● inherited
● all lens fibers affected
● seen as white calcified mass w/in pupil
● capsule shrinkage

Front 27

Age-related "Senile' Cataract
1. Prevalence
2. Risk factors

Back 27

1. Prevalence-Most common

2. Risk factors
● aging
● smoking
● steroids
● diabetes
● nutrional factors
● UV

Front 28

Define "Intumescence"

Back 28

swelling of the lens

Front 29

Cortical Cataract
1. Cause
2. Incidence
3. Sx
4. Clinical signs

Back 29

1. Cause
● increase permeability of capsule --> liquefaction of lens fibers --> breakdown and coagulation of fiber proteins --> opacification

2. Incidence
● 3% at age 40-55
●30% > 75 age

3. Sx
● glare
● dec acuity
● dec contrast
● monocular diplopia
● slight inc in hyperopic shift

4. Clinical signs
● vacuole
● water clefts
● spokes
● lamellar separation
● diffuse opacification
● morgagnian
● phacotoxic-phacoanaphylactica
● phacomorphic glaucoma

Front 30

Define "Vacuoles"

Back 30

circular pocket of fluid

Front 31

Define "Spoke"

Back 31

wedge-shaped opacity

Front 32

Mature vs Hypermature cataract

Back 32

Mature: entire cortex is hazy and more gray

Hypermature: entire cortex is comlpletely opaque and white

Front 33

Define "Morgagnian" cataract

Back 33

solid HARD nucleus floats in "white" liquefied fluid cortex
.Usually sinks inferiorly.

Front 34

Define "phacotoxic"

Back 34

lens induced uveitis

Front 35

Define " phacolytic glaucoma"

Back 35

lens induced
proteins and macrophages in TM impede AH outflow --> increase IOP

Front 36

Define "phacomorphic glaucoma"

Back 36

swelling of lens cortex --> shallows the AC --> Secondary angle closure glaucoma

Front 37

Cortical cataract vs Nuclear cataract

Back 37

Cortical cataract
● liquefaction of lens fiber
● SOFT cataract
● hyperopic shift

Nuclear cataract
● hardening of lens fibers
● HARD cataract
● myopic shift (-0.5~15D)

Front 38

Color appearance in nuclear cataract is due to (2)

Back 38

modification of proteins
formation off "Urochrome pigment"

Early stage: yellow-gold
Later stage: dark brown

Front 39

Most common age-related cataract is

Back 39

Nuclear sclerosis (55% > 75 age)

Front 40

Nuclear cataract
1. sx
2. clinical signs

Back 40

1. Sx
● Distance blur
● Improved near vision ("Second sight")
● Myopic shift
● loss of color discrimination
● Diplopia

2. Clinical signs
● yellowing of the lens and loss of central lens lines

Front 41

2 types of posterior subcapsular cataract

Back 41

1. Cupuliform (More common)
● cup shape
● w/ aging, steroids use, myotonic dystrophy, atopic dermatitis.

2. Complicated (Less common)
● w/ longstanding intraocular disease
● RP, myopic degeneration, posterior uveitis

Front 42

What is the LEAST common age-related cataract

Back 42

Posterior subcapsular cataract
(11% >75)

Front 43

From most common to least common age-related cataract

Back 43

Nuclear > Cortical > Post. subcapsular

Front 44

Posterior subcapsular cataract
1. Sx
2. Clinical signs (Cupuliform vs Complicated)

Back 44

1. Sx
● decrease in vision (esp when pupils are small)
● in dim, can see around the opacity

2. Clinical signs (Cupuliform vs Complicated)
● Opacity stays in subcapsular region only in Cupuliform while opacity spread to adjacent cortex in Complicated one.
● Faint iridescence of B&G in Cupuliform while Polychromatic colors of B&G&R in Complicated cataract.

Front 45

If seeing Unilateral cataract, what is the possible cause

Back 45

Trauma

Front 46

Traumatic cataract generally shows what type of pattern

Back 46

Stellate (star)
Rosette ( petals of rose)

Front 47

Pseudocataracts include

Back 47

1. Vossius ring
2. Epicapsular stars
3. Pseudoexfoliation

Front 48

If this is an unilateral cataract, what is the most likely type

Back 48

Traumatic cataract ( due to stellate shape)

Front 49

Identify

Back 49

Vossius ring
● imprint of pigment from iris on ant. lens capsure
● 2' to blunt trauma and compression of ant. seg

Front 50

Identify

Back 50

Epicapsular stars
● remnant of hyaloid system
● in high mag, look like little starfish
● pseudocataract

Front 51

identify

Back 51

Pseudoexfoliation
● amyloid like fiber abnormality
● risk of developing glaucoma
● Don't be mistaken as cataract

Front 52

Define "Cerulean"

Back 52

Bluish punctate opacities w/in adult nucleus or cortex

Front 53

Diabetic cataract
1. clinical signs

Back 53

1. signs
● White snowflake-like opacity w/in Ant/Post. subcapsular regions
● RAPID progression

Front 54

Define "Glaucomflechen"

Back 54

grayish flecks in Ant. subcapsular region, asso w/ episodes of RAPID increase in IOP (>50 mmHg)

Front 55

identify

Back 55

Crystalline cataract
● "X'mas tree" cataract
● very colorful
● usually unilateral

Front 56

identify

Back 56

Crystalline cataract
● "X'mas tree" cataract
● very colorful
● usually unilateral

Front 57

identify

Back 57

Glaucomflechen
● gray flecks in Ant. subcapsular region

Front 58

Intracapsular cataract extraction

Back 58

remove entire lens + capsule

Front 59

Extracapsular cataract extraction

Back 59

suture-less clear corneal incisions and intraocular lens implants (IOL)

Front 60

Surgical ocular complications of Cataract surgery

Back 60

1. Corneal edema ( pseudophakic bullous keratopathy)
2. Infection (unusual)
3. Prolonged inflammation
● UGH syndrome
● U= Uveitis
● G= Glaucoma
● H= Hyphemas

4. Iris prolapse
5. Iris capture of IOL (not common)
6. Iris atrophy (due to rubbing)
7. IOL decentration ( see halos, aberrations)
8. Posterior capsule tear (lead to post. seg inflammation)
9. Retained cortical material
10. Retinal detachment
11. 2' mb/ Elschnig's pearls ( opacification of post. capsule)