Senile cataract

Presented by:- Dr Nikhil Bansal

J.N.M.C.,Wardha

General Concepts

Almost universal in people over 70 years of age.

Occurs equally in men and women.

Considerable genetic influence. Average age of onset is earlier

in tropical countries.

Types of Senile cataract

1. Cortical cataract2. Nuclear or sclerotic cataract

Cortical cataract

Etio-pathogenesis:- Hydration followed by coagulation of lens proteins in the cortex.

Features:- Occurs in following stages :-1. Stage of lamellar separation 2. Stage of incipient cataract3. Immature senile cataract4. Mature senile cataract 5. Hypermature senile cataract

Stage of lamellar separation

Demarcation of cortical fibres owing to their separation by fluid.

Demonstrated by Slit-lamp examination only.

Characteristic grey appearance of pupil.

Changes are reversible.

Stage of Incipient cataract

Wedge shaped opacities with clear areas in between( Lens striae).

Most common in periphery and lower nasal quadrant.

Only seen in dilated pupil. Irregularities in refraction, visual

deterioration and polyopia.

Immature senile cataract

Opacification becomes more diffuse and irregular.

Lens is swollen. Iris shadow still visible. Anterior chamber becomes shallow.

Mature senile cataract

Complete opacification. Whole cortex is involved . Lens appears pearly white in colour. Also known as ripe cataract.

Hyper-mature senile cataract

Cortex is disintegrated and transformed into pultaceous material.

Usually occurs in two forms:-1. Morgagnian hyper–mature cataract2. Sclerotic hyper–mature cataract

Morgagnian hyper–mature cataract

Complete cortex is liquefied and appears milky white in colour.

Nucleus settles at the bottom. Calcium deposits may also be seen

on the lens capsule.

Sclerotic hyper–mature cataract

Disintegrated cortex. Shrunken lens. Wrinkled anterior capsule . Dense white capsular cataract in

pupillary area. Deep Anterior-Chamber. Tremulous Iris .

Nuclear or Sclerotic cataract

Etio-pathogenesis:- Intensification of age related degenerative changes associated with dehydration of and compaction of nucleus.

Features:- Hard cataract is formed. Significant increase in water insoluble protein. Lens becomes in-elastic and looses power of

accommodation. Changes begin centrally and slowly spread to

periphery. Deposition of pigments gives characteristic

colour to nucleus.

Nuclear or Sclerotic cataract

Other types of Nuclear or Sclerotic cataract

cataracta brunescens cataracta nigra

Cataracta rubra

Complications of senile cataract

1. Phacoanaphylactic uveitis2. Lens induced glaucoma3. Subluxation or dislocation of lens

References

Parson’s diseases of eye Comprehensive ophthalmology:-

Khurana and Khurana wikipedia.org

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