NISHITA AFRINB.OPTOM, 3RD BATCHINSTITUTE OF COMMUNITY OPHTHALMOLOGY

INVESTIGATION AND MANAGEMENT OF SENILE CATARACT

SENILE CATARACT

INVESTIGATION

INVESTIGATION OF SENILE CATARACT

PREOPERATIVE EVALUATION OF SENILE CATARACT HISTORY General health of the patient - Diabetes mellitus, Hypertension,

ischemic heart disease , chronic obstructive pulmonary disease , bleeding disorders , parathyroid tetany, myotonic dystrophy, galactosaemia , down syndrome, atopic dermatitis, neurofibromatosis type 2

CATARACT IN SYSTEMIC DISEASE

a. Diabetic snowflake cataract

b. advance diabetic catarctc. stellate posterior

subcapsular cataract in myotonic dystrophy

d. Advance left cataract in a patient with myotonic dystrophy

e. bilateral advance cataract in atopic dermatitis

f. shield like anterior sub capsular cataract in atopic dermatitis

CONTINUE……….

Patient ocular history : Trauma, Inflammation, Amblyopia ,

glaucoma , optic nerve abnormalities , or retinal disease

social history

OCULAR INVESTIGATION…

MEASUREMENTS OF VISUAL FUNCTION

1. Visual status assessment - visual acuity, perception of light ((PL),

perception of rays (PR)2. Refraction – 3. Brightness acuity 4. Contrast sensitivity 5. Visual field testing

VISUAL ACUITY TEST

CONTRAST SENSITIVITY…

PELLI-ROBSON CONTRAST SENSITIVITY CHART

VISUAL FIELD TEST

CONTINUE…..

External examination : a. Extra ocular Motility

b. pupils

c. cover test

MOTILITY…

PUPILLARY REACTION TEST

a.Swinging flash light test

b.consensual light reflex

COVER TEST…..

CONTINUE……

Special Tests : Potential acuity estimation Tests for Macular Function-

1. Two light discrimination test 2. maddox rod test3. Color perception

4. Entoptic visualisation 5. Blue Light entoptoscopy

6. Purkinje’s entoptic phenomenon

MADDOX ROD TEST…

ENTOPTIC VISUALISATION

BLUE LIGHT ENTOSCOPY…

COLOR PERCEPTION…

CONTINUE….

Retinal function test PR – must be present in all 4

quadrants Electro-retinogram Electro-oculogram Visual evoked potential

CONTINUE….

Slit-Lamp Examination : Eyelids, Lacrimal apparatus, sclera Conjunctiva , Anterior chamber , Cornea Iris Crystalline Lens

CONTINUE…….

Fundus Evaluation :

- Ophthalmoscopy

- Optic nerve - Fundus evaluation with

opaque media

OPHTHALMOSCOPY…

CONTINUE…..

Measurement of IOP conjunctival swab for C/S Sac patency test to exclude chronic

dacryocystitis Oro-dental check up to exclude septic

foci

MEASUREMENT OF IOP…

CONTINUE……

Preoperative Measurement : Biometry 1.keratometry 2. A- scan

ultrasonography

KERATOMETER…..

CONTINUE….

B-scan ultrasonography Corneal Topography Corneal phachymetry Specular microscopy

B-SCAN ULTRASONOGRAPHY

CORNEAL TOPOGRAPHY….

SYSTEMIC INVESTIGATION….

Clinical : - BP Lab test : - RBS/FBS - Urine - X-Ray chest and ECG – If needed

MANAGEMENT

MANAGEMENT……

NON-SURGICAL MEASURES ---- 1. Treatment of cause of cataract 2. Measures to delay progression topical preparation containing

iodine salts of calcium and potassium, role of vitamin E and aspirin

3. Measures to improve in the presence of incipient and immature cataract-----

Refraction, Arrangement of illumination, use of dark goggles, Mydriatics

CONTINUE…..

SURGICAL MANAGEMENT ----- 1. Visual improvement 2. Medical indication 3. cosmetic indication

PREOPERATIVE MEDICAL AND PREPARATIONS

Consent Srcub bath, care of hair, and marking

of the eye Preoperative antibiotics and

disinfectants IOP lowering Mydriasis

TYPES OF SURGERY

Intra capsular cataract (ICCE)

Extra capsular cataract (ECCE)

Pseudophakia – SICS , Phacoemulsification

COUNSELING AFTER POSTOPERATIVE CATARACT SURGERY

The post-operative recovery period (the period after cataract extraction is done) is usually short. The patient is usually ambulatory on the day of surgery but is advised to move cautiously and avoid straining or heavy lifting for about a month

The eye is usually patched on the day of surgery and at night using an eye shield is often suggested for several days after surgery

. Intraocular lenses are usually monofocal, correcting for either distance or near vision, however, multifocal lenses may be implanted to improve near and distance vision simultaneously, but these lenses may increase the chance of unsatisfactory vision

PREOPERATIVE COMPLICATIONS IN SENILE CATARACT

Anxiety Nausea and gastritis Irritative or allergic conjunctivitis Corneal abrasion complications due to local anaesthesia – - Retrobulbar haemorrhage - Oculocardiac reflex - Perforation of globe - Subconjunctival haemorrhage - Spontaneous dislocation of lens

COMPLICATIONS OF CATARACT SURGERY Retinal detachment Endophthalmitis Corneal edema Cystoid macular edema Pseudophakic bullos keratopathy Epithelial keratopathy Fibrous downgrowth

LOW VISION MANAGEMENT FOR CATARACT High – add spectacles, magnifiers, CCTV , Telescopeic loupes for reading and close

work Direct lighting when reading or

performing near work Glare can be reduce by filter,tints, and

sunlenses

CONTINUE….

Large print reading material Bold line writing paper and Typoscope

REFERRANCES……. LENS AND CATARACT – AMERICAN ACADEMY OF OPHTHALMOLOGY COMPREHENSIVE OPHTHALMOLOGY – A. K. KHURANA KANSKI CLINICAL OPHTHALMOLOGY PARSON’S DISEASE OF THE EYE