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
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