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60 Cards in this Set

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What are the possible causes for cataract
1. Uveitis, RP
2. corticosteroids
3. Diabetes, myotonic dystrophy, atopic dermatitis
4. Down syndrome
5. Many are idiopathic
Lens development
1. 3rd wk
2. 6th wk
3. 7th mon
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
Lens anterior epithelium
1. in which region is responsible for production of ner fibers
Epithelial region near the equator
Lens
-Zone of discontinuity
Alternating light & dark bands/ lines seen with SLE ( Most visible at 30-40age)

-different indices of refraction
Lens
-zone of disjunction
Relatively "Clear" or "Darker" region seen under the Ant. lens capsure

-composed of the NEWEST, YOUNGEST fibers
Time of development
1. Embryonic nucleus
2. Fetal nucleus
3. Juvenile nucleus (Infantile)
4. Adult nucleus
5. Cortex
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
What are the anatomical regions of lens that present at birth
embryonic nucleus
fetal nucleus
Y suture
capsule
Name the clinical features of the lens from Center to Anterior capsule
Embryonic nucleus
Fetal nucleus
Y suture
Juvenile nucleus (infantile)
Adult nucleus
Cortex
"Zone of disjunction"
Capsule
What lens anomalies is this?
Mittendorf dot
● remnant of hyaloid system (small, white, circular)
● at INF+NAL on Post. lens capsure
● not clinically impt to affect vision
Vogt's Reflex line
Remnant of hyaloid
Faint, gray thing line
Reversed C-shaped line
Post. lens surface
Not clinically impt to affect vision
Coloboma
1. definition
2. appearance
1. Definition
● incomlete lens development

2. appearance
● Notch in the edge
Define "Ectopia lentis"
aka "Lens luxation"

Marfan's: UPWARD
Homocystinuria: DOWNWARD

● DO NOT dilate if lens is loose, can fall into AC --> pupillary block glaucoma
Lenticonus
1. usually one eye or both eye
2. Alport's syndrome
3. Lowe's syndrome
4. vision problem
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
Define "Spherophakia" , associated with
●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)
Define "Congenital Cataract"
present AT birth, or within 3 month after birth
Congenital Cataract
1. Cause
1. Cause
● MOST are Idiopathic
● 25% are inherited and part of a syndrome

2. BILATERAL = inherited = autosomal Dominant
Cataractogenic agents for Congenital Cataracts
●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
Review Types of Congenital Cataracts in Esther's final study guide on p. 35
Embryonic nuclear cataract
cataracta centralis pulveralenta
etc
Congenital cataracts that are Bilateral
Embryonic nuclear cataract-autosomal dominant
Sutural cataract- X-lnked
Zonulae-Lamellar cataract-abnormal Ca metabolism
Stellate/ stalagmite/coraliform
放射狀
what type of congenital cataract is this?
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"
Effect on vision:

ANT. polar vs Post. polar cataract
Ant little visual decrease

Post. GREATER vision decrease b/c closer to nodal point
Most common congenital cataract is
Zonule /Lamellar
Which congenital cataract accounts for 30% of all cases
Sutural cataract
What type of congenital cataract is it?
Zonular-lamellar cataract
● bilateral
●circular zone with clear center surrounding nucleus
● associated with ABNORMAL Ca++ metabolism
what type of cataract is it?
Total/Diffuse cataract
● inherited
● all lens fibers affected
● seen as white calcified mass w/in pupil
● capsule shrinkage
Age-related "Senile' Cataract
1. Prevalence
2. Risk factors
1. Prevalence-Most common

2. Risk factors
● aging
● smoking
● steroids
● diabetes
● nutrional factors
● UV
Define "Intumescence"
swelling of the lens
Cortical Cataract
1. Cause
2. Incidence
3. Sx
4. Clinical signs
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
Define "Vacuoles"
circular pocket of fluid
Define "Spoke"
wedge-shaped opacity
Mature vs Hypermature cataract
Mature: entire cortex is hazy and more gray

Hypermature: entire cortex is comlpletely opaque and white
Define "Morgagnian" cataract
solid HARD nucleus floats in "white" liquefied fluid cortex
.Usually sinks inferiorly.
Define "phacotoxic"
lens induced uveitis
Define " phacolytic glaucoma"
lens induced
proteins and macrophages in TM impede AH outflow --> increase IOP
Define "phacomorphic glaucoma"
swelling of lens cortex --> shallows the AC --> Secondary angle closure glaucoma
Cortical cataract vs Nuclear cataract
Cortical cataract
● liquefaction of lens fiber
● SOFT cataract
● hyperopic shift

Nuclear cataract
● hardening of lens fibers
● HARD cataract
● myopic shift (-0.5~15D)
Color appearance in nuclear cataract is due to (2)
modification of proteins
formation off "Urochrome pigment"

Early stage: yellow-gold
Later stage: dark brown
Most common age-related cataract is
Nuclear sclerosis (55% > 75 age)
Nuclear cataract
1. sx
2. clinical signs
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
2 types of posterior subcapsular cataract
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
What is the LEAST common age-related cataract
Posterior subcapsular cataract
(11% >75)
From most common to least common age-related cataract
Nuclear > Cortical > Post. subcapsular
Posterior subcapsular cataract
1. Sx
2. Clinical signs (Cupuliform vs Complicated)
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.
If seeing Unilateral cataract, what is the possible cause
Trauma
Traumatic cataract generally shows what type of pattern
Stellate (star)
Rosette ( petals of rose)
Pseudocataracts include
1. Vossius ring
2. Epicapsular stars
3. Pseudoexfoliation
If this is an unilateral cataract, what is the most likely type
Traumatic cataract ( due to stellate shape)
Identify
Vossius ring
● imprint of pigment from iris on ant. lens capsure
● 2' to blunt trauma and compression of ant. seg
Identify
Epicapsular stars
● remnant of hyaloid system
● in high mag, look like little starfish
● pseudocataract
identify
Pseudoexfoliation
● amyloid like fiber abnormality
● risk of developing glaucoma
● Don't be mistaken as cataract
Define "Cerulean"
Bluish punctate opacities w/in adult nucleus or cortex
Diabetic cataract
1. clinical signs
1. signs
● White snowflake-like opacity w/in Ant/Post. subcapsular regions
● RAPID progression
Define "Glaucomflechen"
grayish flecks in Ant. subcapsular region, asso w/ episodes of RAPID increase in IOP (>50 mmHg)
identify
Crystalline cataract
● "X'mas tree" cataract
● very colorful
● usually unilateral
identify
Crystalline cataract
● "X'mas tree" cataract
● very colorful
● usually unilateral
identify
Glaucomflechen
● gray flecks in Ant. subcapsular region
Intracapsular cataract extraction
remove entire lens + capsule
Extracapsular cataract extraction
suture-less clear corneal incisions and intraocular lens implants (IOL)
Surgical ocular complications of Cataract surgery
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)