Cataract Lecturer

8/19/2019 Cataract Lecturer

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C A T A R A C T

Dr. T. Budi Sulistya, Sp.MDr. Anny Sulistiyowati, Sp.M

Dr. Sony Agung Santoso, Sp.M

Department of OphthalmologyFaculty of Medicine Brawijaya ni!ersity

Saiful Anwar "ospital


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# Bicon!e$

# A!ascular

# Transparent

# Thic%ness& ' mm,diameter ( mm

# Ant & a)ueous humo

# *ost & !itreous# *osition& suspensory

ligament +onula-

inn


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PHYSIOLOGY

/ens transparency & control water 0electrolyte

Dehydrated

1 22

Amino Acid

3a4

5l

> "A 06itreous< "A 06itreous


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BIOCHEMISTRY

# 789 water

# :89 *rotein, mineral, glutathione,

*otassium, Ascor;ic acid, etc.# 3utrition&


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"yperglicemic Osmotic ↑ Swelling

Opaci=cation


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PATHOLOGY

# Ad!ance age

# Trauma# >n?ammation

# Meta;olic disorder

# 5orticosteroid# @adiation


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Age Related Cataract

5ommon

3uclear, 5ortical, *osterior Su;

5apsular 5ataract +*S5-


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STAGES OF SENILECATARACT

# Stadium >3S>*>3T

# Stadium >MMAT@

# Stadium MAT@

# Stadium "*@ MAT@


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RISK FACTOR

# Age

# Dia;etes mellitus

# Drugs& corticosteroid, phenothiaine,chlorpromaine

# ltra!iolet radiation

# Smo%ing

# Al%ohol


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DIAGNOSIS &

EXAMINATIONC. 6isual distur;ance&

depends on& opacity

location.


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EXAMINATION

C. 6isual acuity& natural, ;est corrected

. Anterior segment

:. *upilary dilatation

'. Funduscopic e!aluation &

E $amine with

ophthalmoscope E Blac%

spot o!er orange ;ac%ground +insipient Eimmature-

E 3egati!e +mature-


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Additioal te!t

C. >ntraocular pressure

. 1eratometry and ;iometry

:. @etinometry

'. ltrasonography

8. Blood pressure7. Blood sugar

. "emostasis


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MANAGEMEN

TNo S"rgical

C. Spectacle lens

. Magni=cation G !isual aids

:. Appropriate illumination

S"rgical

@educed !isual funcion

5omplication & Secondary

glaucoma


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Indication of Surgery

C.6isual >mpairment

# @esponsi;le for the patientHs disa;ility

in desired acti!ity +dri!ing, reading,

occupational needs-


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# 6isual disa;ility increases due to glare or

dim illumination

# *atient complains of monocular diplopia or

polyopia

# 6isual disparity e$ists ;etween two eyes


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. Other indications&

/ens induced diseases & phacomorphic

glaucoma, phacolytic glaucoma

5oncomitant ocular disease that

re)uires clear media& re)uired to

ade)uately diagnose dia;etic

retinopathy


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#$ Stadi"% INSIPIENT

6isual acuity can ;e normal Opacity starts as a line at lens edge

Iheel appearance

5entral one stillclear

May ;e stationer


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$ Stadi"% IMMAT'RE

/ens a;sor;s water ;ulging glaucoma

# 6A& 8G7 CG7J

# Fundus re?e$ +4-# Opacity not

homogen

# >ris shadow test +4-

# >ndication for

surgery +4-


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# 6isual acuity CG7J /* +4-

# "omogen opacity

# Fundus re?e$ +-

# >ris shadow test +-

# O;!ious indication for surgery

($ Stadi"% MAT'RE


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)$ Stadi"% HIPERMAT'RE

Degeeratio o* le! corte+ adca,!"le

S-r".e cataract / le! !-ri.! ad t-i! d"e

to lo!! o* 0ater

Morgagia Cataract / corte+ !o*te! ad

li1"e2e! "cle"! !i.!


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S"rgical Proced"re

# $tra 5apsuler 5ataract $traction 55

3uclear $pressionG$traction

*hacoemulsi=cation

# >ntra 5apsuler 5ataract $traction >55

E


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EXTRA CAPS'LAR

E+tra ca,!"lar

>ncision KCJ mm corneoscleral

Anterior capsulotomy

3ucleus $pressed from capsular ;ag

@esidual corte$ remo!ed

*osterior capsule is intact

/arge incision& suture 22

For all %inds of cataract

Manual Small >ncisi 5ataract Surgery

+MS>5S-


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P-acoe%"l!i2catio

# E : mm

# 5lear cornea

# 5apsulotomy& 5ontinuous

5ur!elinear 5apsulore%sis

555

# ltrasonic

# 3o sutures


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INTRA CAPS'LAR

# >55

# /arge incision# /ens 0 5apsule intoto

# "igher ris% of !itreous loss

# For mature 0 hypermature cataract

# 5an not ;e done for congenital 0 ju!enile cat.


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INTRAOC'LAR LENS

# More *hysiological

More co%*orta3le

# *MMA, Silicone, Acrylic

# >nside capsular ;ag

# 6A 7G7

# *seudopha%ia


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COMPLICATIONS# ndophthalmi

tis

# Iound lea%

# >ris prolapse

# !eitis

# >ncreased >O*

# 5orneal

edema

# Bullous %eratopaty

# Dislocated >O/

# 6itreous /ost

# 5M

# @D

# 5horoidal

hemorrhage


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POST S'RGICAL REHA4ILITATION

# *atients complaint

# 6A

# Anterior segment

# Sign of in?ammation

# >O*

# Iound healing.# *ersonal hygiene

# Spectacle correctionGreading


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COMM'NITY OPHTHALMOLOGY

# Blindness& C.8 9, cataract C 9

# "andling& Dept of "ealth

3


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4ac.log Cataract

# 5ataract& C 9 CJ.JJJ

# Surgical capacity& KJ.JJJGyear

#Bac%log & C:J.JJJGyear

# ANected ;y& unawareness community

high cost of surgery

ophthalmologist LL

reach surgical capacity

LL


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# 5ommunity ophthalmology& elimination

cataract&

*romotion

*re!ention

5ure

@eha;ilitation

Ophthalmologist


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Documents

Cataract Lecturer