DISORDERS OF LENS

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• ????
• DISORDERS OF LENS
• ????????????????
• ????
• EYE HOSPITAL OF THE 1ST CLINICAL MEDICAL COLLEGE,
  HMU

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• ???(lens)?????,???,?????????,?????????????????????
  ?????????????????????????????,?????????The lens
  is a kind of avascular transparent tissue with
  complex metabolic process. Its nourishment mainly
  comes from aquous humour. The disorder of the
  lens is commonly loss of its transparency and
  abnormality of its position both can induce
  severe visual disturbance.

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??? CATARACT

• ??(Introduction)
• ?????????????????(cataract),??????????,???????
• The opacity of lens is generally called cataract.
  But mild opacity of the lens has no affection to
  vision without any clinical significance.

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• ??(Etiology)????,????????????????????????????,???
  ??????,??????????????,??????????,?????????????,???
  ??

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??????CLASSIFICATION OF CATARACT

• 1.???(according to etiology)????(injuried)????(co
  mplicated)????(metabolic)????(toxic)????(radiating
  )????(develoing)????(after-cataract)????

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• 2. ?????(according to age of occurring)
  ???(congenital)????( infantile)?
  ????(juvenile)????(adult)????(senile)?
• 3. ?????(according to the site of opacity)
  ???(cortical)???( nuclear)????(subcapsular)????(ca
  psular)?

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• 4. ??????(according to the degree of
  opacity)??(incipient)????(immature)????(mature)??
  ??(hypermature)?
• 5. ?????(according to the shape of
  opacity)??(punctate)???(coronary)??????(lamellar)
  ?

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????????(age-related cataract)

• ??????????????,??????,????????????????????,???????
  ???????????????????
• is the most common one, often seen in the elder
  more than 50 years old. With aging its morbidity
  rate goes higher. It is gradually appeared
  degenerative change in the course of lens aging.
  Its pathologic mechanism isnt understood
  completely yet, related with ultraviolet ray,
  with systemic disease such as diabetes,
  hypertension, arteriosclerosis, genetic factor as
  well as lens nourishment and metabolic condition
  and so on.

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????(clinical findings)

• ?????,???????,????????????????????????????????????
  ????????,????????????????,???????,????????????????
  ?????????????,????????,?????????

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• ??(symptoms)
• ??????????????????????????????????
• ???????3?
• 1.???????????
• 2.????,?????????
• 3.?????????????????

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??(signs)

• ??????????,????,???????,??????????,???????????????
  ??,???????????????????

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• 1. ??????(cortical cataract) ?????????????4??
• It is the most common type of senile cataract,
  according to the development it is divided into
  4 stages.
• (1) ??(incipient stage) ?????????????????????????
  ??,????????????????????????,?????????????????????,
  ??????????????????,????????,????????

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• Cuneiform opacity appears at the periphery of
  anterior and posterior cortex, its base is at the
  equator, its tip towards the center, often
  occurring at lower part, then similar opacity
  occurs at bilateral and upper parts, then forms
  wheel-like opaque. The pupillary area is not
  affected, commonly without blurred vision. The
  early phenomenon is separation of lens fibrous
  lamina like feather, sometimes vacuole appears.

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• (2) ???(immature stage)?????(intumescent)????????
  ??,?????,???????????,??????,????,???????,????,????
  ????????????????????,???????
• The opacity gradually becomes obvious, the cortex
  absorbs water to swollen. Lens volume increases
  to push iris forward and the anterior chamber
  shallows, and may induce acute attack of glaucom.

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• (3).???(mature stage)???????????????,??????????,?
  ?????????????????????????????????????????10???????
  ???
• Lens became opaque totally, swelling of the lens
  diminished, the anterior chamber restored to
  normal. The fundus can not be seen, vision
  decreased to light perception or hand movement,
  but the light seeking and color sensation were in
  normal.

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• (4).???(hypermature stage) ???????????,??????????
  ???,????,????,????????????????,????,?????????????,
  ????,?????????????,????????????Morgagnian?????????
  ????,??????????????????,???????????????????????,??
  ??????????????????????????????,???????????????????
  ???????????????,?????????

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• The mature stage continued for over long time,
  generally for several years,the water in the
  lens lost continuously, the volume of lens
  diminished, the capsular membrane shrank, the
  anterior chamber deepened with iridodonesis. Lens
  fibers decomposed and dissolved in cream-white
  liquefaction, brown-yellow hard nuclear sank
  down, the anterior chamber in upper part became
  deep, called Morgagnian cataract. The nucleus may
  move with change of body position,vision may
  increased suddenly. Lens cortex leaked out of
  lens capsule may induce glaucoma. Severe
  vibration may make lens capsule rupture lens
  mucleus dislocated into the chamber or vitreous
  body to induce glaucoma. Lens ligament was often
  retrograde degeneration that was easy to bring
  about lens dislocation.

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• 2. ?????(nuclear cataract)
• ?????????,??????,?????????????????,????,??????????
  ?????????????,???????????????,???????????,??????,?
  ??????????????????,???????????????????????????????
  ?????????????,???????

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• 3. ??????(subcapsular cataract)
• ??????????????,?????????,????????????,????????????
  ???,?????????????
• It is a manifestation of cortical cataract, may
  happen beneath the anterior or posterior capsule.
  In posterior subcapsular cataract, there is
  disciform opaque beneath the posterior at early
  stage, composed of many dense punctates, with
  vacuoles and crystalloid granules among them,
  similar to the surface of slag brick called
  disciform cataract too. Subcapsular cataract may
  develop and form total cortical cataract.

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??(DIAGNOSIS)

• ???,?????????????????????????????????????????,????
  ??,???????????????

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??(TREATMENT)

• ????????????,????????????,????????
• At present, there is not any effective drug, so
  cataract can take operation for treatment.
• ??????????????????????????????????,?????0.3(?0.5)
  ,??????????????

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• ????(pre-operation examination)
• (1) ????(systemic )????(blood
  pressure)???(blood sugar)????(electrocardiogram,
  ECG)???(chest X-ray)???(liver function)????????8.3
  mmlo/L?
• (2) ????(ocular ) ??(visual acuity)????(light
  preception)???(IOP)?????(endothelium)?????(corneal
  curvature)?IOL??????

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• ????(operative method)
• (1) ??????????????????????????
• extracapsular cataract extraction (ECCE) and
  posterior chamber lens implantation is the best
  operating method.
• (2) ????????,???????????????????
• Intracapsular cataract extraction, the
  complications such as vitreous prolapse, retinal
  detachment are more than ECCE.

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• (3)???????????????????????????????,??????????????
  ????????????
• It is a method to crush the hard lens nucleus
  with ultra-emulsifier and extracted through a
  small incision.

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• ??????????
• ??????,???IOL???????,?????????,???????????,?????(g
  lasses)?????(contact lens).

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??????(CONGENITAL CATARACT)

• ???????????????????,?????????,????????????????????
  ????
• It is a result of growing and developing
  disturbance in the process of lens fetal
  development.

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• ??(ETIOLOGY)
• 1. ??(heredity) ?1/3???????????????????
• 2. ???(exogenous) ?????3?????????,???????????????
  ????????,?????????????,??????????,?????????
• There are some damages to the lens induced by
  mother virus infection, such as rubella, measles,
  chicken pox, parotitis at first 3 months of
  pregnancy.

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• 3. ???????,?????3?????????,????????????????,????X
  ??
• 4. ???????????????????,????????????(hypothyroidis
  m)?????????????

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• ???? (Clinical findings)
• ????????????????????????,?????????????????????????
  ?????????????
• congenital cataract commonly is bilateral,
  static a few develop continuously after birth.
  Occasionally it affects vision till childhood or
  juvenile. It may be classified according to the
  site and the shape of lens opacity, commonly as
  follows

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• 1.??????(anterior polar cataract)?????????????,??
  ??,????,??????,????????,??????????,???????????????
  ,??????
• 2. ??????(posterior polar cataract)
• ??????????????????????????????,????,??????????????
  ,???,??????,????????????????,??????????

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• 3. ?????(coronary cataract)??????????????????????
  ?????????,??????????????????????,???????????
• 4. ?????(punctate cataract) ?????????????????????
  ??????????,???,????????

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• 5. ??????(perinuclear cataract)
  ?????????????????????????????,????????????????????
  ??????????????????????????????,?????????(lamellar
  cataract)??????????????????
• It is called lamellar or zonular cataract too, as
  a cream white, thin opaque, encircling around the
  transparent lens nucleus. Sometimes at outside of
  the lamellar opacity, there are one or some
  layers of opacities sleeved and separated by
  clear cortex among them. At the most external
  layer, there are often arcuate opacities called
  rider, vision decreased obviously, as one of
  the most cataracts in children. Most of them are
  binocular, static, as autosomal dominant
  inheritance, with unclear etiology. It may have
  relation to hypo-parathyroidism, hypocalcemia of
  the fetus and subnutrition of mother.

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• 6. ?????(nuclear cataract) ??????????????????????
  ,???????,???????????????,????????,??????????????
• 7. ????(total cataract) ?????????????,???????,???
  ????????????????????????????????????????,?????????
  ???????????????,????????,?1????????????,????????

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• 8. ?????(membranous cataract) ???????????????????
  ???,?????????,?????????????????????,??????????????
  ??????,?????????????????????,???????
• 9. ?? ???????(sutural cataract),
  ?????????,????????????????,?????,???,????????????
  ?(fusiform cataract), ????????,??????????????(cor
  alliform), ???,??????

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?????????

• 1. ????????,?????????????,????????,???????????????
  ??????????,????????
• If it is static and nearly no affection to
  vision, treatment is commonly not needed, for
  example, punctate cataract, coronary cataract,
  anterior polar cataract.
• Those affecting vision obviously should be
  treated by operation, such as total cataract.

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• 2. ??????,???????????????????,???????????????,????
  ????????????,????????,???????
• 3. ????????????????,????,????????????????
• ????(correction by glasses)
• ?????(contact lens)
• IOL??(intraocular lens implantation)

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??????(traumatic cataract)

• ?????????????????????????????????????,??????
• Opacity in lens caused by penetrating injury,
  contusion, radiation injury as well as electric
  injury are called traumatic cataract.

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• 1. ????????????,??????????????,?????????Vossius?,
  ??????????,???????,???????????????,?????????????,?
  ????????????,???????,?????????????,???????????????
  ???????,?????,???????,??????????????????,??????,??
  ??????????

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• 2. ??????????????,????????,??????,?????????????,?
  ??????,???????
• 3. ???????????????????????,??????????????????????
  ???????????????
• 4. ????????(electric cataract)???????????????????
  ???????????????????,?????????????

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• ??(TREATMENT)
• ???????????,???????????????,???????????,??????,???
  ?????????,??????,???????,??????????,??????????????
  ?????IOL?

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??????METABOLI CATARACT

• ?????????????????????
• 1. ???????(diabetic cataract) ????????,?????????
  ???????????????????????
• It is due to high blood sugar, glucose in lens
  get increased. It is transformed into
  sorbitol,which leads osmotic pressure to going
  high. Lens absorbs water, the fibers become
  swollen and degeneration. It is divided into two
  kinds diabetic and age-related cataract in the
  elderly with diabete.

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• ????(clinical findings)?????????????????,????????
  ????????,?????,?????
• ?????????????30???,????????????????????,????,?????
  ?????????????

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• ??(treatment)??????????????????,??????,??????????
  ??????????,???????????????IOL???,???????????,?????
  ?????????,?????????????

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• 2. ???????(galactose cataract)
• ?????????????????-1-?????????????,????????????????
  ???????????????????????????????,????????????,?????
  ?,???????

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• ??(DIAGNOSIS)?????????,?????????????????????-1-??
  ????????,????????-1-???????????,??????????????????
  ,??????
• ??(TREATMENT)???????????,???????????????

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• 3. ????????(tetanic cataract)
• ????????,??????????????????,??????????????????????
  ????,????????????????????????????????????,????????
  ?

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• ??????????????????????????????????????????????,??
  ?????????????????????????
• ???????????????,????,?????
• ??????????D???,?????,??????,???????

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??????COMPLICATED CATARACT

• ?????????????????????????,????????????,???????????
  ???????????????????????????????????
• It is induced by ocular diseases such as uveitis,
  retinitis pigmentosa, retinal detachment,
  glaucoma, high myopia, etc.

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• ?????????????????????????????????????????????,???
  ???????????????????????,????????,?????????????????
  ???,???????????,?????????????????
• ????????????????,????????,??????,????????????????
  ?????,????????,????????

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????????? DRUG-INDUCED TOXIC
CATARACT

• ??????????????????,????????????,??????????????????
  ??????????????,?????????????????????
• Use of some drugs, contact with chemicals for a
  long time may induce lens opacity in different
  degree.

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• 1. ?????????(corticaosteroid cataract)???????????
  ????????????????????????,????????????????????,????
  ??,????????
• 2. ?????????(miotic cataract)????????,????????,??
  ???????????,?????????

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• 3. ?????????(chlorpromazing cataract)??????????,?
  ????????????????,??????????,????????????????,?????
  ??????????,?????,??????
• 4. ?????(TTT)????????????????????????????????????
  ?????????????,??????????????????,????????,????????
  ??????????????????,????????

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??????RADIATION CATARACT

• ???????????,????????,??????????????
• ???????
• 1. ????????(infra-red cataract)
• ??????????????,???????????????????????,???????

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• 2. ????????(ionizing radiation cataract)
  ????????????X????????ß?,????????????
• 3.???????(microwave cataract)????????????????????
  ?????????????????????????????????,????????????????
  ???,???????????
• ????????????,????????????

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??????AFTER-CATARACT

• ???????????,?????????????????????????(posterior
  capsular opacification, PCO)?
• After operation of ECCE or phaco-operation,
  posterior capsule or residual cortex got opacity.

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• ?????????????
• ?????????????PCO???????50??????????????PCO??????
  ??????????Elsching???????????????????????
• ????NdYAG??????????????????,????????

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• ????????????
• (????????)

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???????DISLOCATION OF LENS

• ?????????????????????,????????????????????????????
  ???????,????????,??????????,???????????,??????????
  
• the lens is suspended on the ciliary body to
  maintain a definite situ by apparatus
  suspensorius lentis. Its positional abnormality
  has two causes rupture of suspensory ligament
  induced by injury and congenital aplasia or
  weakness and laxation of the ligament, both can
  induce lens dislocation or subdislocation.

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??????????

• ?????????????,?????????????????????????????,?????
  ???????????????????????,????????????????,??,??????
  ????????,?????

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??????????

• ??????????,??????????,???????????????????
• 1. ???????????????,?????????????????,????????
• 2. ?????????????????????????,?????

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• 3. ????????????????
• 1. Marfan???
• 2. ???????
• 3. Marchesani???

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???????

• ??????????????????????????,???????,??????????
• ???????
• ???????????????,?????????????

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?????????

• ???????
• ??????????,???????????????????????????????????????
  ?????,???????????,????????????????????????????????
  ????,????????????????????????????????????,????????

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?????

• ??????????,????????
• 1.????
• 2.??????
• 3.????????,?????????????
• 4.?????????????????????????
• 5????????????????????????????

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• ?????????????????????????????,????????????90?,????
  ??????????180???,??????????
• ??????????,?????????,????,????,???????????????????
  ?

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????????

• 1. ????????????????
• 2. ???????????????????????,?????????????????????
  ?????
• 3. ????????????,?????????????,?Marfan??
• 4. ?????

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???????

• ?????????????
• 1. ???????????????????????????????,???????,?????,
  ?????????
• 2.??????????,????????,???????????????,??????????,
  ??????????,????????

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