Cataract Surgery: Cataract,Types,Risk factors, Sign&Symptom,surgery trick.

            CATARACT

Mature Cataract

1. DEFINITION

2. RISK FACTOR

3. TYPES OF CATARACT

4. PATHOPHYSIOLOGY

5. MATURATION OF CATARACT

6. SIGN & SYMPTOM

7. DIAGNOSIS

8. OPERATIVE MANAGEMENT (TRICK)

9. COMPLICATION OF SURGERY

10. DISCHARGE INSTRUCTION

DEFINITION

Cataract is  characterized by Opacification of lens resulting Blurred Vision

Cataract often develop gradually and can affect one or both Eye.

Most common type of Cataract is age related cataract called Senile Cataract >50 year of age due to decrease the protein synthesis in lens caused Denaturation of Protein.

RISK FACTOR:-

>Exposure of ultraviolet rays
>Exposure of Bright light]
>High Altitude (hilly area)

High Altitude (hilly area)

↓

Decrease oxygen

↓

Change Protein Metabolism

↓

Impaired Protein Synthesis 

>Diet Low Protein 

>Vitamin Deficiency(A,C)

>Smoking

TYPES OF CATARACT

1.Aging Process (Senile Cataract)

2.Heredity (Congenital Cataract)

3.Secondary (Traumatic Cataract)

1.Aging Process (Senile Cataract):-

Visual Impaired Disease Progressively Clouding or Thickening of lens of the Eye.

Age related Cataract

Most common Cataract

It is the Worlds leading cause of Treatable Blindness.

2.Heredity (Congenital Cataract):-

Congenital Cataract may be unilateral or Bilateral

Infection 

Diabetes Mellitus

Maternal Infection:-

• T- TOXOPLASMOSIS
• O- OTHER AGENT
• R- RUBELLA (GERMAN MEASLES) [ THE MOST COMMON CAUSE)
• C- CYTOMEGALOVIRUS
• H- HERPES SIMPLEX 

3.Secondary (Traumatic Cataract):-

>Previous Cataract Surgery
>Injury
>Accident
>Copper toxicity 

>Use of Corticosteroids

PATHOPHYSIOLOGY

CASE-1

DUE TO ANY ETIOLOGY

↓

Reverse Sodium Potassium pump

↓

Sodium retained in lens

↓

Increase lens Osmolarity

↓

Fluid Accumulation in lens

↓

Lens Swelling

↓

Opacification of Lens

↓

CATARACT

CASE-2

DUE TO ANY ETIOLOGY

↓
Decrease Amino Acid
↓
Decrease Protein Synthesis in Lens
↓
Denaturation of Protein
↓
Opacification of Lens
↓

CATARACT

MATURATION OF CATARACT

1.STAGE 1- Laminar separation

>Separate lens Fiber

2.STAGE 2- Stage of Incipient

>Center and Periphery opacification

3.STAGE 3- Opacification of Entire Lens

>Immature cataract

>Entire lens opacification

>Grayish White vision

4.STAGE 4- Mature Cataract
>Appear Pearly white [late sign of Cataract]
>Liquefaction of lens fiber

5.STAGE 5- Stage of Hypermature Cataract
>Denature protein fiber comes into Anterior Chamber
>lens became Completely Dry

SIGN & SYMPTOM

>Glare effect [Early Sign]
>Halos
>Blurred Vision
>Lens Swelling
>Secondary myopic Shift
>Pain
>Pearly white lens [Late Sign]
>Decrease visual Acuity 
>Vision loss gradually

DIAGNOSIS

>Opthalmoscopy
>Slit Lamp Test

OPERATIVE MANAGEMENT 

Surgery is the only option to Treat the CATARACT

A. PREOPERATIVE MEDICATION

Administer Mydriatics(Dilate the Pupil) and Cycloplegic medication before the surgery

Example:- ATOPINE SULPAHTE 

B. SURGICAL PROCEDURE (Trick Ending The Post)

1. EXTRA CAPSULAR CATARACT EXTRECTION (ECCE)

In this surgical remove of lens fiber with Anterior Capsule and remain "Intact Posterior Capsule"

ECCE is a elective surgery emergency removal of  cataract when Cataract cause Glaucoma and eye is severely inured or Infective.

After the Surgery KERATOMETRY special testing is needed for the Patient.

KERATOMETRY:-  In this testing The Opthalmologist asses the CORNEAL CURVATURE.

IT IS PAINLESS PROCEDURE.

2. INTRACAPSULAR CATARACT EXTRECTION (ICCE)

Entire Cataract lens with lens Capsule remove

This procedure has high risk of complication because large incision is required.

3. PHACOEMULSIFICATION

It is advance type of ECCE 

Nucleus converted into pulp by emulsification of high frequency wave with help of Ultraviolet device 

↓

Sucked the lens material

↓

Hydration the lens Capsule

↓

Intraocular lens is Implanted 

COMPLICATION OF SURGERY

>Hyphema

>Infection

>Retinal detachment

>Irregular Pupil

>Corneal edema

>Iris Prolapse

>Increase Intraocular Pressure

DISCHARGE INSTRUCTION

>POSITION:- Elevate the Head of Bed 30-45 degree.

>Instruct the client to Importance of Hand washing.

>After the Cataract Surgery Sunglasses use for 6 weeks.

>Avoid head bath 1 to 2 week.

>Instruct the client to Change the dressing regularly.

>Avoid rubbing,massaging the eye

>Apply eye shield before bed time at Night

>Avoid all activities which increase Intraocular pressure like Straining,coughing,weight lifting,sneezing.

>Palace the Patient on non operative site.

>Prevent the injury to the Patient

>Assist with Ambulating the Patient

>Take Acetaminophen for minor eye disorder

>Contact the doctor if decrease in Visual Aquity Occur.

>Keep cool and calm environment.

>Eye itching and discomfort are normal for a few days after the procedure.

>Instruct the client if  fever,redness,pain,discharge contact the doctor.

>DO not take Alcohol for at least 24 hour.

>Instruct the client to avoid watching T.V. for 24 hour.

TRICK OF CATARACT SURGERY

Trick of Cataract Surgery

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