A5 - Lens Flashcards
Anterior polar cataract
Common
<3mm diameter
White dot in center of anterior capsule
Uni or bilateral
-U: can be assoc with anisometropia and amblyopia
Non-progressive
Visually insignificant
Nuclear cataract
~3mm
Stable, then progresses
Bilateral > uni
Inherited or sporadic
Glaucoma risk due to growth
Lamellar/zonular cataract
Round
1+ layers of cotex around nucleus
~5mm diameter
Bilateral > uni
Better prognosis than nuclear due to later onset
Posterior lenticonus/globus
Due to progressive thinning of central posterior capsule
Oil droplet app with red reflex
Later, cortical fibers at outpouching gradually opacify
Unilateral
Visual prognosis good after surgery
Posterior subcapsular cataract
Less common in children
Progressive
From:
- steroid use
- uveitis
- raidation
- NF2
Persistent fetal vasculature
Common cause of unilateral cataract
Features*:
- prominent hyaloid vessel remnants
- large Mittendorf dot (nasally)
- Bergmeister papilla
- may have microphthalmic eye
- elongated ciliary processes
- traction on ON
- severe cases -> cataracts
- AC shallowing
- secondary glaucoma
Cataract eval in children
- size of significant central opacity/cortical distortion
- opacities with large clear areas
- if nystagmus is present
- if can’t view post seg
3mm+
Allows good visual development
-may use phenyl off-label to dilate
Visually significant ct
B-scan
Cataract eval in children
- when to run labs
- when to do genetic eval/counseling
Bilateral non-hereditary
If assoc with disorders
Visual outcome
-depends on (5)
Age of onset
Type of ct
Timing of surgery
-early sx does not ensure good prognosis
Choice of correction
Amblyopia tx
Factors to consider for cataract surgery (2)
When to perform it
- younger = greater urgency (deprivation amblyopia), visually significant unilateral should be before 6 weeks old
- older = based on level of interference (20/50 or worse)
Whether to use IOL or not
- depends on age and laterality
- higher rate of complications in infants/younger
- more common in 1-2 yo
- secondary IOL can be performed after ~2 years
Lensectomy without IOL implant
- how
- important to*
Small limbal/pars plana incision
Ultrasonic phacoemulsification not required (soft cortex)
Remove all cortical material - chance of reproliferation of epi cells
-PCO occurs rapidly
Sufficienct periph capsule should be left
Lensectomy with IOL implant
-concerns
Proper IOL power Accurate K’s/axial lengths Adult power formula Infections/bleeding Strabismus Risk of glaucoma
Post-op care
Topical antibiotics, corticosteroids, and cycloplegics for few weeks
Steroids more aggressive in children with IOL impants*
-greater post-op inflamm
Amblyopia tx
ASAP after surgery
Correction within 1 week of sx
Patching
-amount based on age
Congenital aphakia
Absence of lens at birth
Abnormal eye
