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Ophthalmology > Cataract > Flashcards

Cataract Flashcards

1
Q

What is a Cataract?

A

Progressive cloudiness of the lens causing gradual vision loss and blindness if untreated.

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2
Q

What is the most common type of cataracts?

A

Age-related.

1 - Nuclear
2 - Cortical
3 - Posterior Subscapular.

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3
Q

What Grades are used to describe cataracts?

A

Immature - Partially opaque
Mature - Completely opaque
Hypermature - Shrunken anterior capsule due to leakage of material outside the lens.
Morgagnian - A form of hyper mature cataract with liquefaction to the cortex.

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4
Q

Describe a Nuclear Cataract?

A

Cloudiness of the nucleus, the central portion of the lens.

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5
Q

Describe a Cortical Cataract?

A

Swelling of the cortex causing spokes/wedge-like peripheral cloudiness.

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6
Q

Describe a Posterior subcapsular Cataract?

A

Opacity in the posterior capsule of the lens

Seen in younger individuals, steroid users, and diabetics.

Most visually significant and quick progression.

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7
Q

Most common source of organisms leading to post-operative endophthalmitis?

Most likely causative organism?

A

Patient’s lids (Own periocular flora)

Staphylococcus Epidermidis

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8
Q

What medication increases risk of complications during cataract surgery?

A

Doxazosin

or other A1-Angonists (Tamulosin) -> May cause intraoperative floppy iris syndrome

Intracameral phenylephrine can be used to dilate pupils in high risk patients.

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9
Q

What steps are recommended post cataract surgery to prevent post-cataract endophthalmitis?

Pre-operatively?

A

Sub-conjunctival injection of antibiotic at the end of surgery.

Using Iodine to clean patients eyes

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10
Q

Explain second sight phenomenon?

A

When there is a temporary change in vision during early cataract development. Before vision deteriorates, vision, especially close-up reading vision, improves significantly.

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11
Q

Main symptoms of Nuclear cataracts ?

A

Reduced VA, Myopic shift (Increasing myopia), dullness of colour.

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12
Q

What is the characteristic feature of cortical cataracts?

A

Glare with bright lights / halos when driving at night.

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13
Q

Explain the nature of cortical cataracts?

A

Opacification fo the lens cortex causing wedge shaped opacities.

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14
Q

Associated conditions with cortical cataracts?

A

Alport syndrome- Anterior lenticonus with cortical cataract.

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15
Q

Types of subcapsular cataracts?

A

Anterior - Opacities under the anterior capsule.

Posterior - Patients complain of glare and pdifficulty seeing in bright lights and near vision

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16
Q

What causes of acquired posterior subcapsular cataract?

A 
Corticosteroids
Diabetes (snowflake shaped) 
Retinitis pigmentosa 
NF2
Chloroquine
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17
Q

What causes of acquired posterior subcapsular cataract?

A 
Blunt Trauma (FLOWER-SHAPED)
Atopic dermatitis (SHEILD-LIKE)
Wilsons (SUNFLOWER)
Infrared radiation (GLASS-BLOWER)
Post congestive angle closure glaucoma (GLAUKOMFLECKEN)
Gold
18
Q

ASSOCIATED CONDITION?

BLUE DOT CATARACT

A

Downs syndrome

19
Q

ASSOCIATED CONDITION?

CHRISTMAS TREE LIKE CATARACT APPEARANCE

A

MYOTONIC DYSTROPHY

20
Q

ASSOCIATED CONDITION?

POLYCHROMATIC CATARACT- TREE LIKE APPEARANCE

A

HYPOPARATHYROIDISM

21
Q

WHAT CATARACT APPEARANCE WOULD RUBELLA GIVE?

A

PEARLY NUCLEAR SCLEROTIC

22
Q

GOLD STANDARD MANAGEMENT OF CATARACT?

+Brief explanation

A

Phacoemulsification

Ultrasonically driven needle (phase tip) to chop the nucleus and then aspirate the lens material.

23
Q

What technique may be used for very hard cataracts?

A

Extracapsular cataract extraction (ECCE)

24
Q

What is the equation for calculating power of the intraocular lens?

A

P = A - 2.5L -0.9K [SRK/T Formula]

P= Lens power (diopters)
A= Constant
L= Axial length of the eye (mm) 
K= Average keratometry (Diopteric measurement of the curvature of the cornea)
25
Q

What is the normal axial length of the adult eye?

Usual lens power in adults and children

A

22-25mm
15-20D (Adults)
43-47D (Infants)

26
Q

What is Biometry?

A

Process of using biological measurements of the eye to calculate a lens that will offer a set refractive outcome.

27
Q

Types of IOL used in cataract surgery?

A

Rigid

Flexible - Acrylic Hydrophobic/hydorphilic or Silicone lens

28
Q

List the Intraoperative and Postoperative Complications of cataract surgery?

A

Intraoperative - Posterior lens capsule rupture, Floppy iris syndrome, suprachoriaidal haemorrhage (avoid px with uncontrolled bp/high inr), Trauma (Cornea, Iris, Anterior capsule, Dropped nucleus)

Postoperative - Posterior cataract opacification(PCO)
Endophthalmitis, Macular oedema (Irving glass syndrome) , Acute uveitis/Chronic post op uveitis, Retinal detachment (High myopic patients)

29
Q

Define Endophthalmitis?

A

Inflammation of the vitreous and qaqeuous humour caused by infection.

30
Q

Main features of Endophthalmitis?

A

Progressive vitritis (blurred vision, floaters), pain, hypopyon and corneal haze.

31
Q

Types of Endophthalmitis?

A

Acute - Within 1st week of surgery [Staph.Epiderimis]
Delayed - 6wks onwards [Propionbacterium acnes]
Post-trauma - Staphylococcus or Bacillus
Fungal - Immunocomprimised patients

32
Q

Management of Endophthalmitis?

A

Intravitreal ABx or Pars Plana Vitrectomy

33
Q

What is the most common complication of cataract surgery?

SS, Treatment ?

A

Posterior capsular opacification

Posterior migration of lens epithelial cells

S - Gradual Vision loss and glare, Sommering rings, Elschnig pearls (grape-like collection of swollen lens epithelial cells)

Tx- Capsulotomy with Laser

34
Q

Define Lenticonus?

A

Abnormality in the eye that causes a bulge in the front of the lens (anterior lenticonus) or at the back of the lens (posterior lenticonus)

35
Q

Conditions associated with Anterior and posterior lenticonus?

A

Anterior - Alport Syndrome (T4 Collegen mutation disorder)
Bilateral

Posterior - Lowe syndrome, Congenital cataracts
Mainly unilateral

36
Q

CONGENITAL CATARACTS

WHAT TYPE IS MOST COMMON?

A

BILATERAL 2/3 - Mostly Autosomal dominance inheritance

UNILATERAL 1/3

37
Q

6 MOST COMMON CAUSES OF CONGENITAL CATARACTS?

A
  1. Galactosaemia [AR]
  2. Lowe Syndrome (XLR)
  3. Fabry Disease
  4. Downs Syndrome
  5. TORCH intrauterine infections
  6. Mannosidosis [AR]
38
Q

Which type of congenital cataracts require more urgent treatment?

A

Unilateral <6wks - Higher risk of amblyopia

Bilateral - 8 to 10wks

39
Q

Management of congenital cataracts?

A

Surgery

Unilateral possible pharmacological mydriasis of the good eye to avoid amblyopia while delay in cataract surgery to allow stable eye growth

40
Q

Explain Near accommodation of the lens?

A

Eye brings near objects into focus by contracting the ciliary muscle, Causes relaxation of the zones making the lens more spherical and increasing its diopter power.

41
Q

Explain Far accommodation of the lens?

A

Eye brings far obects into focus by relaxing the ciliary muscle .

Increases zonular tension , making the lens flat

42
Q

What is the term when the lens loses the ability to focus on near objects?

A

Presbyopia
Natural ageing process caused by the lens becoming more stiffer. Making it tougher for the ciliary muscle to change the lens shape.

Ophthalmology (13 decks)

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