Gradual visual loss

Question 1

What is a cataract?

Answer 1

Vision impairing disease characterised by gradual, progressive loss of transparency of the lens

Question 2

What are the 4 stages of development of a cataracts?

Answer 2

1) Immature cataracts
2) Mature cataract
3) Hypermature cataract
4) Morgangnian cataract

Question 3

What is an immature cataract

Answer 3

Lens partially opaque

Question 4

What is a mature cataract

Answer 4

Anterior cortical changes sufficiently dense to obsccure the view of post lens

Question 5

What is a hypermature cataract

Answer 5

Lens shrunken, lens capsule = wrinkled b/c leakage H2O

Question 6

What is Morgagnian cataract?

Answer 6

Hypermature - total liquefaction of cortex

Nucleus sinks inferiorly

Question 7

Clinical features of cataracts (5)

Answer 7

Decreased visual acuity 
Glare 
Myopic shift 
Monocular diplopia 
'Blurry/misty vision'

Question 8

Which type of cataracts are the majority?

Answer 8

Age-related cataracts

Question 9

By 75, what % have lens opacities?

Answer 9

75%

Question 10

By 100, what % have lens opacities?

Answer 10

100%

Question 11

Factors causing cataracts (7)

Answer 11

Allergy 
HoTN
HTN 
Mental retardation 
UV light 
IR radiation 
DM

Question 12

What % congenital cataracts is inherited?

Answer 12

33%

Question 13

When does juvenile cataracts develop?

Answer 13

During first 12 years of life

Question 14

Appearance of juvenile cataarcts?

Answer 14

Snow-flake opacities in ant + post subcapsular location

Question 15

Appearance of blunt trauma cataracts

Answer 15

Rosette-shaped appearance + PSC

Question 16

Appearance of penetrating trauma cataracts

Answer 16

Whole lens may become cataractous if large

If small - localised @ site penetration

Question 17

Causes of traumatic cataracts (3)

Answer 17

Glass blowers
Electric shock
IR

Question 18

What is a true diabetic cataract?

Answer 18

Osmotic overhydration of lens –> post/ant lens opacities

Question 19

Appearance of galactosaemia cataract

Answer 19

Oil droplet appearance

Question 20

Appearance of galactokinase deficiency cataract

Answer 20

Lamellar opacities

Question 21

Which drugs can cause PSC?

Answer 21

Corticosteroids

Question 22

What can chlorpromazine cause?

Answer 22

Yellow deposits

Question 23

Causes of high myopia

Answer 23

Glacuomfleken

Post-surgical

Question 24

Appearance of atopic dermatitis cataracts

Answer 24

Fibrotic anterior subcapsular cataract

Question 25

Appearance of myotonic dystrophy cataracts

Answer 25

Christmas tree appaerance

Question 26

Apperance of Marfans cataracts

Answer 26

Ectopia lentis - lens displacement

Question 27

Where is a PSC?

Answer 27

In front of posterior capsule

Question 28

Appearance PSC?

Answer 28

Vacuolated/plaque like appearance

Question 29

What is PSC associated with?

Answer 29

Steroid use | DM

Question 30

What do people with PSC have issues with?

Answer 30

Bright sunlight/oncoming headlights

Question 31

In PSC, is reading or distance vision better

Answer 31

distance vision

Question 32

Where is a nuclear sclerotic cataract?

Answer 32

In lens nucleus

Question 33

Nuclear sclerotic cataract appearance

Answer 33

``` Yellwish hue (early) --> brownish discoloration ```

Question 34

What is Nuclear sclerotic cataract associated with?

Answer 34

Smoking Calcitonin Low milk intake

Question 35

In NSC is reading or distance vision better?

Answer 35

Near vision

Question 36

Appearance cortical cataracts

Answer 36

Starts as clefts/vacuoles in cortex between lens + fibres | --> opacification --> radial spoke like opacities

Question 37

What are cortical cataracts associated with?

Answer 37

Enviro stressers; UV, DM, Dx ingestion, old age

Question 38

When should you Tx a congenital cataracts if <2y/o?

Answer 38

Immediately

Question 39

When should you Tx a congenital cataracts if 2-7y/o

Answer 39

within 1 week

Question 40

Types of partial congenital cataracts (3)

Answer 40

Either planar, zonular or membranaceous

Question 41

Types of zonular congenital cataracts (4)

Answer 41

Lamellar, stellate, sutural or nuclear

Question 42

If vision is obstructed in congenital cataracts, what must be done and why?

Answer 42

Extraction within days/weeks | Prevent irreversible amblyopia

Question 43

Differential diagnosis cataracts (3)

Answer 43

Macular degeneration Presbyopia Retinal disease

Question 44

2 investigations required for diagnosis cataracts

Answer 44

Hx | Slit lamp exam for corneal intergrity/endothelial layer

Question 45

When would you use a B-scan USS in cataracts

Answer 45

When fundus = obscured by dense cataract to rule out posterior segment disease

Question 46

What can be used to predict post-op morbidities in cataracts

Answer 46

Pachymetry + specular microscopy

Question 47

What factors should be considered before cataract surgery?

Answer 47

``` Degree disability Pt opinion Best correct visual acuity General health Coexisting ocular pathology Age ```

Question 48

What is ICCE?

Answer 48

Intracapsular cataract extraction

Question 49

When is ICCE used?

Answer 49

When zonular integrity = severely impaired

Question 50

What is ECCE?

Answer 50

Removal lens nucleus through ant ccapsule opening | Post capsule integrity retained

Question 51

What is PE?

Answer 51

Phacoemulsification Extraction of lens nucleus through ant capsule opening Irrigation + aspiration cortical material IOL into post capsular bag

Question 52

What is beneneficial about PE?

Answer 52

Smaller incisions means more rapid wound healing + better control IOP

Question 53

Intraoperative complications cataracts

Answer 53

Capsular tear | Haemorrhage

Question 54

Complications - when does retinal detachment usually occur?

Answer 54

Within 6 months

Question 55

Complications - when does acute endophthalmitis usually occur?

Answer 55

Within 2-5 days

Question 56

Features acute endophthalmitis?

Answer 56

``` Marked visual loss Pain Poor red reflex Educate Hypopyon ```

Question 57

Tx acute endophthalmitis?

Answer 57

ABx

Question 58

Within 3 years of cataracts surgery, what % --? post-capsular opacification?

Answer 58

10-50%

Question 59

Tx post-capsular opacification?

Answer 59

Nd/YAG laser