lens Flashcards by American Mouse

acquired ectopia lentis causes

trauma
large eye
anterior uveal tumor
hypermature cataract

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hereditary ectopia lentis causes

familial ectopia lentis 
ectopia lentis et pupillae
marfan syndrome
weill-marchesani syndrome
homocystinuria

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hereditary ectopia lentis RARER causes

aniridia
stickler syndrome
ehlers danlos
hyperlysinaemia
sulphite oxidase deficiency

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familial ectopia lentis

AD
bilateral
symmetrical
superotemporal

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ectopia lentis et pupillae

bilateral ectopia of lens and pupil but in different directions

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marfan syndrome ectopia lentis

AD
bilateral
symmetrical
superotemporal
Intact zonules

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weill-marchesani syndrome ectopia lentis

AD or AR
bilateral
inferior

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homocystinuria ectopia lentis

AR
inferonasal
disintegration of zonules

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ectopia lentis complications

refractive error
optical distortion
glaucoma
cataract
endothelial damage
lens induced uveitis

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ectopia lentis tx

spectacles for astigmatism/ aphakic correction

surgery for cataract, glaucoma, uveitis, endothelial touch

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coloboma

notching or segmental agenesis at inferior equator

absence of zonular fibres

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lenticonus

conoid curvature + thinning of capsule

ant = Alports

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lentiglobus

spherical curvature + thinning of capsule

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microspherophakia
def
causes

spherical lens with a small diameter

familial AD
Marfan
weill-marchesani syndrome
hyperlysinaemia
congenital rubella

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microspherophakia
complications

ocular associations

lenticular myopia
subluxation
dislocation into ant chamber

Peters anomaly
Familial ectopia lentis et pupillae

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congenital cataract

types

nuclear
lamellar
sutural
ant polar
post polar
coronary/ supranuclear
blue dot

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congenital cataract inheritance

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congenital cataract

metabolic causes

Galactosemia oil droplet
galactokinase def
lowe syndrome
hypocalcemia
hypo/hyperglycemia
mannosidosis

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congenital cataract
infectious causes
TORCH

toxo
rubella
CMV
HSV

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congenital cataract

chromosomal abnormalities

Trisomy 21, 13, 18
turner
cri du chat

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complications of cataract surgery

rupture of post capsule
post loss of lens material
post dislocation of IOL
Suprachoroidal haem
endophthalmitis acute/ delayed
capsular opacification
decentration of IOL
Retinal detachment
CMO

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rupture of post capsule
problems

vitreous loss
post loss of lens material

remove lens material
clear vitreous from ant chamber

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long term comp of vitreous loss

updrawn pupil
chronic uveitis
endothelial vitreous touch
retinal detachment
CMO

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post loss of lens material
COMP

glaucoma
chronic uveitis
retinal detachment
CMO

remove nuclear fragments by pars plana vitrectomy

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post dislocation of IOL COMP Tx

vitreous haem uveitis retinal detachment CMO pars plana vitrectomy remove IOL

Suprachoroidal haem Predisposing Tx

``` elderly glaucoma increased axial length systemic CV disease vitreous loss ``` immediately close incision U/S Pars plana vitrectomy 7-14 days later

endophthalmitis acute | pathogen

staph epidermidis coag-neg Staph aureus GP Pseudomonas, Proteus GN

endophthalmitis acute | prevention

tx blepharitis, conjunctivitis, dacryocystitis pre-op povidone-iodine meticulous draping prophylactic ABX - drops, irrigation, subconj injection

endophthalmitis acute | Dx severe

``` 2-7 days post op pain large hypopyon poor VA no red reflex cant see fundus ```

endophthalmitis acute | Dx moderate

mild/ absent pain mild/ absent hypopyon partial red reflex partial view of fundus

endophthalmitis acute | micro Dx, get

0.1ml of acqeous on tuberculin syringe

endophthalmitis acute tx

vancomycin bethamethasone vitrectomy

endophthalmitis delayed | pathogens

propionibacterium acnes staph epidermidis actinomyces israelii corynebacterium

endophthalmitis delayed | presentation when

4 wks - 1 yr | most 9 months post op

endophthalmitis delayed | signs

low grade uveitis mutton fat precipitates | white capsular plaque = pseudomonas

endophthalmitis delayed | clinical course

initial good response to topical steroids | recurrence fails to respond

endophthalmitis delayed | tx

steroids + abx intravitreal vancomycin +-vitrectomy remove capsular bag, residual cortex, IOL

capsular opacification SIGNS

Elschnig pearls on posterior capsule post capsular fibrosis ant fibrosis --> capsulophimosis

comp of YAG laser capsulotomy

``` damage to IOL = pitting IOL sublux increase IOP transient chronic CMO Rhegmatogenous retinal detachment - myopics ```

decentration of IOL causes tx

operative malplacement post op trauma, capsular contraction mild - constrict pupil w/ miotics severe - replace IOL

Retinal detachment | risk factors

lattice deg/ retinal breaks high myopia post capsule rupture vitreous loss YAG laser capsulotomy

CMO risk factors

post capsule rupture | vitreous prolapse

Density of congenital cataract

red reflex quality fundus view quality portable slit lamp

Congenital cataract | ASSOCIATED PATHOLOGY IN ANT SEGMENT

keratopathy microphthalmos glaucoma persisitent hyperplastic primary vitreous

Congenital cataract | ASSOCIATED PATHOLOGY IN POST SEGMENT

chorioretinitis leber amaurosis rubella retinopathy foveal/ optic nerve hypoplasia

Congenital cataract | signs of severe visual impairment

absence of central fixation nystagmus strabismus

Congenital cataract | special tests

forced choice preferntial lookig | visually evoked potentials

Congenital cataract | serological investigations

anti-rubella IgM, IgG ELISA for toxo Anti-CMV

Congenital cataract | URINALYSIS

Galactosemia | Lowe syndrome

Congenital cataract | other investigations

fasting blood glucose serum calcium, phosphorus RBC transferase, galactokinase Chromosome analysis

timing of surgery | bilateral congenital cataracts

dense - within 6 wks | partial - later, if at all

timing of surgery | unilateral congenital cataracts

dense - urgent within days | partial - pupillary dilatation/ contralateral occlusion

congenital cataracts surgical techniques

lens aspiration w/ vitreous cutter/ Sicoe cannula post capsulorrhexis limited ant vitrectomy

congenital cataracts | visual rehab

spectacles/ contact lens for aphakia | IOL implantation

Morgagnian cataract

hypermature | nucleus has sunk inf

causes of presenile cataract

DM Myotonic dystrophy Atopic dermatitis steroids chlorpromazine/ amiodarone

DM cataract

snowflake

Myotonic dystrophy cataract

stellate post subcapsular

Atopic dermatitis cataract

shield like

steroids cataract

post subcapsular then ant subcapsular

chlorpromazine/ amiodarone cataract

stellate, yellowish brown granules on ant lens capsule

secondary cataract causes

``` chronic ant uveitis acute congestive angle closure glaucoma high myopia trauma hereditary fundus dystrophies ```

anaesthesia for cataract surgery

general local - retrobulbar/ peribulbar/ sub-Tenon topical-intracameral

for cataract surgery | IOL positioning

post chamber w/ capsular fixation | ant chamber w/ angle fixation

IOL design

rigid IOLs PMMA 5-6.6mm incision | flexible IOLs silicone, acrylic, hydrogel, collamer, 2.5-3mm incision