1. Lens Disease China Medical University NO.4 Affiliated hospital Ophthalmology; Ophthalmology hospital of China Medical University

2. Introduction Lens disease: –Change of transparency cataract –Position and morphological abnormality dislocation malformation

3. Basic knowledge

4. Anatomy Equator Anterior capsule Posterior capsule Diameter:9-10mm Thickness:4-5mm Lens zonule

5. Anatomy Capsule: integrity—maintain transparency Lens epi. — PCO Lens substance: lens fiber –Nucleus –Cortex

6. Function Refraction Accommodation Protection: UV filtration What is accommodation? –The capability that eyes change refractive condition in order to acquire clear near sight. !

7. What is cataract? Turbidity of lens WHO: turbidity of lens + VA<0.5

8. What is cataract?

9. Case: turbid lens, but VA=0.8

10. Cataract Cataract is the No. 1 eye disease that causing blind. 46% blindness is caused by cataract !

11. Etiology Any factors that change the intraocular environment to affect lens metabolism. –Such as: ageing, mechanical, chemical, operation, inflammation, metabolic Malformation Congenital factors

12. Risk factors UV Diarrhea Malnutrition Diabetes Smoking Drinking alcohol

13. Classification On etiology: –Congenital –Senile –Complicated –Metabolic –Drug induced or toxic –Traumatic –After cataract

14. Classification On location: –Cortical –Nuclear –Subcapsular On degree: –Immature –Intumescent –Mature –Hypermature

15. Pathogenesis The common route that causing cataract is the oxidation injury by peroxide free radical. Apoptosis—hot spot of research !

16. Clinical manifestations Symptoms: –Progressive vision decrease –Contrast sensitivity decrease –Refraction changes –Diplopia –Glare –Change of color sensation –Visual field defect

17. Functionality vision contrast test Positive wave contrast test CSF curve contrast test

18. Color vision excursion glare visual field loss Vision abnormity

19. Clinical manifestations Signs: Turbidity of lens

20. Senile Cataract Now called Age-related Cataract Most commonly seen >50 yrs old >80 yrs old→100% Degenerative changes

21. Classification Cortical Nuclear Subcapsular

22. Cortical cataract 4 stages Incipient stage: wedge turbidity

23. Cortical cataract 4 stages Intumescent stage (immature): iris projection Induce acute angle- closure glaucoma

24. Cortical cataract 4 stages Mature stage

25. Cortical cataract 4 stages –Hypermature stage: Morgagni cataract Phacoanaphylactic uveitis Phacolytic glaucoma

26. Nuclear cataract

27. Subcapsular cataract Affecting vision early

28. Congenital cataract Etiology: –Hereditary –Environmental: Virus infection Malnutrition Radiation Drug Systemic disease V D deficiency

29. Congenital cataract Morphology

30. Congenital cataract Treatment –observation –Early operation –Amblyopia Treatment

31. Complicated cataract Caused by other eye diseases –Corneal ulcer –Glaucoma –Uveitis –Retinal detachment –Retinitis pigmentosa –Intraocular tumor –myopia

32. Old anterior uveitis Complicated cataract glaucoma Complicated cataract （ vogt spot ） Pigmentosa eyeSilicon oil eye Kinds of Complicated cataract

33. Metabolic cataract Caused by systemic metabolic diseases –Diabetic cataract –Galactosemia cataract –Hand-foot-twitch cataract

34. Drug induced or toxic cataract Glucocorticosteroid cataract Chlorpromazine cataract Miotic cataract TNT cataract Metal: copper, iron, mercury, silver, zinc

35. Traumatic cataract Contusive Penetrating Radiative Electric

36. After cataract Now usually called PCO (posterior capsular opacification) Adult: 30-50% Child: 100% Pathogenesis: Proliferation, migration & metaplasia of lens epi. !

37. Treatment Drug? NO USE Operation: the only effective therapy –ICCE (intracapsular cataract extraction) –ECCE (extracapsular cataract extraction) –PEA (phacoemulsification) !

38. ICCEECCE ICCE And ECCE

39. Treatment IOL (intraocular lens) implantation –AC and PC –Hard and foldable

40. Treatment IOL (intraocular lens) implantation

41. Treatment PEA & F-IOL

42. PEA & F-IOL ( video )

43. Treatment Correction of aphakia: –Frame glasses –Contact lens –IOL –Laser

44. Lens Dislocation Etiology: –Congenital –Marfan syndrome –Traumatic –Spontaneous

45. Clinical Manifestations Subluxation Dislocation

46. Clinical Manifestations Complications: –Uveitis –Secondary glaucoma –Retinal detachment –Corneal turbidity

47. Trends Photolysis of cataract Injective IOL Accommodative IOL