1. Welcome Home

2. THEORY LECTURES reduced from 80 --- 40 hours
2 x per week [ Tues and Fri.]
In 7th semester there will be no lectures BUT in your case it is going to be an exception
because of Electives in JUNE
Cover all major topics

3. Text books : Khurana , Parson’s Diseases of the Eye
Reference books : Kanski
Reading on your own and consistent
No more spoonfeeding
Attendance 75 % .
    

4. Practicals or clinical posting
Reduced from 10 weeks to 4 weeks
4 weeks meaning morning and afternoon
In the 7th Semester in H. Melaka. You may do a rotation in other hospitals such as in Muar or Terendak

5. Practicals or clinical posting
Log book cases
Instruments - torchlight and ophthalmoscope
Dress code in hospital
No jeans, slippers , tee- shirts , hipsters
Skirts – below knee level
Males - proper shoes, shirts with ties
Hair neatly combed nto hanging over your face bor BOTH
Language -courteous
Behaviour - professional

6. Examinations 6th semester – Midsemester + 5o marks -- Sessional
-EPT
-OSCE
Eligibility for University Examinations – attendance and internal asssesment

9. LENS Development: ectodermal Transparent Avascular Spherical
Location : between the iris and vitreous
Suspended by zonules

10. ANATOMY
cortex
nucleus
capsule

11. Anatomy Capsule: Thicker anteriorly especially at the equator.
Cuboidal cells form the ant. subcapsular epithelium It is not present on the post.lens epithelium . Becomes columnar at the equator--- Lens fibres.
Lens fibres arise from the anterior epithelial cells.
Nucleus
In children it is soft
In adults it is firm
In older age it looses transparency and it is flat on both surfaces.

12. PHYSIOLOGY Nutrition from aqueous + vitreous
66% of water + 34% of proteins[ 85% are soluble proteins]
Traces of mineral
Glutathione + Ascorbic acid
[ Reduces with age + cataract formation]
Carbohydrates-- energy
Amino Acids ---structure
Metabolism Low metabolism and utilisation of O2 and glucose.
Carbohydrates—HMP- shunt, glycolysis, citric acid cycle
Amino acids and fatty acids via the citric acid cycle in the mitochondria of lens epithelium.

13. Classification of cataract
Aetiological : Congenital / developmental
: Acquired
Morphological: location and configuration

14. Acquired causes Senile :Age
Complicated :Uveitis , R.D, endophthalmitis
Traumatic
Metabolic : D.M., Wilson’s disease ,galactosemia
Maternal infections : TORCHES
Drugs [Toxic] : Steroids
Radiation : Gamma rays ,X-Rays, Microwave???
Dermatogenic :Atopic dermatitis
Cataract associated with syndromes e.g. Downs syndrome,
Dystrophia myotonica

15. Acquired causes Senile :Age
Complicated :Uveitis , R.D, endophthalmitis
Traumatic

16. Acquired causes Metabolic : D.M., Wilson’s disease ,galactosemia
Maternal infections : TORCHES
Drugs [Toxic] : Steroids

17. Acquired causes Radiation : Gamma rays , X-Rays, Microwave???
Dermatogenic :Atopic dermatitis
Cataract associated with syndromes
e.g. Downs syndrome, Dystrophia myotonica

18. Morphological Classification
Capsular
Cortical
Nuclear
Polar 1

19. Morphological Classification
Capsular
Cortical
Nuclear
Polar

20. Cataract Is an opacity in a clear lens.
Is the most common cause of painless visual loss in the elderly.
Is the most common cause of preventable blindness.
Normally the human lens converges the light rays.
What happens when there is an opacity?

21. What happens when there is a opacity in the lens ?

22. Senile cataract Bilateral above 60 yrs
Can occur at a younger age—hereditary tendency
Both sexes are equally affected
Two forms : Cortical
: Nuclear

23. Development of senile cortical cataract
Lamellar separation or presenile changes
Incipient stage
Intumuscent stage
Mature cataract
Hypermature cataract

24. Stages of maturation in cortical cataract
Lamellar separation
Collection of fluid between
the lens fibres.
Change in refraction—hypermetropic [mild ]
No symptoms

25. Stages of maturation in cortical cataract
Incipient stage
Cuneiform – spokes in the periphery
Cupuliform– opacity in the posterior cortex
Does the vision get affected ?

26. Clinical features of the incipient form
Change in refractive index of lens
Polyopia
Haloes
Defective vision in the evening or night
On examination they appear black against the red glow
with the direct ophthalmoscope
Or grey opacities

27. What do you think the vision is ?
Intumuscent stage
Progression of the hydration of the lens fibres
Swelling and opacification of the lens
Lens pushed forward
A.C. shallow and Sec. Angle closure glaucoma
Opaque lens
Pupil in contact with the lens
No iris shadow
What do you think the vision is ?

28. Stages of maturation in cortical cataract
Mature cataract
Loss of fluid
Entire cortex is opaque
?? visual acuity

29. Hypermature Cataract Signs of hypermature cataract
Wrinkled capsule / calcification
Iridodonesis
Ac may be deep
Subluxation due to
weak zonules
Sclerotic cataract
Morgagnian cataract

30. Calcification of the capsule in hypermature cataract

31. Cortex liquifies
Hard nucleus sinks
nucleus
Morgagnian cataract

32. Nuclear cataract Progressive sclerosis in the nucleus
Brown [brunescent ]
+ refractive index
Myopic
Seldom becomes hypermature