SENILE CATARACT- Pathophysiology, Symptoms, Complications

SENILE CATARACT- Pathophysiology, Symptoms, Complications


PATHOPHYSIOLOGY OF SENILE CATARACT

  • Pathophysiology of loss of transparency of lens is different for nuclear & cortical senile cataract:

A) Cortical senile cataract:

The main biochemical features are:

  1. Decreased levels of total protein, amino acids & potassium.
  2. Increased concentration of sodium & marked hydration of lens.
  3. Coagulation & denaturation of lens proteins

B) Nuclear senile cataract:

  • Usual degenerative changes are intensification of the age related nuclear sclerosis.
  • Associated with dehydration & compaction of the nucleus resulting in a hard cataract.
SYMPTOMS OF SENILE CATARACT
 

SYMPTOMS

CONDITIONS

Visual field loss All types of cataract
Frequent change of glasses Cortical or nuclear cataract
Monocular diplopia or polyopia Cortical cataract (Incipient stage)      (spoke or cuneiform)
Colour shift (becomes more obvious after surgery) Cortical cataract
Glare Cortical & posterior subcapsular cataract
Loss of ability to see objects in bright sunlight, blinded by light of oncoming headlamps when driving at night. Posterior subcapsular cataract

Nuclear cataract

‘Second sight’ or myopic shift

(change in refractive index of the nucleus causes index myopia improving near vision)

Nuclear cataract
Index myopia Nuclear cataract
Index Hypermetropia Cortical cataract

COMPLICATIONS OF SENILE CATARACT

1. Lens induced Glaucoma: Cataract can give rise to secondary glaucoma in following ways:

i) Phacomorphic glaucoma:

  • Lens may swell up by absorbing fluid resulting in shallow anterior chamber (intumescent cataract).
  • Most common type of lens induced glaucoma.
  • Beside intumescent stage of senile cataract, phacomorphic glaucoma is also seen in anterior subluxation/dislocation of lens & spherophakia (congenital small spherical lens).

ii) Phacolytic glaucoma: 

  • In hypermature stage the lens proteins leak out into the anterior chamber & engulfed by macrophages.
  • A type of secondary open angle glaucoma.

iii) Phacotopic glaucoma:

  • Hypermature lens subluxation/ dislocation may cause glaucoma by blocking the pupil or angle of anterior chamber. 

2. Lens induced Uveitis

3. Subluxation or Dislocation of Lens

  • In stage of of hypermaturity the zonules of the lens may weaken & break.
  • This leads to subluxation of the lens or dislocation.

Exam Important

  • Intumescent cataract is the most common type of lens induced glaucoma.
  • Visual deterioration due to senile cataract is painless and gradually progressive in nature.
  • Second sight phenomenon is seen in Nuclear cataract.
  • Polyopia is a symptom of Cortical cataract.
  • Most visually handicapping cataract is Posterior subcapsular cataract.
  • Highest visual morbidity is seen in Posterior subcapsular cataract.
  • Steroid induced cataract is Posterior subcapsular cataract.
  • Nuclear cataract is most commonly associated with ageing.
  • In senile nuclear cataract Index myopia  is seen.
  • Polychromatic Lustre is seen in Posterior cortical cataract.
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