Senile Cataract

SENILE CATARACT


SENILE  CATARACT

  • Commonest type of acquired cataract.

Factors responsible for senile cataract :

  1. Higher concentration of UV rays in tropical su-light.
  2. Nutritional deficiency factors (vitamin A,C & E)

MORPHOLOGICAL TYPES OF SENILE CATARCT

1. Cortical senile cataract (soft cataract)- Opacities in cortex may be of two types:

  1.  Cuneiform cataract: Wedge shaped opacities (spokes) in the cortex.
  2. Posterior subscapular (Cupuliform) cataract: Saucer shaped opacity under the posterior capsule.

2. Nuclear senile cataract (Hard cataract): Opacity in the nucleus

  • Most common type of senile cataract is cuneiform cortical (70%) followed by nuclear (25%) & cupuliform.

MATURATION OF CATARACT

A) Maturation if the cortical type of senile cataract

1. Stage of lamellar separation:

  • The earliest senile change is demarcation of cortical fibres owing to their separation by fluid.
  • These changes are reversible.

2. Stage of incipient cataract:

  • In this stage early detectable opacities with clear areas b/w them are seen.
  • Two distinct types of senile cortical cataracts can be recognized at this stage:

a) Cuneiform senile cortical cataract-

  • Characterized by wedge-shaped opacities with clear areas in between.
  • On oblique illumination these present a typical radial spoke- like pattern of grayish white opacities.

b) Cupuliform senile cortical cataract (Posterior subcapsular)-

  • Saucer shaped opacity develops just below the capsule.
  • Usually in the central part of posterior cortex (posterior subcapsular cataract), which gradually extent outwards. 
  • Cupuliform cataract lies right in the pathway of the axial rays & thus causes an early loss of visual acquity.
  • Loss of vision is early in bright light as there is constriction of pupil & opacity is in the center.

3. Immature senile cataract (ISC):

  • In this stage, opacification progresses further.
  • In some patients, at this stage, lens may become swollen due to continued hydration.
  • This condition is called ‘intumescent cataract’.

4. Mature senile cataract (MSC):

  • In this stage, opacification becomes complete, i.e whole of cortex involved.
  • Lens becomes pearly white in colour.
  • Such a cataract is also labeled as ‘ripe cataract’.

5. Hypermature senile cataract (HMSC):

  • Occurs in any of the 2 forms:

a) Morgagnian hypermature cataract –

  • Small brownish nucleus settles at the bottom, altering its position with change in the position of he head.
  • Such a cataract os called Morgagnian cataract.
  • Calcium deposits may also be seen on the lens capsule.

b) Sclerotic type hypermature cataract –

  • The anterior capsule is wrinkled & thickened due to proliferation of anterior cells & a dense white capsular cataract may be formed in the pupillary area.
  • Due to shrinkage of lens, anterior chamber becomes deep & iris becomes tremulous (iridodonesis).

B) Maturation of nuclear senile cataract

  • The sclerotic process renders the lens inelastic & hard.
  • The nucleus may become diffusely cloudy (greyish) or tinted (yellow to black) due to deposition of pigments.
  • The commonly observed pigmented nuclear cataracts are either amber brown (cataracta brunescens) or black (cataracta nigra) & rarely reddish (cataracta rubra) in colour.

Exam Important

  • Most common type of senile cataract is Cunieform.
  • The commonest type of cataract in adults is Cortical cataract.
  • Immature senile cataract can be best differentiated from mature senile cataract by Distant direct ophthalmoscopy.
  • Senile cataract is painless gradual vision loss.
  • 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.
  • Polychromatic Lustre is seen in Posterior cortical cataract.
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