Eye > Cataract > Flashcards

Cataract Flashcards

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1
Q

Nuclear cataract causes which type of refractive error

A

Index myopia due to increase in optics density of nucleus

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2
Q

What is second cataract

A

PCO

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3
Q

What step to be avoided in posterior polar cataract

A

Hydro Dissection as there may be associated posterior capsular defect

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4
Q

Golden ring sign seen in

A

Hydrodelineation

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5
Q

What is hydro dissection

A

Separation of capsule and cortex

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6
Q

What is hydro delineation

A

Between nucleus and epi nucleus/cortex

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7
Q

What is cataract

A

Opacification of crystalline lens
That is loss of transparency

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8
Q

Full form of LOCS

A

Lens opacity classification system

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9
Q

Maturity of cataract

A

Immature (NS PSC CC)
Mature (total white /intumescent)
Hypermature (morgagnian )

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10
Q

Full form of FLACS

A

Femtosecond Laser Assisted Cataract Surgery

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11
Q

Laser used in FLACS with its frequency

A

Infrared NDYAG 1053 nm

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12
Q

Femtosecond means?

A

10 raise to the power -15
Ultrashort pulses

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13
Q

Mechanism of FLACS

A

Photodisruption
Plasma formation
Plasma expansion
Cavitation bubbles
Separate the tissue

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14
Q

What Steps does FLACS do

A
  1. Arcuate keratotomies (limbal relaxing incisions) for low Astigmatism
  2. Corneal incisions
  3. Capsulorhexis
  4. Lens fragmentation
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15
Q

Lens fragmentation pattern by FLACS

A
  1. Liquefy > spherical cuts for soft cataract
  2. Chop > pie cuts for hard nucleus
  3. Hybrid > 3 cylindrical & 3 chop cuts
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16
Q

🔹 Advantages of FLACS

A

• Greater precision and reproducibility.
• Reduced ultrasound energy → less endothelial cell loss.
• Potential for better IOL positioning and visual outcomes.
• Less trauma to the eye.
Precision position phaco less

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17
Q

Disadvantages and Contraindications of FLACS

A

High cost.

Requires specialized equipment.

Increased surgical time (initially).

Small/non-dilating pupils.
Dense/mature cataract.
Corneal opacities
Uncooperative patients

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18
Q

What is a subluxated lens?

A

Lens displaced from its normal position but remains in pupillary area.

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19
Q

What is a dislocated lens?

A

Lens completely displaced from the pupillary area (anterior or posterior).

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20
Q

Main causes of lens subluxation/dislocation?

A

Traumatic, iatrogenic, primary ocular conditions, systemic conditions with ectopia lentis, hereditary ectopia lentis without systemic association.

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21
Q

Most common cause of lens subluxation?

A

Trauma (non-progressive).

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22
Q

One iatrogenic cause of lens subluxation?

A

During cataract surgery.

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23
Q

Name primary ocular disorders associated with lens subluxation.

A

Pseudoexfoliation, hypermature cataract, high myopia, coloboma, retinitis pigmentosa, congenital glaucoma/buphthalmos, aniridia, intraocular tumor.

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24
Q

Most common cause of heritable ectopia lentis?

A

Marfan syndrome.

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25
Which gene is mutated in Marfan syndrome?
Fibrillin-1 gene (FBN1).
26
Direction of lens subluxation in Marfan syndrome?
Superotemporal.
27
Systemic features of Marfan syndrome?
Tall stature, pectus excavatum, scoliosis, arachnodactyly, hypermobile joints, cardiovascular anomalies (aortic dilation, dissection, MVP).
28
Direction of lens subluxation in homocystinuria?
Inferonasal.
29
Systemic features of homocystinuria?
Marfanoid habitus, intellectual disability, chest deformities, high thrombotic risk (esp. anesthesia).
30
Ocular findings in homocystinuria?
Inferonasal subluxation, high myopia, pupillary block glaucoma.
31
Genetics of Weil–Marchesani syndrome?
Autosomal dominant or recessive.
32
Ocular findings in Weil–Marchesani syndrome?
Microspherophakia, shallow anterior chamber, myopia, subluxation/dislocation, secondary glaucoma.
33
Systemic features of Weil–Marchesani syndrome?
Short stature, brachydactyly, joint stiffness, thickened skin, pseudomuscular build, cardiovascular defects, mild intellectual disability.
34
Hereditary ectopia lentis without systemic association?
Ectopia lentis et pupillae.
35
Non-surgical management of mild lens subluxation?
Spectacles or contact lenses.
36
What is a capsular tension ring used for?
To stabilize the capsular bag in zonular weakness/subluxation.
37
Surgical options for lens subluxation?
Capsular tension devices, scleral-fixated IOL, iris-claw IOL, pars plana lensectomy with vitrectomy.
38
Preferred surgery in children with ectopia lentis and amblyopia risk?
Early lens extraction with visual rehabilitation.
39
Complications of lens subluxation?
Glaucoma, retinal detachment, uveitis, amblyopia (in children).
40
How does lens subluxation cause glaucoma?
Via pupillary block, angle crowding, or secondary open-angle from pseudoexfoliation.
41
Retinal complication associated with Marfan syndrome and lens subluxation?
Retinal detachment.
42
What is the purpose of a capsular tension ring (CTR)?
To stabilize the capsular bag by redistributing zonular tension in cases of zonular weakness.
43
Standard CTR – when is it used?
When zonular dialysis involves less than 3–4 clock hours.
44
Modified CTR (Cionni ring) – what is unique about it?
It has one or two fixation eyelets that can be sutured to the sclera for severe zonular weakness or dialysis >4 clock hours.
45
Capsular tension segment (CTS) – when is it used?
Segmental support for localized zonular loss; sutured to sclera if required.
46
When should a CTR be avoided?
In cases with posterior capsular rupture, advanced zonular dialysis, or pediatric cataracts (risk of complications).
47
What is the structure of a Capsular Tension Ring (CTR)?
Flexible PMMA open C-shaped ring.
48
What are the indications for CTR?
Mild to moderate zonular weakness (<3–4 clock hours).
49
What is the mechanism of action of CTR?
Distributes zonular forces evenly around the capsule.
50
What are the limitations of CTR?
Not useful in severe zonular loss; difficult removal if needed. CI in PCR or Rhexus tear
51
What is the structure of a Modified CTR (Single Eyelet Cionni Ring)?
CTR with one scleral fixation eyelet.
52
What are the indications for Single Eyelet Cionni Ring?
Moderate to severe zonular dialysis (>3-6 clock hours)
53
What are the advantages of Cionni Ring?
Long-term stability with scleral anchoring. In Advanced or Progressive ZD
54
What are the limitations of Single Eyelet Cionni Ring?
Requires scleral suturing
55
What is the structure of a Double Cionni Ring?
CTR with two fixation eyelets placed 180° apart.
56
What are the indications for Double Cionni Ring?
Extensive zonular weakness (6–8 clock hours or more)
57
What is the mechanism of action of Double Cionni Ring?
Dual scleral fixation ensures symmetric centration.
58
What are the advantages of Double Cionni Ring?
Excellent stability in advanced progressive zonulopathy.
59
What are the limitations of Double Cionni Ring?
Technically demanding
60
What is the structure of a Capsular Tension Segment (CTS/Ahmed Segment)?
PMMA partial ring segment with fixation eyelet.
61
What are the indications for CTS?
Localized zonular dialysis (2–4 clock hours).
62
What is the mechanism of action of CTS?
Provides localized capsular support
63
What are Capsule Retention Hooks / Capsule Retractors?
Temporary nylon/metal hooks anchored to limbus.
64
What is the mechanism of Capsule Retractors?
Provide intraoperative centration and stabilization of capsular bag.
65
What is the Capsule Anchor (Assia device)?
Titanium anchor with scleral fixation.
66
What are the indications for Capsule Anchor?
Severe zonular dialysis
67
What is the mechanism of action of Capsule Anchor?
Direct anchoring of capsule equator to sclera.
68
What are the advantages of Capsule Anchor?
Provides strong localized fixation.
69
What are the limitations of Capsule Anchor?
Limited availability
70
What are Iris Hooks (for capsule support)?
Polypropylene retractors placed through paracentesis.
71
What are the indications for Iris Hooks as capsule support?
Intraoperative zonular weakness when CTR not sufficient.
72
What lifestyle factor causes a threefold increase in risk of nuclear cataract?
Smoking
73
How does smoking contribute to cataract formation?
Reduces endogenous antioxidants and introduces heavy metals like cadmium
74
What is the water content of a normal lens?
~65%
75
How does water content change in cortical cataract?
Increases from ~70% (immature) to ~80% (hypermature)
76
What is the effect of protein content in cortical cataract?
Decreases with maturation of cortical cataract
77
Which protein fraction shows loss in cortical cataract?
Soluble: α-crystallin, gamma Crytallin
78
What biochemical changes occur in cortical cataract?
Decrease: Protein, Free amino acids, K+ Increase: Water, Na+, Ca++
79
What is the significance of free amino acids in cortical cataract?
They increase with maturation but decrease later due to leakage
80
What is the hallmark biochemical change in nuclear cataract?
Dehydration and compaction of nucleus
81
Which protein fraction increases in nuclear cataract?
Water-insoluble proteins
82
Which pigments are associated with nuclear cataract?
Urochrome and melanin-derived pigments
83
What antioxidant molecules protect the lens against oxidative stress?
Glutathione and ascorbic acid
84
Which oxidants cause lens protein damage?
Superoxide anions H2O2
85
What are enzymatic antioxidant defense mechanisms of the lens?
High Glutathione Glutathione peroxidase SOD Catalase
86
What are non-enzymatic antioxidant defense mechanisms of the lens?
Ascorbic acid (Vit C) Vit E Carotenoids
87
What causes depletion of glutathione in cataract?
↓ Synthesis Inc Permeability Dec G. Reductase
88
What is galactosaemic cataract associated with?
Inborn error of galactose metabolism.
89
What are the two forms of galactosaemia?
1. Classical galactosaemia (deficiency of GPUT), 2. Deficiency of galactokinase (GK).
90
What lens changes are seen in galactosaemic cataract?
Oil droplet central lens opacities.
91
How can galactosaemic cataract be prevented?
By eliminating milk and milk products from diet if diagnosed early.
92
What are the synonyms for true diabetic cataract?
Snowflake cataract, Snow-storm cataract.
93
In which patients is true diabetic cataract usually seen?
Juvenile and young diabetics.
94
What are the initial changes in diabetic cataract?
Fluid vacuoles beneath anterior and posterior capsule.
95
Which enzyme is key in sugar cataract pathogenesis?
Aldose reductase.
96
What does aldose reductase do in sugar cataract?
Converts excess sugar into sugar alcohols (glucose→sorbitol, galactose→dulcitol).
97
Why does sugar alcohol accumulate in lens?
It cannot escape or be metabolized, making cytoplasm hypertonic.
98
What results from hypertonicity in lens?
Water influx, Na+/K+ alteration, lens swelling.
99
What is the effect on lenticular architecture in sugar cataract?
Disruption leading to light scattering and opacification.
100
Pathogenesis of Sugar cataract
1. Sorbitol accumulation 2. Autooxidation of sugars 3. Non enzymatic Glycation of proteins
101
What is the theory of non-enzymic glycosylation in diabetic cataract?
Non-enzymic glycosylation of lens proteins leads to conformational changes, thiol oxidation, aggregation, disulphide & covalent crosslinks, and inactivation of enzymes.
102
Corticosteroid induced Cataract pathogenesis
induce aberrant differentiation and migration of epithelial cells leading to the PSC • Elevation of glucose • Inhibition of Na, K-ATPase • Increased cation permeability • Inhibition of glucose 6-phosphate dehydrogenase • Inhibition of RNA synthesis • Loss of ATP • Covalent binding of steroids to lens proteins
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