Cataracts

Question 1

Nuclear Sclerosis

• Etiology
• Signs?
• Refractive shift
• Speed of progression?

Answer 1

Hardening and yellowing of the lens nucleus

• Etiology: Age
• Signs?: Yellow lens nucleus, may progress to brown.
• Refractive shift: Myopic refractive shift
• Speed of progression?: Slow.

Question 2

Cortical cataract

• Etiology
• Early sign
• Late signs
• Refractive shift
• Speed of progression?

Answer 2

Opacification of the lens cortex

• Etiology: Age related
• Early signs: Cortical water clefts and vacuoles
• Late signs: Spoke or wedge like opacities in the cortex. Begins in the periphery then approach visual axis.
• Refractive shift: typically a hyperopic shift and lenticular cyl.
• Speed of progression?: Very slow.

Question 3

Mature cataract

• Etiology
• Symptoms
• Signs?
• Complications
• How to evaluate posterior segment pathology

Answer 3

Complete opacification of the entire lens

• Etiology: Progression of cortical or nuclear cataract
• Symptoms: Significantly blurred vision.
• Signs? Opacification of entire lens. Leukocoria. Shallow anterior chamber.
• Complications- phacomorphic glaucoma. Lens changes shape and causes glaucoma.
• Order B scan.

Question 4

Hypermature cataract. (morgagnian cataract)

• What is it?
• Etiology
• Symptoms
• Signs
• Complications

Answer 4

• What is it? Mature cataract with liquefaction of the cortex and sinking of the nucleus to the bottom of the lens capsule.
• Etiology: Progression of a mature cataract
• Symptoms: Significantly blurred vision
• Signs: Complete opacification of the entire lens with the nucleus floating freely in the liquefied cortex. Leukocoria. Shallow anterior chamber.
• Complications: lens capsule rupture can cause uveitis or glaucoma.

Question 5

Posterior sub capsular cataract

• What is it?
• Etiology
• Symptoms
• Signs
• Progression

Answer 5

• What is it?: Opacification between the posterior cortex and capsule.
• Etiology: age related. Also associated with uveitis, prolonged steroid use, systemic disease, radiation.
• Symptoms: Blurred vision at near
• Signs: Granular or plaque like opacification anterior to the posterior capsule. commonly begins as a round opacity in the visual axis.
• Progresses more rapidly than other cataracts.

Question 6

Anterior sub capsular cataract

• What is it?
• Etiology
• Signs

Answer 6

• What is it? opacification between the anterior capsule and cortex.
• Etiology: Associated with angle closure. Cataract is called glakomflecken. Meds, radiation.
• Signs: Granular or plaque like opacification posterior to the anterior capsule.

Question 7

Sunflower cataract (Chalcosis lentos)

Opacification
Etiology
Signs
Management

Answer 7

Opacification in a sunflower pattern between the anterior capsule and cortex.

Etiology: Coper deposition. Wilson disease.

Signs: Yellow, green, or red sunflower like opacification beneath the anterior capsule.

Management: refer to PCP for eval of wilson’s disease. May resolve if improvement in copper levels.

Question 8

Snowflake cataract

• What is it?
• Etiology
• Signs
• Management
• Progression

Answer 8

• What is it: White opacities in the cortex.
• Etiology: DM
• Signs: White, snowflake like opacities in the cortex
• Management: Refer to PCP for DM eval. May resolve.
• Progression: Progresses rapidly

Question 9

Christmas Tree cataract (polychromatic cataract)

• What is it?
• etiology
• May evolve into
• Management

Answer 9

• What is it: Glittering, multi colored opacity in the cortex.
• etiology: Myotonic dystrophy, rarely. Age related.
• May evolve into typical cortical or sub capsular opacities like in a star conformation.
• Management: refer to PCP for myotonic dystrophy eval.

Question 10

After cataract (posterior capsular opacification- PCO)

• What is it?
• Etiology
• Signs
• Management
• Up to ___% of patients develop PCO after surgery

Answer 10

• What is it: Opacification between a PCIOL and posterior capsule.
• Etiology: proliferation of lens epithelial cells onto the posterior capsule.
• Signs: Granular or plaque like opacification of the posterior capsule. Elschnig’s pearls, wrinkling of the posterior capsule.
• Management: YAG
• Up to 50% of patients develop PCO after surgery