CHAPTER I

INTRODUCTION

Cataract means an opacity of the lens and it is the commonest potentially
blinding condition that confronts the eye surgeon. This is not to say that every
person with cataract is liable to go blind. Many patients have relatively slight lens
opacities that progress slowly. Fortunately, the results of surgery are good, a
satisfactory improvement of vision being obtained in over 90% of cases. It is
usually possible to forewarn the patients when there is an extra element of doubt
about the outcome. To the uninformed patient, the word cataract strikes a note
of fear and it might be necessary to explain that opacities in the lens are extremely
common in elderly people. It is only when the opaque lens fibres begin to interfere
with the vision that the term cataract is used. Many patients have a slight degree
of cataract, which advances so slowly that they die before any visual problems
arise. Nobody need now go blind from cataract; however, one still encounters
elderly people who, from ignorance or neglect, are left immobilized by this form
of blindness, and it is especially important that the general practitioner is able to
recognise the condition.
In the United States, age-related macular degeneration is the leading cause of
irreversible central visual loss (20/200 or worse) among people aged 52 or older.
Because certain types of macular degeneration are treated effectively with laser, it
is important to recognize this entity and to refer for appropriate care. It is
important to distinguish between the possible causes of visual loss, whether
cataract (surgicall correctable), glaucoma (medically or surgically treatable), or
macular degeneration (potentially laser treatable).






CHAPTER II
LITERATURE REVIEW

A. Anatomy and Physiology of Lens
The lens is a transparent, biconvex, crystalline structure placed between iris
and the vitreous in a saucer shaped depression the patellar fossa. Its diameter is 9-
10 mm and thickness varies with age from 3.5 mm (at birth) to 5 mm (at extreme
of age). Its weight varies from 135 mg (0-9 years) to 255 mg (40-80 years of age).
It has got two surfaces: the anterior surface is less convex (radius of curvature 10
mm) than the posterior (radius of curvature 6 mm). These two surfaces meet at the
equator. Its refractive index is 1.39 and total power is 15-16 D. The
accommodative power of lens varies with age, being 14-16 D (at birth); 7-8 D (at
25 years of age) and 1-2 D (at 50 years of age).
A.1. Stucture of Lense
1. Lens capsule. It is a thin, transparent, hyaline membrane surrounding the lens
which is thicker over the anterior than the posterior surface. The lens capsule
is thickest at pre-equator regions (14 ) and thinnest at the posterior pole (3
).
2. Anterior epithelium. It is a single layer of cuboidal cells which lies deep to
the anterior capsule. In the equatorial region these cells become columnar, are
actively dividing and elongating to form new lens fibres throughout the life.
There is no posterior epithelium, as these cells are used up in filling the
central cavity of lens vesicle during development of the lens.
3. Lens fibres. The epithelial cells elongate to form lens fibres which have a
complicated structural form. Mature lens fibres are cells which have lost their
nuclei. As the lens fibres are formed throughout the life, these are arranged
compactly as nucleus and cortex of the lens.
a. Nucleus. It is the central part containing the oldest fibres. It consists of
different zones, which are laid down successively as the development
proceeds. In the beam of slit-lamp these are seen as zones of discontinuity.
Depending upon the period of development, the different zones of the lens
nucleus include:
1) Embryonic nucleus. It is the innermost part of nucleus which
corresponds to the lens upto the first 3 months of gestation. It consists
of the primary lens fibres which are formed by elongation of the cells
of posterior wall of lens vesicle.
2) Fetal nucleus. It lies around the embryonic nucleus and corresponds to
the lens from 3 months of gestation till birth. Its fibres meet around
sutures which are anteriorly Y-shaped and posteriorly inverted Y-
shaped.
3) Infantile nucleus corresponds to the lens from birth to puberty, and
4) Adult nucleus corresponds to the lens fibres formed after puberty to
rest of the life.
b. Cortex. It is the peripheral part which comprises the youngest lens fibres.
4. Suspensory ligaments of lens (Zonules of Zinn). Also called as ciliary
zonules, these consist essentially of a series of fibres passing from ciliary
body to the lens. These hold the lens in position and enable the ciliary muscle
to act on it. These fibres are arranged in three groups:
a. The fibres arising from pars plana and anterior part of ora serrata pass
anteriorly to get inserted anterior to the equator.
b. The fibres originating from comparatively anteriorly placed ciliary
processes pass posteriorly to be inserted posterior to the equator.
c. The third group of fibres passes from the summits of the ciliary processes
almost directly inward to be inserted at the equator.



Figure 2.1. Stucture of the crystalline lense
A.2. Applied Physiology And Biochemistry
The crystalline lens is a transparent structure playing main role in the
focussing mechanism for vision. Its physiological aspects include :
1. Lens transparency
Factors that play significant role in maintaining outstanding clarity and
transparency of lens are:
a. Avascularity,
b. Tightly-packed nature of lens cells,
c. The arrangement of lens proteins,
d. Semipermeable character of lens capsule,
e. Pump mechanism of lens fibre membranes that regulate the electrolyte
and water balance in the lens, maintaining relative dehydration and
f. Auto-oxidation and high concentration of reduced glutathione in the lens
maintains the lens proteins in a reduced state and ensures the integrity of
the cell membrane pump.


2. Metabolism
Lens requires a continuous supply of energy (ATP) for active transport of ions
and aminoacids, maintenance of lens dehydration, and for a continuous protein
and GSH synthesis. Most of the energy produced is utilized in the epithelium
which is
the major site of all active transport processes. Only about 10-20% of the ATP
generated is used for protein synthesis.
Source of nutrient supply. The crystalline lens, being an avascular structure is
dependent for its metabolism on chemical exchanges with the aqueous humour.
The
chemical composition of the lens vis a vis aqueous humour and the chemical
exchange between the two is depicted in.
Pathways of glucose metabolism. Glucose is very essential for the normal working
of the lens. Metabolic activity of the lens is largely limited to epithelium, and
cortex, while the nucleus is relatively inert. In the lens, 80% glucose is
metabolised anaerobically by the glycolytic pathway, 15 percent by pentose
hexose monophosphate (HMP) shunt and a small proportion via oxidative Kreb's
citric acid cycle. Sorbitol pathway is relatively inconsequential in the normal lens;
however, it is extremely important in the production of cataract in diabetic and
galactosemic patients.

Figure 2.2. Chemical composition of the lens vis-a-vis aqueous humour and the
chemical exchange (pump-leak mechanism) between them. Values are in m
moles/kg of lens water unless otherwise stated.
B. Cataract
B.1. Definition
The crystalline lens is a transparent structure. Its transparency may be
disturbed due to degenerative process leading to opacification of lens fibres.
Development of an opacity in the lens is known as cataract.
B.2. Classification
1. Etiological classification
a. Congenital and developmental cataract
b. Acquired cataract
1) Senile cataract
2) Traumatic cataract (see page 405)
3) Complicated cataract
4) Metabolic cataract
5) Electric cataract
6) Radiational cataract
7) Toxic cataract (e.g. Corticosteroid-induced cataract, Miotics-induced
cataract, Copper (in chalcosis) and iron (in siderosis) induced cataract)
8) Cataract associated with skin diseases (Dermatogenic cataract).
9) Cataract associated with osseous diseases.
10) Cataract with miscellaneous syndromes (e.g. Dystrophica myotonica,
Down's syndrome, Lowe's syndrome, Treacher - Collin's syndrome)
2. Morphological classification
a. Capsular cataract. It involves the capsule and may be:
1) Anterior capsular cataract
2) Posterior capsular cataract
b. Subcapsular cataract. It involves the superficial part of the cortex (just below
the capsule) and includes:
1) Anterior subcapsular cataract
2) Posterior subcapsular cataract
c. Cortical cataract. It involves the major part of the cortex.
d. Supranuclear cataract. It involves only the deeper parts of cortex (just outside
the nucleus).
e. Nuclear cataract. It involves the nucleus of the crystalline lens.
f. Polar cataract. It involves the capsule and superficial part of the cortex in the
polar region only and may be:
1) Anterior polar cataract
2) Posterior polar cataract


Figure 2.3. Morphological shapes of cataract.

C. Senile Cataract
Also called as age-related cataract, this is the commonest type of acquired
cataract affecting equally persons of either sex usually above the age of 50 years.
By the age of 70 years, over 90% of the individuals develop senile cataract. The
condition is usually bilateral, but almost always one eye is affected earlier than the
other. Morphologically, the senile cataract occurs in two forms, the cortical (soft
cataract) and the nuclear (hard cataract). The cortical senile cataract may start as
cuneiform (more commonly) or cupuliform cataract. It is very common to find
nuclear and cortical senile cataracts co-existing in the same eye; and for this
reason it is difficult to give an accurate assessment of their relative frequency. In
general, the predominant form can be given as cuneiform 70 percent, nuclear 25
percent and cupuliform 5 percent.
C.1. Etiology
Senile cataract is essentially an ageing process. Though its precise
etiopathogenesis is not clear, the various factors implicated are as follows:
1. Factors affecting age of onset, type and maturation of senile cataract.
a. Heredity. It plays a considerable role in the incidence, age of onset and
maturation of senile cataract in different families.
b. Ultraviolet irradiations. More exposure to UV irradiation from sunlight
have been implicated for early onset and maturation of senile cataract in
many epidemiological studies.
c. Dietary factors. Diet deficient in certain proteins, amino acids, vitamins
(riboflavin, vitamin E, vitamin C), and essential elements have also been
blamed for early onset and maturation of senile cataract.
d. Dehydrational crisis. An association with prior episode of severe
dehydrational crisis (due to diarrhoea, cholera etc.) and age of onset and
maturation of cataract is also suggested.
e. Smoking has also been reported to have some effect on the age of onset of
senile cataract. Smoking causes accumulation of pigmented molecules3
hydroxykynurinine and chromophores, which lead to yellowing. Cyanates
in smoke causes carbamylation and protein denaturation.
2. Causes of presenile cataract. The term presenile cataract is used when the
cataractous changes similar to senile cataract occur before 50 years of age. Its
common causes are:
a. Heredity. As mentioned above because of influence of heredity, the
cataractous changes may occur at an earlier age in successive generations.
b. Diabetes mellitus. Age-related cataract occurs earlier in diabetics. Nuclear
cataract is more common and tends to progress rapidly.
c. Myotonic dystrophy is associated with posterior subcapsular type of
presenile cataract.
d. Atopic dermatitis may be associated with presenile cataract (atopic
cataract) in 10% of the cases.
3. Mechanism of loss of transparency. It is basically different in nuclear and
cortical senile cataracts.
a. Cortical senile cataract. Its main biochemical features are decreased levels
of total proteins, amino acids and potassium associated with increased
concentration of sodium and marked hydration of the lens, followed by
coagulation of proteins. The probable course of events leading to senile
opacification of cortex.
b. Nuclear senile cataract. In it the usual degenerative changes are
intensification of the agerelated nuclear sclerosis associated with
dehydration and compaction of the nucleus resulting in a hard cataract. It
is accompanied by a significant increase in water insoluble proteins.
However, the total protein content and distribution of cations remain
normal. There may or may not be associated deposition of pigment
urochrome and/or melanin derived from the amino acids in the lens.

D. Stages of maturation
D.1. Maturation of 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. This phenomenon of lamellar
separation can be demonstrated by slit-lamp examination only. These changes are
reversible.
2. Stage of incipient cataract. In this stage early detectable opacities with clear
areas between them are seen. Two distinct types of senile cortical cataracts can be
recognised at this stage:
(a) Cuneiform senile cortical cataract. It is characterised by wedge-shaped
opacities with clear areas in between. These extend from equator towards centre
and in early stages can only be demonstrated after dilatation of the pupil. They are
first seen in the lower nasal quadrant. These opacities are present both in anterior
and posterior cortex and their apices slowly progress towards the pupil. On
oblique
illumination these present a typical radial spoke-like pattern of greyish white
opacities. On distant direct ophthalmoscopy, these opacities appear as dark lines
against the red fundal glow. Since the cuneiform cataract starts at periphery and
extends centrally, the visual disturbances are noted at a comparatively late stage.
(b) Cupuliform senile cortical cataract. Here a saucershaped opacity develops just
below the capsule usually in the central part of posterior cortex (posterior
subcapsular cataract), which gradually extends outwards. There is usually a
definite demarcation between the cataract and the surrounding clear cortex.
Cupuliform cataract lies right in the pathway of the axial rays and thus causes an
early loss of visual acuity.
3. Immature senile cataract (ISC). In this stage, opacification progresses further.
The cuneiform or cupuliform patterns can be recognised till the advanced stage of
ISC when opacification becomes more diffuse and irregular. The lens appears
greyish white but clear cortex is still present and so iris shadow is visible. In some
patients, at this stage, lens may become swollen due to continued hydration. This
condition is called intumescent cataract'. Intumescence may persist even in the
next stage of maturation. Due to swollen lens anterior chamber becomes shallow.
4. Mature senile cataract (MSC). In this stage, opacification becomes complete,
i.e., whole of the cortex is involved. Lens becomes pearly white in colour. Such a
cataract is also labelled as ripe cataract.
5. Hypermature senile cataract (HMSC). When the mature cataract is left in situ,
the stage of hypermaturity sets in. The hypermature cataract may occur in any of
the two forms:
Morgagnian hypermature cataract: In some patients, after maturity the whole
cortex liquefies and the lens is converted into a bag of milky fluid. The small
brownish nucleus settles at the bottom, altering its position with change in the
position of the head. Such a cataract is called Morgagnian cataract. Sometimes in
this stage, calcium deposits may also be seen on the lens capsule.
Sclerotic type hypermature cataract: Sometimes after the stage of maturity, the
cortex becomes disintegrated and the lens becomes shrunken due to leakage of
water. The anterior capsule is wrinkled and thickened due to proliferation of
anterior cells and a dense white capsular cataract may be formed in the pupillary
area. Due to shrinkage of lens, anterior chamber becomes deep and iris becomes
tremulous (iridodonesis).
(A) (B)
(C)
Figure 2.4. Stage of Maturation (A) Immature senile cortical cataract, (B) Mature
senile cortical cataract, (C) Morgagnian hypermature senile cataract

D.2. Maturation of nuclear senile cataract
In it, the sclerotic process renders the lens inelastic and hard, decreases its ability
to accommodate and obstructs the light rays. These changes begin centrally and
slowly spread peripherally almost up to the capsule when it becomes mature;
however, a very thin layer of clear cortex may remain unaffected. The nucleus
may become diffusely cloudy (greyish) or tinted (yellow to black) due to
deposition of pigments. In practice, the commonly observed pigmented nuclear
cataracts are either amber, brown (cataracta brunescens) or black (cataracta
nigra) and rarely reddish (cataracta rubra) in colour.

E. Clinical features
Symptoms. An opacity of the lens may be present without causing any symptoms;
and may be discovered on routine ocular examination. Common symptoms of
cataract are as follows:
1. Glare. One of the earliest visual disturbances with the cataract is glare or
intolerance of bright light; such as direct sunlight or the headlights of an
oncoming motor vehicle. The amount of glare or dazzle will vary with the
location and size of the opacity.
2. Uniocular polyopia (i.e., doubling or trebling of objects): It is also one of the
early symptoms. It occurs due to irregular refraction by the lens owing to
variable refractive index as a result of cataractous process.
3. Coloured halos. These may be perceived by some patients owing to breaking
of white light into coloured spectrum due to presence of water droplets in the
lens.
4. Black spots in front of eyes. Stationary black spots may be perceived by some
patients.
5. Image blur, distortion of images and misty vision may occur in early stages of
cataract.
6. Loss of vision. Visual deterioration due to senile cataract has some typical
features. It is painless and gradually progressive in nature. Paitents with
central opacities (e.g., cupuliform cataract) have early loss of vision. These
patients see better when pupil is dilated due to dim light in the evening (day
blindness). In patients with peripheral opacities (e.g. cuneiform cataract)
visual loss is delayed and the vision is improved in bright light when pupil is
contracted. In patients with nuclear sclerosis, distant vision deteriorates due to
progressive index myopia. Such patients may be able to read without
presbyopic glasses. This improvement in near vision is referred to as second
sight'. As opacification progresses, vision steadily diminishes, until only
perception of light and accurate projection of rays remains in stage of mature
cataract.
Signs. Following examination should be carried out to look for different signs of
cataract:
1. Visual acuity testing. Depending upon the location and maturation of cataract,
the visual acuity may range from 6/9 to just PL +.
2. Oblique illumination examination. It reveals colour of the lens in pupillary
area which varies in different types of cataracts.
3. Test for iris shadow. When an oblique beam of light is thrown on the pupil, a
crescentric shadow of pupillary margin of the iris will be formed on the
greyish opacity of the lens, as long as clear cortex is present between the
opacity and the pupillary margin. When lens is completely transparent or
completely opaque, no iris shadow is formed. Hence, presence of iris shadow
is a sign of immature cataract.
4. Distant direct ophthalmoscopic examination. A reddish yellow fundal glow is
observed in the absence of any opacity in the media. Partial cataractous lens
shows black shadow against the red glow in the area of cataract. Complete
cataractous lens does not even reveal red glow.
5. Slit-lamp examination should be performed with a fully-dilated pupil. The
examination reveals complete morphology of opacity (site, size, shape, colour
pattern and hardness of the nucleus).
Grading of nucleus hardness in a cataractous lens is important for setting the
parameters of machine in phacoemulsification technique of cataract extraction.
The hardness of the nucleus, depending upon its colour on slit-lamp examination

F. Treatment
There is no effective simple treatment including drugs or herbs. Sometimes a
new prescription for glasses can help people cope. Surgery is the only effective
cure and while it is a substantial and delicate operation it is safe and effective with
very good results in more than 95% of cases.
When a cataract is sufficiently developed to be removed by surgery, the most
effective and common treatment is to make an incision (capsulotomy) into the
capsule of the cloudy lens in order to surgically remove the lens. There are two
types of eye surgery that can be used to remove cataracts: extra-capsular
(extracapsular cataract extraction, or ECCE) and intra-capsular (intracapsular
cataract extraction, or ICCE).
Extra-capsular (ECCE) surgery consists of removing the lens but leaving the
majority of the lens capsule intact. High frequency sound waves
(phacoemulsification) are sometimes used to break up the lens before extraction.
Intra-capsular (ICCE) surgery involves removing the entire lens of the eye,
including the lens capsule, but it is rarely performed in modern practice.
In either extra-capsular surgery or intra-capsular surgery, the cataractous lens
is removed and replaced with a plastic lens (an intraocular lens implant) which
stays in the eye permanently.
Cataract operations are usually performed using a local anaesthetic and the
patient is allowed to go home the same day. Recent improvements in intraocular
technology now allow cataract patients to choose a multifocal lens to create a
visual environment in which they are less dependent on glasses. Under some
medical systems multifocal lenses cost extra. Traditional intraocular lenses are
monofocal.
Complications are possible after cataract surgery, including endophthalmitis,
posterior capsular opacification and retinal detachment. In ICCE there is the issue
of the Jack in the box phenomenon where the patient has to wear aphakic
glassesalternatives include contact lenses but these can prove to be high
maintenance, particularly in dusty areas.


















CHAPTER III
CASE

1. Patient identity
Name : Mr. K
Sex : Male
Age : 51 years old
Address : Dusun Mega Timur
Ethnic : Melayu
Job : Unemployment
Religion : Moslem
Patient was examined on May 13
rd
, 2014
2. Anamnesis
a. Main complaint : Blurry vision in right eye.
History of disease : Patient complains blurry vision in right eye since 1
year ago, and he had complain blurry vision in left eye since 7 months ago,
and become worse. Patient feels like there is some cloudy in his sight.
Sensitive to the light, see something like haloes around the light. Headache
(-), pain in the eyes (-), discharge (-), redness(-), itching (-). Traumatic
history (-).
History of medication : Patient ever had not specificly eye drops drugs for
his complains, but his complains didnt reduce.
b. Past clinical history: Patient claims that there is no history of the same
symptoms before. History of using contact lens (-), history of using
another drugs (-) {such as steroid, miotics, etc}. Hypertension history (-),
DM history (-), another disease (-).
c. Family history : There are no one of his family have the same complaint.

3. General Physical Assessment
General condition : good
Awareness : compos mentis
Vital Signs:
Heart Rate : 56x/minute
Respiration freq. : 20x/minute
Blood Pressure : 130/80 mmHg
Temperature : 36
o
C

4. Ophthalmological status
Visual acuity:
a. OD : 1/300 good proyection
b. OS : / 60

Right eye Left eye
Ortho Eye ball position Ortho
ptosis (-), lagoftalmos
(-), edema (-)
Palpebra ptosis (-), lagoftalmos (-),
edema(-)
Redness (-),injection (-
), discharge (-) ,
fibrovascular growth (-)
Conjunctiva Redness (-), injection (-),
discharge (-) ,
fibrovascular growth (-)
edema (-), defect (-),
infiltrate (-)
Cornea edema (-), defect (-),
infiltrate (-)
Clear, deep COA Clear, deep
Iris colour : brown
Pupil: circular, 3mm,
anisokor, reactive to
light
Iris and pupil Iris colour : brown
Pupil: circular, 3 mm,
anisokor, reactive to light
Totally opaque Lens Partially opaque
Cannot be described Vitreous Cannot be described
Cannot be described Fundus Cannot be described



Eye ball movement








Shadow test :
OD : Negative
OS : Positive
Tonometry
OD : Not performed
OS : Not performed
Visual field test
OD : Can not be evaluated
OS : Normal
Ishihara test
OD : Not performed
OS : Not performed
0
0
0
0
0
0
0
0
+
+
+
+
+
+
+
+
OD
OS
Fluorescein test
OD : Not performed
OS : Not performed

5. Resume
A man, 51 years old, came to ophthalmologic clinic with the complain of
blurry vision since 1 year ago, and become worse. Photopobia (+), halos
around lights (+). There is no history of hipertension, diabetes mellitus, eye
trauma, and other form of eye disorder before.
Visual acuity is 1/300 with good proyection for OD, / 60 for OS. Both of
lense seems opaque. Funduscopy cannot be described because of the lense
opacity. From clinical assessment, there is opacity on the both lense, that
cause funduscopy can not be described. Shadow test (-) in OD and shadow
test (+) in OS.

6. Diagnose
Working Diagnose:
OD : Mature Senile Cataract
OS : Immature Senile Cataract

7. Plan for examination
Slit lamp , for identification type of cataract
Full blood count, blood glucose test.

8. Treatment
Surgery -> firstly in OD
Control os, after post op

9. Prognosis
OD
Ad vitam : bonam
Ad functionam : bonam
Ad sanactionam : bonam

OS
Ad vitam : bonam
Ad functionam : bonam
Ad sanactionam : bonam


CHAPTER IV
DISCUSSION

A man, 51 years old complains that he had blurry vision since 1 year ago,
and become worse. Photopobia (+), halos around lights(+). Visual acuity is 1/300
with good proyection for OD, / 60 for OS. Palpebra, conjunctiva, cornea and
anterior chamber is inspected normally, while both of lense seems opaque. No
foreign body was found. Funduscopy cannot be described because of the lense
opacity. From clinical assessment, there is opacity on the both lense, that cause
funduscopy can not be described. shadow test (-) in OD and (+) in OS.
From the description above, it can be concluded that the diagnosis of this
patient is mature senile cataract in OD and immature senile cataract in OS. From
anamnesis, there is no risk factor that can support diagnosis of secondary cataract,
because this patient has no risk factor for it. Beside of that, based on his history,
there was no history of trauma to his eyes (even a blunt or sharp trauma) can
cause traumatic cataract and he has slowly progression of visual loss to the patient
(some traumatic cataracts usually cause acute visual lost and needs early treatment
that is included in emergency) . So, the best diagnosis of all to this patient is
degenerative cataract, that is usually senile cataract (more often occurs in old
people / more than 60 years old), with the type of mature and immature cataract.
A maturity of cataract can be understood by the clinical finding of the opacity of
the lense , while a shadow test support this diagnosis. Beside of that, a normally
observed of anterior chamber indicates this one. The kind of cataract based on its
location can not be known, because the examiner do not use slitlamp on
examining the patient.
This can be because of degeneration process that happened in lense. It can
be caused by some factor, the most common correlation is age. By the age
increasing, degeneration process will be increasing too. Patient in this case is
about 51 years old. It can be an early degeneration that can cause by some factor
(ex: increment of free radical and prolonged exposure to UV light, dietary factor)
that are expected to increase the incidence of cataracts.
These are some discussion about the clinical finding from the anamnesis to
the patient :
Blurred vision is caused by the opacity of the lense, that can cause
disrupting the refraction media and finally, it can hampered the light to
retinal
Vision slowly blurred because of the progression of opacity in the lense
(thickness of opacity infulence the degree of vision lost)
Haloes around the light These may be perceived by some patients owing
to breaking of white light into coloured spectrum due to presence of water
droplets in the lens.
AV : is 1/300 with good proyection for OD, / 60 for OS opacity of
OD is thicker than OS OD must be treated firstly
Pain in the eyes (-), cephalgia (-), normal palpable of ocular tension,
chamber of anterior is deep, normal eye appearance (redness (-), injection
(-) there is no secondary glaucoma
The plan of therapy for this patient is cataract surgery and then after that we
put intra ocular lense to change the lense that has been extracted away from the
eye ball. There is no medicamentosa therapy for cataract. The most common
therapy is extracting the lense that has been blurred in one eye (this surgery
cannot be done in the same time to both of eyes).
A cataract does not have to be removed just because it is there. It should be
removed when people cannot cope comfortably and it interferes with their life.
Age is no barrier to surgery. When a cataract is sufficiently developed to be
removed by surgery, the most common surgical is extra capsular cataract
extraction. In this technique, major portion of anterior capsule with epithelium,
nucleus and cortex are removed; leaving behind intact posterior capsule.
Presently, extracapsular cataract
extraction technique is the surgery of choice for almost all types of adulthood as
well as childhood cataracts unless contraindicated.



CHAPTER V
CONCLUSION

A male, 51 years old came to Opthalmologic clinic with main complaint is
blurry vision in right eye. From physical examination and history of patient, the
patient can be diagnosed as senile cataract. Therapy to this patient is surgical.

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