1.

Mekanisme terbentuknya katarak

2. Mekanisme kerusakan pada retinopati diabetikum

3. Faktor resiko katarak dan retinopati diabetikum

4. Algoritma retinopati diabetikum

5. Klasifikasi dan grading katarak
6. Fisiologi lensa mata
7. Katarak
 Etiology
o EYE INJURY
o SUN EXPOSURE
o SMOKING
o HYPERTENSION
o KIDNEY DISORDERS
o DIABETES MILLETUS
o LONG TERM USE OF STEROIDS
o TOXIC SUBSTANCES
o HEREDITARY

 Classification of cataract
a. Morphological classification
o Subcapsular cataract
- Anterior subcapsular cataract
- Posterior subcapsular cataract
o Nuclear cataract involves the nucleus of lens.
- Yellow to brown voloration
- Degenerative changes occurring as nuclear sclerosis
- Increase in water insoluble proteins,
- compaction of nucleus resulting in a hard cataract.
- Disturbance of lamellar arrangement in fibres
o Cortical cataract
- wedge shaped or radial spoke-like opacities.
- Denaturation and coagulation of lens proteins.
- Decrease level of aminoacids and protein systhesis
- Increased hydration brought by decrease in potassium due to reversal of Na/K
pump mechanism.
o Polar cataract
b. Classification according to maturity

o An immature cataract
o A mature cataract
o A hypermature cataract
o A morgagnian cataract
c. Etiological classification
o Congenital and developmental cataract
 Congenital cataract develops from some disturbance to normal development of
lens .
- The disturbance occurs before the birth
- The opacity may limit to embryonic or foetal nucleus.
 Developmental cataract occurs from infancy to adolescence.
- The opacity involves infantile or adult nucleus.
 3 children out of 10,000 live births.
- Two third of the cases are bilateral.
o Acquired cataract
 Senile cataract
- Common and bilateral above the age of 50 years.
- Male: Female::1:1
- Etiology
 Hereditary : Incidence, age of onset and maturation
 Ultravoilet radiation : More exposure to UV-rays = early maturation.
 Dietary factors : Poor diatery factors eg, lack of certain aminoacids,
Vitamines (Vitamin E, Vitamin C, riboflavin) and essential minerals.
 Dehydrational crisis : Prior episode of severe dehydration due to diarrhea
and cholera.

 Traumatic cataract
 Complicated (secondary) cataract . eg, uveitis, pathological myopia,
glaucoma, retinal detachment, retinitis pigmentosa etc,
 Metabolic cataract . Eg, Diabetes, hypocalcaemia, Wilson’s disease, Lowe’s
syndrome
 Electric cataract
 Radiational cataract
 Drug induced cataract eg, corticosteroid, copper, iron, Chlorpromazine,
Busulphan, Allopurinol, Amiodarone, etc,
 Cataract associated with skin diseases . Eg, atopic dermatitis, scleroderma,
etc,
 Cataract with miscellaneous syndromes . Eg, Dystrophica myotonica,
Down’s syndrome etc,
d. Age of onset classification
1.CONGENITAL
 2.INFANTILE

3.JUVINILE
4.PRE-SENILE
5.SENILE
 Signs and Symptoms
o Signs :
 Opacification of the normally clear lens seen through the pupil
 Indistinct on retina examination
 Red reflex may be dim
 No afferent pupillary defect
 Myopic shift
o Symptoms :
 Blurred vision
 Painless progressive visual loss
 Glare

 Reduced color perception

 Color haloes
 Uniocular diplopia
 Based on the location and density
  Grading
GRADE 0: CLEAR LENS
GRADE 1: SWOLLEN FIBRES AND SUB CAPSULAR OPACITIES
GRADE 2: NUCLEAR CATARACT AND VISIBLE LENS FIBRES
GRADE 3: STRONG NUCLEAR CATARACT WITH PERINUCLEAR AREA OPACITY
GRADE 4: TOTAL OPACITY

8. Indikasi dilakukan operasi katarak

9. Teknik operasi pada katarak