KATARAk

Dr Herwindo Dicky P, Sp M
Laboratorium/SMF Ilmu Kesehatan
Mata
FK Unibraw/RSU Dr. Saiful Anwar
Malang
ANATOMY Of EYE & LENS
Biconvex
Avascular
Transparent
Thickness: 4 mm,
diameter 9 mm
Ant : aqueous humor
Post : vitreous
Position: suspensory
ligament (zonula)
zinn
 PATHOLOGY

Advance age
Trauma
Inflammation
Metabolic disorder
Corticosteroid
Radiation
STAGES OF SENILE
CATARACT
Stadium INSIPIENT

Stadium IMMATURE

Stadium MATURE

Stadium HYPER MATURE

1. Stadium INSIPIENT

Visual acuity can be normal

Opacity starts as a line at lens edge
Wheel appearance
Central zone still
clear
May be stationer
2. Stadium IMMATURE

Lens absorbs water bulging glaucoma

VA: 5/6 - 1/60

Fundus reflex (+)
Opacity not
homogen
Iris shadow test (+)
Indication for
surgery (+)
3. Stadium MATURE

Visual acuity 1/60 - LP (+)

Homogen opacity
Fundus reflex (-)
Iris shadow test (-)
Obvious indication for surgery
4. Stadium HIPERMATURE
Degeneration of lens cortex and
capsule
Shrunken cataract : lens shrinks and thins due
to loss of water
Morgagnian Cataract : cortex softens and
liquefies nucleus sinks
RISK FACTOR
Age
Diabetes mellitus
Drugs: corticosteroid, phenothiazine,
chlorpromazine
Ultraviolet radiation
Smoking
Alkohol
DIAGNOSIS &
EXAMINATION
1. Visual disturbance:
depends on: - opacity
- location

2. Glare

3. Altered contrast sensitivity

4. Combination 2 & 3

5. Diplopia
EXAMINATION
1. Visual acuity: natural, best corrected
2. Anterior segment
3. Pupilary dilatation
4. Funduscopic evaluation :
Examine with
ophthalmoscope Black
spot over orange background (insipient
immature)
Negative (mature)
Additional test

1. Intraocular pressure
2. Keratometry and biometry
3. Retinometry
4. Ultrasonography
5. Contrast sensitivity
6. Blood pressure
7. Blood sugar
8. Hemostasis
MANAGEMEN
T
Non Surgical
1. Spectacle lens
2. Magnification / visual aids
3. Appropriate illumination

Surgical
Reduced visual funcion
Complication : Secondary
glaucoma
 Indication of Surgery

1.Visual Impairment

Responsible for the patients disability

in desired activity (driving, reading,
occupational needs)
 Visual disability increases due to glare or
dim illumination

Patient complains of monocular diplopia or

polyopia

Visual disparity exists between two eyes

2. Other indications:
Lens induced diseases : phacomorphic
glaucoma, phacolytic glaucoma

Concomitant ocular disease that

requires clear media: required to
adequately diagnose diabetic
retinopathy
 Surgical Procedure
Extra Capsuler Cataract Extraction ECCE

Nuclear Expression/Extraction

Phacoemulsification

Intra Capsuler Cataract Extraction ICCE

 EXTRA CAPSULAR

Extra capsular
Incision 8-10 mm corneo-scleral
Anterior capsulotomy
Nucleus Expressed from capsular bag
Residual cortex removed
Posterior capsule is intact
Large incision: suture >>
For all kinds of cataract
Manual Small Incisi Cataract Surgery
(MSICS)
Phacoemulsification

1.8 2.75 mm

Clear cornea

Capsulotomy: Continuous

Curvelinear Capsuloreksis

CCC

Ultrasonic

No sutures
 INTRA CAPSULAR

ICCE
Large incision
Lens & Capsule intoto
Higher risk of vitreous loss
For mature & hypermature cataract
Can not be done for congenital &
juvenile cat.
 INTRAOCULAR LENS

More Physiological

More comfortable
PMMA, Silicone, Acrylic
Inside capsular bag
VA 6/6
Pseudophakia
 IOL Anterior Chamber
IOL Posterior Chamber

}
IOL Monofocal Spheric
IOL Toric
Aspheric
IOL Multifocal / acomodatif
COMPLICATIONS
Endophthalmi Bullous keratopaty

tis Dislocated IOL

Wound leak Vitreous Lost

Iris prolapse CME

Uveitis RD

Increased IOP Choroidal

Corneal hemorrhage

edema
POST SURGICAL REHABILITATION

Patients complaint
VA
Anterior segment
Sign of inflammation
IOP
Wound healing.
Personal hygiene
Spectacle correction/reading