Disease of the lens课件讲义整理

DiseaseofthelensEYENo.11广西医科大学第一临床医学院眼科DiseaseofthelensEYENo.11广西AnatomyandPhysiologyofthelensPosition:Thelensconnectedwiththeciliarybodybythesuspensoryligamentthatfixesitbehindtheiris,infrontofthevitreous.EYENo.22广西医科大学第一临床医学院眼科AnatomyandPhysiologyoftheAnatomy:Thelensiscomposedoflenscapsuleandlensfiber.Thelenscapsuleisalayerofelastichomogeneousmembrane.Thelensfibersaretheextensionandelongationforwardsandbackwardsoftheepithelialcellsattheequator.3广西医科大学第一临床医学院眼科Anatomy:ThelensiscomposedItisapproximately9mmindiameterand4-5mminthethickness.Butweonlyuse2.5-4mminthecenter(becausetheiriskeepsouttherestlensandonlycanviewsthecenterportionthroughthepupil.)4广西医科大学第一临床医学院眼科Itisapproximately9mmindiPhysiologyofthelensThelensisskindoftransparentandnon-bloodvesseltissue.Itisanimportantpartofrefractivemediaoftheglobe.Thelens’nourishmentareofferedbyaqueoushumor.5广西医科大学第一临床医学院眼科Physiologyofthelens5广西医科大学第Thedisorderofthelenscommonlyiflossofitstransparency(cataract)andabnormalityofitsposition;bothcaninduceseverevisualdisturbance.6广西医科大学第一临床医学院眼科ThedisorderofthelenscommoCataractCataractisthefirstcauseofblindnessinChinaandothermanydevelopingcountry.Thereareonemillionofcataractsuffererwhoareinneedofoperationtorestoretheirvisions.EYENo.47广西医科大学第一临床医学院眼科CataractCataractisthefirstClassificationAccordingtotheageofoccurring:CongenitalcataractInfantilecataractJuvenilecataractAdultcataractAge-relatedcataract(senile)EYENo.58广西医科大学第一临床医学院眼科ClassificationAccordingtotheAccordingtoetiology:Traumaticcataract:bluntorpenetratinginjuryComplicatedcataract:uveitisMetaboliccataract:diabetesDrug-inducedortoxiccataractDevelopingcataractAfter-cataract9广西医科大学第一临床医学院眼科Accordingtoetiology:9广西医科大学第age-relatedcataractItisthemostcommoncataract,oftenseenintheoldswithagemorethan50yearsold.Theincidenceofthediseaseis100%whenthepatientexceed80yearsold.EYENo.610广西医科大学第一临床医学院眼科age-relatedcataractItisthePathologicmechanismThediseaseisrelatedwithseveralfactor:UltravioletrayGeneticfactorSystemicdiseasesuchasdiabetes,hypertension.Lensnourishmentandmetaboliccondition11广西医科大学第一临床医学院眼科PathologicmechanismThediseasClinicalfindings:BilateraldiseaseFixedblackspotbeforetheeyesVisualdecreasewithoutpainRefractivechangeEYENo.712广西医科大学第一临床医学院眼科Clinicalfindings:EYENo.712广西classification

Accordingtothesitewherecataractbeginstoform:corticalAnteriorcapsulePosteriorcapsulesubcapsularAge-relatedcataractEYENo.8nuclear13广西医科大学第一临床医学院眼科classification

Accordingtothcorticalcataract

Itisdividedinto4stages:Incipientstage:

TobeginopacityappearsattheperipheryofanteriorandposteriorcortexThecenterlensisalmostclear,thepupillaryareaisn’taffected,commonlywithoutinfluencingvision.Tobediagnoseaftermydriasisunderslit-lampexamination.TodevelopslowlyEYENo.914广西医科大学第一临床医学院眼科corticalcataract

ItisdivideEYENo.10Immaturestage(intumescentstage)TheopacitygraduallybecomesobviousThecortexabsorbswatertobecomeswollenIrisprojection:thecharacteristicofthisstageVisionhasobviouslydecreasedThefunduscan’tbeobservedinSomepatientmayinduceacuteattackofglaucomaduetoshallowanteriorchamber15广西医科大学第一临床医学院眼科EYENo.10Immaturestage(intumeIrisprojection:Toexaminewithobliqueillumination,theirisshadowonprojectedsidefallsonopaquecortexindeeplayer,acrescentprojectionappearsatthepupiloftheside.(becausethereistransparentcortexbetweenirispupillarymarginandlenscortex)16广西医科大学第一临床医学院眼科Irisprojection:16广西医科大学第一临床医学MaturestageThelenshasbecomeopaqueatallincreamwhitecolorTheirisprojectiondisappearedThefunduscan’tbelookedinVisiondecreasestolightperceptionorhandmovementButthelightseekingandcolorsensationareinnormal.17广西医科大学第一临床医学院眼科Maturestage17广西医科大学第一临床医学院眼科HypermaturestageWhenthematurestagecontinuesforoverlongtime,thewaterinthelenshasbeenlostcontinuously,thevolumeofthelensdiminishes,thecapsuleshrinks,theanteriorchamberdeepenswithiridodonesis.Visionmayincreasesuddenly18广西医科大学第一临床医学院眼科Hypermaturestage18广西医科大学第一临床医Morgagniancataract:thelensfibersaredecomposedanddissolvedincream-whiteliquefaction,brown-yellowhardnucleussinksdown,theanteriorchamberinupperpartbecomedeep.19广西医科大学第一临床医学院眼科Morgagniancataract:thelensWhenthelenscapsulerupturedPhaco-anaphylacticuveitisPhacolyticglaucoma:thelenscortexblockedtheanteriorchamberangle,orthelensnucleusdislocatesintotheanteriorchamberorintovitreousbody.20广西医科大学第一临床医学院眼科WhenthelenscapsulerupturednuclearcataractItgenerallybeginsattheageof40ItslowlyprogressOpacitystartsattheembryonicoradultnucleusEYENo.13Thedensityofthelensnucleushasbeenincreased,therefractiveindexobviouslystrengthens,somyopiaoftenappears.21广西医科大学第一临床医学院眼科nuclearcataractItgenerallybNuclearopacityisgrayish-yellowatfirst,thengraduallybecomesthickinyellowish-graybrownorbrownish-black.Inthattime,thefunduscan’tbeseen.Thenuclearchangesoftencontinueunchangedforalongperiod(20~30years),uneasytobematured.22广西医科大学第一临床医学院眼科Nuclearopacityisgrayish-yelSubcapsularcataractAccordingtothesitewherecataractbeginstoformPosteriorcapsularcataract:commonAnteriorcapsularcataract:rare23广西医科大学第一临床医学院眼科SubcapsularcataractAccordingTheopacityoftenoccurtotheposteriorcapsularcenter,sovisiondecreasesinearlystage.Thecataractmaydeveloptobecomecorticalopaquethentotalcataract.24广西医科大学第一临床医学院眼科TheopacityoftenoccurtotheTreatmentThereisn’tanyeffectivedrugtothesenilecataract.Itismajortooperation.25广西医科大学第一临床医学院眼科TreatmentThereisn’tanyeffecOperativetimeAttheimmatureormaturestageThevisionislowerthan0.3toinfluencewithpatient’sworkandlife26广西医科大学第一临床医学院眼科OperativetimeAttheimmaturePreoperativeexaminationSystemicOcularpart:ExamvisualacuitySlit-lampmicroscopeCornealcurvatureA/Bultrasonicexam27广西医科大学第一临床医学院眼科PreoperativeexaminationSystemOperatingmethodPhacoemulsificationextractionofcataractCharacteristic:transparentcornealincision(3.2mm)TocrushthehardlensnucleustobechyloidwithultraemulsifierandextractedToimplantthefoldableintraocularlensinthelenscapsularbag28广西医科大学第一临床医学院眼科OperatingmethodPhacoemulsificstrongpoint:Self-healingwoundThecornealastigmatismafteroperationisfineVisualrestorationissoonShortcoming:TheapparatusisexpensiveSomedescendiblediseasecan’tchoicethismethodToohardlensnucleusmaynotadoptthismethod29广西医科大学第一临床医学院眼科strongpoint:29广西医科大学第一临床医学院眼科ExtracapsularcataractextractionandposteriorchamberintraocularlensimplantationThecorneoscleraltunnelincision(6mm)dispensewithsutureThelensishard(unfoldable)ThepatientcangetgoodvisionsoonafteroperationThecornealastigmatismafteroperationisless.30广西医科大学第一临床医学院眼科ExtracapsularcataractextractIntracapsularcataractextractionTheincisionisbiggerthanECCE,sothecornealastigmatismishigh.ThecomplicationsaremorethanthatofECCE31广西医科大学第一临床医学院眼科IntracapsularcataractextractVisualcorrectionfatercataractoperationAftercataractsurgery,theaphakiaisinastateofhighhyperopia(+10~+12diopters)Byintraocularlens:itisthemosteffectivemethodforcorrectionofaphakiaBycontactlens:themethodislessusedbecauseofmorecomplicationsandusingprocessmoretroubleByglasses:binocularaphakiapatient32广西医科大学第一临床医学院眼科VisualcorrectionfatercataracongnitalcataractDefinition:

congenitalcataractisaresultoflensgrowinganddevelopingdisturbanceintheprocessoffetaldevelopment.Causes:Endogenous:chromosomewithheredity.Exogenous:bymother’sorfetalsystemicdisorder.EYENo.2633广西医科大学第一临床医学院眼科congnitalcataractDefinition:ClinicalfindingsItcommonlyisbilateral,static.Afewdevelopcontinuouslyafterbirth.Itmaybeclassifiedaccordingtothesiteandtheshapeoflensopacity.AnteriorpolarcataractPosteriorcataractPerinuclearcataractNuclearcataractTotalcataract,andsoon34广西医科大学第一临床医学院眼科ClinicalfindingsItcommonlyitreatmentWhetherornotaffectwiththevisionnotObservedaffectSurgeryintimeEYENo.3135广西医科大学第一临床医学院眼科treatmentWhetherornotaffecOpportunityofoperation:theearliertheoperationisdone,thegreaterthechancetogetgoodvisionbecomes.Thesurgerymaybedonesomeweeksafterbirth.Itshouldbedonegenerallyinbabywithageof3~6months.ButtheIOLimplantationmustdoafter3yearsold.EYENo.3236广西医科大学第一临床医学院眼科Opportunityofoperation:theTreatmentpurpose:ReservevisionPreventamblyopiaPromotedevelopmentoffusionfunctionSurgerymethodExtracapsularcataractextractionCataractsuctionIOLimplantationafterthesuction’spatientis3yearsold37广西医科大学第一临床医学院眼科Treatmentpurpose:37广西医科大学第一临床Thecorrection:Byglasses:suitabletobinocularaphakiawithelderage.Itissimpleandconvenient,easytoadjustandreplace.Bycontactlens：suitablemonocularaphakiainchildren.Butitistroublesometotakeoff,andsoon.ByIOL:After3years,thepatientcandotheimplantationtoobtainbettervision.Amblyopiashouldbetreatedactivelyandtimely.38广西医科大学第一临床医学院眼科Thecorrection:38广西医科大学第一临床医学院TraumaticcataractEYENo.33Drug-inducedcataractToxiccataract39广西医科大学第一临床医学院眼科TraumaticcataractEYENo.33DruEctopialentislens’positionalabnormalityhastwocauses:RuptureofsuspensoryligamentinducedbyinjuryCongenitalaplasiaorweaknessandlaxationoftheligament40广西医科大学第一临床医学院眼科Ectopialentislens’positionalSubluxationofthelensisoftenoccursinMarfan’ssyndromepatient41广西医科大学第一临床医学院眼科SubluxationofthelensisoftTreatmentThelensisextractedwhenthevisionisaffectedorthecomplicationsoccurred.42广西医科大学第一临床医学院眼科TreatmentThelensisextractedPreventionandtreatmentofblindnessBlindnessalsoindicatesthatbotheyeslosetheabilitytodistinguishsurroundings,thepatientisn’tabletobecompetentatsomeoccupations,eventotakecareofhimself.EYENo.4343广西医科大学第一临床医学院眼科PreventionandtreatmentofblBlindness:thebestcorrectedvisualacuityofbettereyeislowerthan0.05,orthevisualfieldislessthan10degreeswhilethebestcorrectedvisionofbettereyeismorethan0.05.Thelowvision:thebestcorrectedvisionofbettereyeismorethan0.05,butlowerthan0.3.44广西医科大学第一临床医学院眼科Blindness:thebestcorrectedTable:criterionofclassificationoflowvisionandblindness(WHO,1973)EYENo.4445广西医科大学第一临床医学院眼科Table:criterionofclassificatseveralmajorophthalmopathiescausingblindnessCataract:thefirstcauseKeratopathyGlaucomaTrachomaEyeinjuryandoccupationophthalmopathyGeneticophthalmopathyDiabeticretinopathyEYENo.4546广西医科大学第一临床医学院眼科severalmajorophthalmopathiesDiseaseofthelensEYENo.147广西医科大学第一临床医学院眼科DiseaseofthelensEYENo.11广西AnatomyandPhysiologyofthelensPosition:Thelensconnectedwiththeciliarybodybythesuspensoryligamentthatfixesitbehindtheiris,infrontofthevitreous.EYENo.248广西医科大学第一临床医学院眼科AnatomyandPhysiologyoftheAnatomy:Thelensiscomposedoflenscapsuleandlensfiber.Thelenscapsuleisalayerofelastichomogeneousmembrane.Thelensfibersaretheextensionandelongationforwardsandbackwardsoftheepithelialcellsattheequator.49广西医科大学第一临床医学院眼科Anatomy:ThelensiscomposedItisapproximately9mmindiameterand4-5mminthethickness.Butweonlyuse2.5-4mminthecenter(becausetheiriskeepsouttherestlensandonlycanviewsthecenterportionthroughthepupil.)50广西医科大学第一临床医学院眼科Itisapproximately9mmindiPhysiologyofthelensThelensisskindoftransparentandnon-bloodvesseltissue.Itisanimportantpartofrefractivemediaoftheglobe.Thelens’nourishmentareofferedbyaqueoushumor.51广西医科大学第一临床医学院眼科Physiologyofthelens5广西医科大学第Thedisorderofthelenscommonlyiflossofitstransparency(cataract)andabnormalityofitsposition;bothcaninduceseverevisualdisturbance.52广西医科大学第一临床医学院眼科ThedisorderofthelenscommoCataractCataractisthefirstcauseofblindnessinChinaandothermanydevelopingcountry.Thereareonemillionofcataractsuffererwhoareinneedofoperationtorestoretheirvisions.EYENo.453广西医科大学第一临床医学院眼科CataractCataractisthefirstClassificationAccordingtotheageofoccurring:CongenitalcataractInfantilecataractJuvenilecataractAdultcataractAge-relatedcataract(senile)EYENo.554广西医科大学第一临床医学院眼科ClassificationAccordingtotheAccordingtoetiology:Traumaticcataract:bluntorpenetratinginjuryComplicatedcataract:uveitisMetaboliccataract:diabetesDrug-inducedortoxiccataractDevelopingcataractAfter-cataract55广西医科大学第一临床医学院眼科Accordingtoetiology:9广西医科大学第age-relatedcataractItisthemostcommoncataract,oftenseenintheoldswithagemorethan50yearsold.Theincidenceofthediseaseis100%whenthepatientexceed80yearsold.EYENo.656广西医科大学第一临床医学院眼科age-relatedcataractItisthePathologicmechanismThediseaseisrelatedwithseveralfactor:UltravioletrayGeneticfactorSystemicdiseasesuchasdiabetes,hypertension.Lensnourishmentandmetaboliccondition57广西医科大学第一临床医学院眼科PathologicmechanismThediseasClinicalfindings:BilateraldiseaseFixedblackspotbeforetheeyesVisualdecreasewithoutpainRefractivechangeEYENo.758广西医科大学第一临床医学院眼科Clinicalfindings:EYENo.712广西classification

Accordingtothesitewherecataractbeginstoform:corticalAnteriorcapsulePosteriorcapsulesubcapsularAge-relatedcataractEYENo.8nuclear59广西医科大学第一临床医学院眼科classification

Accordingtothcorticalcataract

Itisdividedinto4stages:Incipientstage:

TobeginopacityappearsattheperipheryofanteriorandposteriorcortexThecenterlensisalmostclear,thepupillaryareaisn’taffected,commonlywithoutinfluencingvision.Tobediagnoseaftermydriasisunderslit-lampexamination.TodevelopslowlyEYENo.960广西医科大学第一临床医学院眼科corticalcataract

ItisdivideEYENo.10Immaturestage(intumescentstage)TheopacitygraduallybecomesobviousThecortexabsorbswatertobecomeswollenIrisprojection:thecharacteristicofthisstageVisionhasobviouslydecreasedThefunduscan’tbeobservedinSomepatientmayinduceacuteattackofglaucomaduetoshallowanteriorchamber61广西医科大学第一临床医学院眼科EYENo.10Immaturestage(intumeIrisprojection:Toexaminewithobliqueillumination,theirisshadowonprojectedsidefallsonopaquecortexindeeplayer,acrescentprojectionappearsatthepupiloftheside.(becausethereistransparentcortexbetweenirispupillarymarginandlenscortex)62广西医科大学第一临床医学院眼科Irisprojection:16广西医科大学第一临床医学MaturestageThelenshasbecomeopaqueatallincreamwhitecolorTheirisprojectiondisappearedThefunduscan’tbelookedinVisiondecreasestolightperceptionorhandmovementButthelightseekingandcolorsensationareinnormal.63广西医科大学第一临床医学院眼科Maturestage17广西医科大学第一临床医学院眼科HypermaturestageWhenthematurestagecontinuesforoverlongtime,thewaterinthelenshasbeenlostcontinuously,thevolumeofthelensdiminishes,thecapsuleshrinks,theanteriorchamberdeepenswithiridodonesis.Visionmayincreasesuddenly64广西医科大学第一临床医学院眼科Hypermaturestage18广西医科大学第一临床医Morgagniancataract:thelensfibersaredecomposedanddissolvedincream-whiteliquefaction,brown-yellowhardnucleussinksdown,theanteriorchamberinupperpartbecomedeep.65广西医科大学第一临床医学院眼科Morgagniancataract:thelensWhenthelenscapsulerupturedPhaco-anaphylacticuveitisPhacolyticglaucoma:thelenscortexblockedtheanteriorchamberangle,orthelensnucleusdislocatesintotheanteriorchamberorintovitreousbody.66广西医科大学第一临床医学院眼科WhenthelenscapsulerupturednuclearcataractItgenerallybeginsattheageof40ItslowlyprogressOpacitystartsattheembryonicoradultnucleusEYENo.13Thedensityofthelensnucleushasbeenincreased,therefractiveindexobviouslystrengthens,somyopiaoftenappears.67广西医科大学第一临床医学院眼科nuclearcataractItgenerallybNuclearopacityisgrayish-yellowatfirst,thengraduallybecomesthickinyellowish-graybrownorbrownish-black.Inthattime,thefunduscan’tbeseen.Thenuclearchangesoftencontinueunchangedforalongperiod(20~30years),uneasytobematured.68广西医科大学第一临床医学院眼科Nuclearopacityisgrayish-yelSubcapsularcataractAccordingtothesitewherecataractbeginstoformPosteriorcapsularcataract:commonAnteriorcapsularcataract:rare69广西医科大学第一临床医学院眼科SubcapsularcataractAccordingTheopacityoftenoccurtotheposteriorcapsularcenter,sovisiondecreasesinearlystage.Thecataractmaydeveloptobecomecorticalopaquethentotalcataract.70广西医科大学第一临床医学院眼科TheopacityoftenoccurtotheTreatmentThereisn’tanyeffectivedrugtothesenilecataract.Itismajortooperation.71广西医科大学第一临床医学院眼科TreatmentThereisn’tanyeffecOperativetimeAttheimmatureormaturestageThevisionislowerthan0.3toinfluencewithpatient’sworkandlife72广西医科大学第一临床医学院眼科OperativetimeAttheimmaturePreoperativeexaminationSystemicOcularpart:ExamvisualacuitySlit-lampmicroscopeCornealcurvatureA/Bultrasonicexam73广西医科大学第一临床医学院眼科PreoperativeexaminationSystemOperatingmethodPhacoemulsificationextractionofcataractCharacteristic:transparentcornealincision(3.2mm)TocrushthehardlensnucleustobechyloidwithultraemulsifierandextractedToimplantthefoldableintraocularlensinthelenscapsularbag74广西医科大学第一临床医学院眼科OperatingmethodPhacoemulsificstrongpoint:Self-healingwoundThecornealastigmatismafteroperationisfineVisualrestorationissoonShortcoming:TheapparatusisexpensiveSomedescendiblediseasecan’tchoicethismethodToohardlensnucleusmaynotadoptthismethod75广西医科大学第一临床医学院眼科strongpoint:29广西医科大学第一临床医学院眼科ExtracapsularcataractextractionandposteriorchamberintraocularlensimplantationThecorneoscleraltunnelincision(6mm)dispensewithsutureThelensishard(unfoldable)ThepatientcangetgoodvisionsoonafteroperationThecornealastigmatismafteroperationisless.76广西医科大学第一临床医学院眼科ExtracapsularcataractextractIntracapsularcataractextractionTheincisionisbiggerthanECCE,sothecornealastigmatismishigh.ThecomplicationsaremorethanthatofECCE77广西医科大学第一临床医学院眼科IntracapsularcataractextractVisualcorrectionfatercataractoperationAftercataractsurgery,theaphakiaisinastateofhighhyperopia(+10~+12diopters)Byintraocularlens:itisthemosteffectivemethodforcorrectionofaphakiaBycontactlens:themethodislessusedbecauseofmorecomplicationsandusingprocessmoretroubleByglasses:binocularaphakiapatient78广西医科大学第一临床医学院眼科VisualcorrectionfatercataracongnitalcataractDefinition:

congenitalcataractisaresultoflensgrowinganddevelopingdisturbanceintheprocessoffetaldevelopment.Causes:Endogenous:chromosomewithheredity.Exogenous:bymother’sorfetalsystemicdisorder.EYENo.2679广西医科大学第一临床医学院眼科congnitalcataractDefinition:ClinicalfindingsItcommonlyisbilateral,static.Afewdevelopcontinuouslyafterbirth.Itmaybeclassifiedaccordingtothesiteandtheshapeoflensopacity.AnteriorpolarcataractPosteriorcataractPerinuclearcataractNuclearcataractTotalcataract,andsoon80广西医科大学第一临床医学院眼科ClinicalfindingsItcommonlyitreatmentWhetherornotaffectwiththevisionnotObservedaffectSurgeryintimeEYENo.3181广西医科大学第一临床医学院眼科treatmentWhetherornotaffecOpportunityofoperation:theearliertheoperationisdone,thegreaterthechancetogetgoodvisionbecomes.Thesurgerymaybedonesomeweeksafterbirth.Itshouldbedonegenerallyinbabywithageof3~6months.ButtheIOLimplantationmustdoafter3yearsold.EYENo.3282广西医科大学第一临床医学院眼科Opportunityofop