LENS & CATARACT
Sources
• Kanski’s Clinical Ophthalmology 9th edition
• Basic Ophthalmology by Renu Jogi 4th ed.
• Clinical Ophthalmology by Shafi [Link] 5th edition
Sequence of Lecture
• Learning Objectives
• Vertical Integration
• Core Subject
• End of Lecture Assessment
• Digital Library References
(Research, Bioethics, Artificial intelligence)
Learning Objectives
At the end of this interactive session, the students would be able to
• Define ectopia lentis
• classify Ectopia Lentis
• Devise Management of ectopia lentis
Core subject
Ectopia lentis
• Hereditary or acquired displacement of the lens from its normal
position
• Completely displaced (dislocation)
• Incompletely displaced (subluxation)
Core subject
Etiological classification
Core subject
Congenital ectopia lentis
Core subject
Metabolic causes
• Marfan’s syndrome
• Homocystinuria
• Weill-Marchesani syndrome
Core subject
Metabolic causes
• Marfan’s syndrome
• Homocystinuria
• Weill-Marchesani syndrome
Core subject
Metabolic causes
• Marfan’s syndrome
• Homocystinuria
• Weill-Marchesani syndrome
Management
• Symptoms:
• blurred vision, diplopia,
• Pain, photophobia,
• Signs:
• Treatment :
• Glasses
• Medical: IOP control
• Surgical: lensectomy
Core subject
Congenital cataract
• A congenital opacity of the crystalline lens.
• ASSOCIATIONS:
• Metabolic disorders
• Galactossemia
• Lowe syndrome
• Fabry disease
• Mannosidosis
• Intrauterine infections (TORCH infections)
• Syndromes
• Down syndrome
• Edward syndrome
Core subject
Morphology
Blue dot Lamellar Oil droplet
Posterior polar Sutural
Core subject
Management
• Complete History (including antenatal, natal and post-natal history)
• Ocular and systemic examination
• Investigations
• Ocular
• Systemic
• Treatment
• Bilateral dense cataract… early surgery (4 to 10 wks)
• Bilateral partial cataract… surgery may be deferred
• Unilateral dense cataract… urgent surgery
• Partial unilateral cataract … may be observed
End of Lecture Assessment
1. A 2-month-old male infant is brought by his parents who noticed a white reflex in his right eye in
photographs. On examination, the red reflex is absent in the right eye, and there is a central lens
opacity. There are no systemic abnormalities.
• What is the most appropriate next step in the management of this patient?
• A. Prescribe corrective spectacles and observe
B. Reassure the parents and review in 6 months
C. Arrange for urgent surgical removal of the cataract
D. Start topical steroids and mydriatics
E. Order a CT scan of the brain
Correct Answer: C. Arrange for urgent surgical removal of the cataract
Rationale: Congenital cataract causing visual axis obstruction requires
urgent surgical intervention, ideally before 6–8 weeks of age to prevent
deprivation amblyopia.
2. A 10-year-old boy presents with gradually decreasing vision in both eyes. On slit-lamp
examination, the lenses are displaced superior-temporally in both eyes. His arm span exceeds his
height, and he has a high-arched palate.
Which of the following is the most likely underlying diagnosis?
A. Homocystinuria
B. Marfan syndrome
C. Weill-Marchesani syndrome
D. Sulfite oxidase deficiency
E. Trauma
Correct Answer: B. Marfan syndrome
Rationale: Bilateral superotemporal lens subluxation in a tall child with long limbs and a high-arched
palate is characteristic of Marfan syndrome, a connective tissue disorder.
Spiral Integration
Research article
Diabetes and Phacoemulsification Cataract Surgery: Difficulties, Risks and Potential
Complications
J. Clin. Med. 2019, 8(5), 716; [Link]
Conclusion
• Cataract surgery in a diabetic patient is associated with several difficulties .
• Diabetic patients present lower endothelial cell density and their endothelium is more
susceptible to trauma associated with surgery.
• A small pupil is common in diabetic patients making surgery technically challenging.
• Finally diabetic patients have an increased risk for developing postoperative
pseudophakic cystoid macular edema, posterior capsule opacification, or
endophthalmitis.
• In patients with severe non-proliferative, proliferative diabetic retinopathy, diabetic
macular edema or iris neovascularization adjunctive therapy such as an intravitreal anti-
VEGF injection, may inhibit exacerbation related to cataract surgery.
Spiral Integration
Bioethics
• Should the patients be informed that a trainee ophthalmologist would be performing the
surgery?
• Who is responsible (trainee or the supervising surgeon) for the complications, if any?
• Wet lab training for the trainees
• thorough preoperative workup
• patient selection
• dequate supervision during surgery is essential
• During the training, the mentors should teach the residents as to how to handle the ethical
issues and the concept that the truth-telling is an integral part of our professional duty
Reference
[Link]
he_eye__bioethics_in.[Link]
