ACQUIRED CATARACT

Refractive error

Cataract

Glaucoma

Uveitis

Macular degeneration

Diabetic and hypertensive retinopathy, retinitis pigmentosa

Keratitis keratoconus corneal dystrophies

Phacomophic glaucoma

Phacoanaphylactic uveitis

Phacolytic glaucoma

Ectopia lentis in hypermature cataract due to week zonules

Ocular assessment

Type of cataract

Visual acuity

Pupillary reaction

Intraocular pressure

Regurgitation test

Lid abnormalities as blephritis

Cornea clarity

AC reaction

Iris Neovessels, posterior synechia

Vitreous clarity

Fundus pathology as diabetic retinopathy

Cover tests

Current refractive status. It is critical to obtain details of the patient’s preoperative refractive error in order to guide intraocular lens (IOL) implant selection. The keratometry readings should be noted in relation to the refraction, particularly if it is planned to address astigmatism by means of targeted wound placement, a toric IOL or a specific adjunctive procedure. It is particularly important to obtain a postoperative refractive result from an eye previously operated upon so that any ‘refractive surprise’, even if minor, can be considered.

Systemic examination

Diabetes hypertension ischemic heart disease asthma hepatitis screening

If fundus cannot be seen then do following tests

I. Projection of light—This test is of utmost importance. The test is done in a dark room with

one eye covered. Patient is asked to look straight ahead. Light is thrown from various directions

and the patient points the correct direction.

II. Macular function test

i. Two point discrimination test—Patient looks through an opaque disc perforated in the

centre with two pinholes close together. If the central area of retina is good, the patient

appreciates the two lights.

ii. Maddox rod test—Patient looks at a distant light through the Maddox rod. The macular

function is good if the red line is straight and unbroken.

iii. Entoptic view of the retina—The eyes are closed and globe is firmly massaged through

the lower lid with a bare lighted bulb of a torch. The patient sees the vascular tree of the

retina on an orange background. Any blanks or scotomas are noted.

iv. Foveal electroretinogram (ERG)—It indicates the condition of fovea and macula.

v. Ultrasonic investigation by B-scan—Retinal detachment and vitreous pathology may be detected.

vi. Photo stress test—The eye is exposed to bright light for 15 seconds and recovery time

is noted. In macular disease, recovery time is prolonged.

Visual improvement: when patient  cannot do his daily tasks.

Medical causes: phacolytic or phacomorphic glaucoma, to get good view of fundus to treat conditions such as diabetic retinopathy

Treatment of senile cataract

Phacoemulsification

Extracapsular cataract extraction

Intracapsular cataract extraction

Phacoemulsification

Extracapsular cataract extraction

Intracapsular cataract extraction