广西医科大学第一临床医学院眼科.ppt

1、1,Disease of the lens,EYE No.1,2,Anatomy and Physiology of the lens,Position: The lens connected with the ciliary body by the suspensory ligament that fixes it behind the iris, in front of the vitreous.,EYE No.2,3,Anatomy: The lens is composed of lens capsule and lens fiber. The lens capsule is a la

2、yer of elastic homogeneous membrane. The lens fibers are the extension and elongation forwards and backwards of the epithelial cells at the equator.,4,It is approximately 9mm in diameter and 4-5mm in the thickness. But we only use 2.5-4mm in the center (because the iris keeps out the rest lens and o

3、nly can views the center portion through the pupil.),5,Physiology of the lens The lens is s kind of transparent and non-blood vessel tissue. It is an important part of refractive media of the globe. The lens nourishment are offered by aqueous humor.,6,The disorder of the lens commonly if loss of its

4、 transparency (cataract ) and abnormality of its position; both can induce severe visual disturbance.,7,Cataract,Cataract is the first cause of blindness in China and other many developing country. There are one million of cataract sufferer who are in need of operation to restore their visions.,EYE

5、No.4,8,Classification,According to the age of occurring: Congenital cataract Infantile cataract Juvenile cataract Adult cataract Age-related cataract (senile),EYE No.5,9,According to etiology: Traumatic cataract : blunt or penetrating injury Complicated cataract: uveitis Metabolic cataract: diabetes

6、 Drug-induced or toxic cataract Developing cataract After-cataract,10,age-related cataract,It is the most common cataract, often seen in the olds with age more than 50 years old. The incidence of the disease is 100% when the patient exceed 80 years old.,EYE No.6,11,Pathologic mechanism,The disease i

7、s related with several factor: Ultraviolet ray Genetic factor Systemic disease such as diabetes, hypertension. Lens nourishment and metabolic condition,12,Clinical findings: Bilateral disease Fixed black spot before the eyes Visual decrease without pain Refractive change,EYE No.7,13,classification A

8、ccording to the site where cataract begins to form:,cortical,Anterior capsule,Posterior capsule,subcapsular,Age-related cataract,EYE No.8,nuclear,14,cortical cataract It is divided into 4 stages:,Incipient stage: To begin opacity appears at the periphery of anterior and posterior cortex The center l

9、ens is almost clear, the pupillary area isnt affected, commonly without influencing vision. To be diagnose after mydriasis under slit-lamp examination. To develop slowly,EYE No.9,15,EYE No.10,Immature stage(intumescent stage) The opacity gradually becomes obvious The cortex absorbs water to become s

10、wollen Iris projection: the characteristic of this stage Vision has obviously decreased The fundus cant be observed in Some patient may induce acute attack of glaucoma due to shallow anterior chamber,16,Iris projection: To examine with oblique illumination, the iris shadow on projected side falls on

11、 opaque cortex in deep layer, a crescent projection appears at the pupil of the side.( because there is transparent cortex between iris pupillary margin and lens cortex),17,Mature stage The lens has become opaque at all in cream white color The iris projection disappeared The fundus cant be looked i

12、n Vision decreases to light perception or hand movement But the light seeking and color sensation are in normal.,18,Hypermature stage When the mature stage continues for over long time,the water in the lens has been lost continuously, the volume of the lens diminishes, the capsule shrinks,the anteri

13、or chamber deepens with iridodonesis. Vision may increase suddenly,19,Morgagnian cataract: the lens fibers are decomposed and dissolved in cream-white liquefaction, brown-yellow hard nucleus sinks down, the anterior chamber in upper part become deep.,20,When the lens capsule ruptured Phaco-anaphylac

14、tic uveitis Phacolytic glaucoma:the lens cortex blocked the anterior chamber angle, or the lens nucleus dislocates into the anterior chamber or into vitreous body.,21,nuclear cataract,It generally begins at the age of 40 It slowly progress Opacity starts at the embryonic or adult nucleus,EYE No.13,T

15、he density of the lens nucleus has been increased, the refractive index obviously strengthens, so myopia often appears.,22,Nuclear opacity is grayish-yellow at first, then gradually becomes thick in yellowish-gray brown or brownish-black. In that time, the fundus cant be seen. The nuclear changes of

16、ten continue unchanged for a long period(2030 years), uneasy to be matured.,23,Subcapsular cataract,According to the site where cataract begins to form Posterior capsular cataract:common Anterior capsular cataract:rare,24,The opacity often occur to the posterior capsular center, so vision decreases

17、in early stage. The cataract may develop to become cortical opaque then total cataract.,25,Treatment,There isnt any effective drug to the senile cataract. It is major to operation.,26,Operative time,At the immature or mature stage The vision is lower than 0.3 to influence with patients work and life

18、,27,Preoperative examination,Systemic Ocular part: Exam visual acuity Slit-lamp microscope Corneal curvature A/B ultrasonic exam,28,Operating method,Phacoemulsification extraction of cataract Characteristic: transparent corneal incision(3.2mm) To crush the hard lens nucleus to be chyloid with ultrae

19、mulsifier and extracted To implant the foldable intraocular lens in the lens capsular bag,29,strongpoint: Self-healing wound The corneal astigmatism after operation is fine Visual restoration is soon Shortcoming: The apparatus is expensive Some descendible disease cant choice this method Too hard le

20、ns nucleus may not adopt this method,30,Extracapsular cataract extraction and posterior chamber intraocular lens implantation The corneoscleral tunnel incision(6mm) dispense with suture The lens is hard(unfoldable) The patient can get good vision soon after operation The corneal astigmatism after op

21、eration is less.,31,Intracapsular cataract extraction The incision is bigger than ECCE, so the corneal astigmatism is high. The complications are more than that of ECCE,32,Visual correction fater cataract operation,After cataract surgery, the aphakia is in a state of high hyperopia (+10 +12 diopters

22、) By intraocular lens: it is the most effective method for correction of aphakia By contact lens: the method is less used because of more complications and using process more trouble By glasses: binocular aphakia patient,33,congnital cataract,Definition: congenital cataract is a result of lens growi

23、ng and developing disturbance in the process of fetal development. Causes: Endogenous:chromosome with heredity. Exogenous:by mothers or fetal systemic disorder.,EYE No.26,34,Clinical findings,It commonly is bilateral, static. A few develop continuously after birth. It may be classified according to

24、the site and the shape of lens opacity. Anterior polar cataract Posterior cataract Perinuclear cataract Nuclear cataract Total cataract, and so on,35,treatment,Whether or not affect with the vision,not,Observed,affect,Surgery in time,EYE No.31,36,Opportunity of operation: the earlier the operation i

25、s done, the greater the chance to get good vision becomes. The surgery may be done some weeks after birth. It should be done generally in baby with age of 36 months. But the IOL implantation must do after 3 years old.,EYE No.32,37,Treatment purpose: Reserve vision Prevent amblyopia Promote developme

26、nt of fusion function Surgery method Extracapsular cataract extraction Cataract suction IOL implantation after the suctions patient is 3 years old,38,The correction: By glasses:suitable to binocular aphakia with elder age. It is simple and convenient, easy to adjust and replace. By contact lens：suit

27、able monocular aphakia in children. But it is troublesome to take off, and so on. By IOL:After 3 years,the patient can do the implantation to obtain better vision. Amblyopia should be treated actively and timely.,39,Traumatic cataract,EYE No.33,Drug-induced cataract,Toxic cataract,40,Ectopia lentis,

28、lens positional abnormality has two causes: Rupture of suspensory ligament induced by injury Congenital aplasia or weakness and laxation of the ligament,41,Subluxation of the lens is often occurs in Marfans syndrome patient,42,Treatment,The lens is extracted when the vision is affected or the compli

29、cations occurred.,43,Prevention and treatment of blindness,Blindness also indicates that both eyes lose the ability to distinguish surroundings,the patient isnt able to be competent at some occupations, even to take care of himself.,EYE No.43,44,Blindness: the best corrected visual acuity of better

30、eye is lower than 0.05,or the visual field is less than 10 degrees while the best corrected vision of better eye is more than 0.05. The low vision:the best corrected vision of better eye is more than 0.05, but lower than 0.3.,45,Table:criterion of classification of low vision and blindness(WHO,1973),EYE No.44,46,several major ophthalmopathies causing blindness,Cataract: the first cause Keratopathy Glaucoma Trachoma Eye injury and occupation ophthalmopathy Genetic ophthalmopathy Diabetic retinopathy,EYE No.45,