Cataracts

D: Opacification of the lens of the eye. ^^

A: Majority of cases are idiopathic age-related ('senile cataracts'). Numerous secondary causes including:

Local: Previous eye trauma, uveitis, intraocular tumours.

Systemic: DM, metabolic disorders (galactosaemia, hypocalcaemia, Wilson's disease), skin disease (atopic dermatitis, scleroderma), drugs (steroids), X-ray and UV radiation, myotonic dystrophy, genetic syndromes (Down's). Congenital: Congenital rubella syndrome.

E: Major cause of treatable blindness worldwide.

H: Gradual onset painless loss of vision.

Glare from bright light, vision may worsen in bright light (especially with central lens opacity).

Some may experience monocular diplopia and see haloes around lights. Some may notice that they can read without glasses (nuclear sclerotic cataract may " lens-converging power). In infants, there may be amblyopia or nystagmus.

E: Loss of red reflex and hazy lens appearance. Reduced visual acuity.

P: (Seen with slit-lamp microscope): In the early stages, there is compression of lens fibre in the central portion of the lens (nuclear sclerosis), with gradual change of the crystalline lens nucleus from translucent to brown or gray. There may be areas of granular opacities (e.g. in posterior subcapsular subtype).

_I: Unnecessary unless occuring at an early age or in background of systemic disease.

M: Congenital cataracts must be treated urgently to avoid amblyopia.

The decision for surgery depends on the effect of the cataracts on the patient's vision and life.

Surgical: Phacoemulsification (using ultrasound probe) followed by aspiration of lens material and insertion of intraocular lens implant is curative. Specific complications include posterior capsule opacification, vitreous humour loss, and endophthalmitis. Usually done as day surgery. Post-op care should include steroid drops (for inflammation), antibiotic drops (infection prophylaxis), avoidance of strenuous exercise and ocular trauma.

C: None, other than reduced quality of life from reduced visual acuity.

P: Good with treatment for age-related cataracts.

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