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DiseaseofthelensEYENo.11廣西醫(yī)科大學(xué)第一臨床醫(yī)學(xué)院眼科AnatomyandPhysiologyofthelensPosition:Thelensconnectedwiththeciliarybodybythesuspensoryligamentthatfixesitbehindtheiris,infrontofthevitreous.EYENo.22廣西醫(yī)科大學(xué)第一臨床醫(yī)學(xué)院眼科Anatomy:Thelensiscomposedoflenscapsuleandlensfiber.Thelenscapsuleisalayerofelastichomogeneousmembrane.Thelensfibersaretheextensionandelongationforwardsandbackwardsoftheepithelialcellsattheequator.3廣西醫(yī)科大學(xué)第一臨床醫(yī)學(xué)院眼科PhysiologyofthelensThelensisskindoftransparentandnon-bloodvesseltissue.Itisanimportantpartofrefractivemediaoftheglobe.Thelens’nourishmentareofferedbyaqueoushumor.5廣西醫(yī)科大學(xué)第一臨床醫(yī)學(xué)院眼科Thedisorderofthelenscommonlyiflossofitstransparency(cataract)andabnormalityofitsposition;bothcaninduceseverevisualdisturbance.6廣西醫(yī)科大學(xué)第一臨床醫(yī)學(xué)院眼科CataractCataractisthefirstcauseofblindnessinChinaandothermanydevelopingcountry.Thereareonemillionofcataractsuffererwhoareinneedofoperationtorestoretheirvisions.EYENo.47廣西醫(yī)科大學(xué)第一臨床醫(yī)學(xué)院眼科ClassificationAccordingtotheageofoccurring:CongenitalcataractInfantilecataractJuvenilecataractAdultcataractAge-relatedcataract(senile)EYENo.58廣西醫(yī)科大學(xué)第一臨床醫(yī)學(xué)院眼科age-relatedcataractItisthemostcommoncataract,oftenseenintheoldswithagemorethan50yearsold.Theincidenceofthediseaseis100%whenthepatientexceed80yearsold.EYENo.610廣西醫(yī)科大學(xué)第一臨床醫(yī)學(xué)院眼科Clinicalfindings:BilateraldiseaseFixedblackspotbeforetheeyesVisualdecreasewithoutpainRefractivechangeEYENo.712廣西醫(yī)科大學(xué)第一臨床醫(yī)學(xué)院眼科corticalcataract

Itisdividedinto4stages:Incipientstage:

TobeginopacityappearsattheperipheryofanteriorandposteriorcortexThecenterlensisalmostclear,thepupillaryareaisn’taffected,commonlywithoutinfluencingvision.Tobediagnoseaftermydriasisunderslit-lampexamination.TodevelopslowlyEYENo.914廣西醫(yī)科大學(xué)第一臨床醫(yī)學(xué)院眼科EYENo.10Immaturestage(intumescentstage)TheopacitygraduallybecomesobviousThecortexabsorbswatertobecomeswollenIrisprojection:thecharacteristicofthisstageVisionhasobviouslydecreasedThefunduscan’tbeobservedinSomepatientmayinduceacuteattackofglaucomaduetoshallowanteriorchamber15廣西醫(yī)科大學(xué)第一臨床醫(yī)學(xué)院眼科Irisprojection:Toexaminewithobliqueillumination,theirisshadowonprojectedsidefallsonopaquecortexindeeplayer,acrescentprojectionappearsatthepupiloftheside.(becausethereistransparentcortexbetweenirispupillarymarginandlenscortex)16廣西醫(yī)科大學(xué)第一臨床醫(yī)學(xué)院眼科MaturestageThelenshasbecomeopaqueatallincreamwhitecolorTheirisprojectiondisappearedThefunduscan’tbelookedinVisiondecreasestolightperceptionorhandmovementButthelightseekingandcolorsensationareinnormal.17廣西醫(yī)科大學(xué)第一臨床醫(yī)學(xué)院眼科HypermaturestageWhenthematurestagecontinuesforoverlongtime,thewaterinthelenshasbeenlostcontinuously,thevolumeofthelensdiminishes,thecapsuleshrinks,theanteriorchamberdeepenswithiridodonesis.Visionmayincreasesuddenly18廣西醫(yī)科大學(xué)第一臨床醫(yī)學(xué)院眼科WhenthelenscapsulerupturedPhaco-anaphylacticuveitisPhacolyticglaucoma:thelenscortexblockedtheanteriorchamberangle,orthelensnucleusdislocatesintotheanteriorchamberorintovitreousbody.20廣西醫(yī)科大學(xué)第一臨床醫(yī)學(xué)院眼科nuclearcataractItgenerallybeginsattheageof40ItslowlyprogressOpacitystartsattheembryonicoradultnucleusEYENo.13Thedensityofthelensnucleushasbeenincreased,therefractiveindexobviouslystrengthens,somyopiaoftenappears.21廣西醫(yī)科大學(xué)第一臨床醫(yī)學(xué)院眼科SubcapsularcataractAccordingtothesitewherecataractbeginstoformPosteriorcapsularcataract:commonAnteriorcapsularcataract:rare23廣西醫(yī)科大學(xué)第一臨床醫(yī)學(xué)院眼科Theopacityoftenoccurtotheposteriorcapsularcenter,sovisiondecreasesinearlystage.Thecataractmaydeveloptobecomecorticalopaquethentotalcataract.24廣西醫(yī)科大學(xué)第一臨床醫(yī)學(xué)院眼科OperativetimeAttheimmatureormaturestageThevisionislowerthan0.3toinfluencewithpatient’sworkandlife26廣西醫(yī)科大學(xué)第一臨床醫(yī)學(xué)院眼科PreoperativeexaminationSystemicOcularpart:ExamvisualacuitySlit-lampmicroscopeCornealcurvatureA/Bultrasonicexam27廣西醫(yī)科大學(xué)第一臨床醫(yī)學(xué)院眼科OperatingmethodPhacoemulsificationextractionofcataractCharacteristic:transparentcornealincision(3.2mm)TocrushthehardlensnucleustobechyloidwithultraemulsifierandextractedToimplantthefoldableintraocularlensinthelenscapsularbag28廣西醫(yī)科大學(xué)第一臨床醫(yī)學(xué)院眼科ExtracapsularcataractextractionandposteriorchamberintraocularlensimplantationThecorneoscleraltunnelincision(6mm)dispensewithsutureThelensishard(unfoldable)ThepatientcangetgoodvisionsoonafteroperationThecornealastigmatismafteroperationisless.30廣西醫(yī)科大學(xué)第一臨床醫(yī)學(xué)院眼科IntracapsularcataractextractionTheincisionisbiggerthanECCE,sothecornealastigmatismishigh.ThecomplicationsaremorethanthatofECCE31廣西醫(yī)科大學(xué)第一臨床醫(yī)學(xué)院眼科VisualcorrectionfatercataractoperationAftercataractsurgery,theaphakiaisinastateofhighhyperopia(+10~+12diopters)Byintraocularlens:itisthemosteffectivemethodforcorrectionofaphakiaBycontactlens:themethodislessusedbecauseofmorecomplicationsandusingprocessmoretroubleByglasses:binocularaphakiapatient32廣西醫(yī)科大學(xué)第一臨床醫(yī)學(xué)院眼科congnitalcataractDefinition:

congenitalcataractisaresultoflensgrowinganddevelopingdisturbanceintheprocessoffetaldevelopment.Causes:Endogenous:chromosomewithheredity.Exogenous:bymother’sorfetalsystemicdisorder.EYENo.2633廣西醫(yī)科大學(xué)第一臨床醫(yī)學(xué)院眼科ClinicalfindingsItcommonlyisbilateral,static.Afewdevelopcontinuouslyafterbirth.Itmaybeclassifiedaccordingtothesiteandtheshapeoflensopacity.AnteriorpolarcataractPosteriorcataractPerinuclearcataractNuclearcataractTotalcataract,andsoon34廣西醫(yī)科大學(xué)第一臨床醫(yī)學(xué)院眼科treatmentWhetherornotaffectwiththevisionnotObservedaffectSurgeryintimeEYENo.3135廣西醫(yī)科大學(xué)第一臨床醫(yī)學(xué)院眼科Opportunityofoperation:theearliertheoperationisdone,thegreaterthechancetogetgoodvisionbecomes.Thesurgerymaybedonesomeweeksafterbirth.Itshouldbedonegenerallyinbabywithageof3~6months.ButtheIOLimplantationmustdoafter3yearsold.EYENo.3236廣西醫(yī)科大學(xué)第一臨床醫(yī)學(xué)院眼科Treatmentpurpose:ReservevisionPreventamblyopiaPromotedevelopmentoffusionfunctionSurgerymethodExtracapsularcataractextractionCataractsuctionIOLimplantationafterthesuction’spatientis3yearsold37廣西醫(yī)科大學(xué)第一臨床醫(yī)學(xué)院眼科Thecorrection:Byglasses:suitabletobinocularaphakiawithelderage.Itissimpleandconvenient,easytoadjustandreplace.Bycontactlens：suitablemonocularaphakiainchildren.Butitistroublesometotakeoff,andsoon.ByIOL:After3years,thepatientcandotheimplantationtoobtainbettervision.Amblyopiashouldbetreatedactivelyandtimely.38廣西醫(yī)科大學(xué)第一臨床醫(yī)學(xué)院眼科TraumaticcataractEYENo.33Drug-inducedcataractToxiccataract39廣西醫(yī)科大學(xué)第一臨床醫(yī)學(xué)院眼科Ectopialentislens’positionalabnormalityhastwocauses:RuptureofsuspensoryligamentinducedbyinjuryCongenitalaplasiaorweaknessandlaxationoftheligament40廣西醫(yī)科大學(xué)第一臨床醫(yī)學(xué)院眼科SubluxationofthelensisoftenoccursinMarfan’ssyndromepatient41廣西醫(yī)科大學(xué)第一臨床醫(yī)學(xué)院眼科TreatmentThelensisextractedwhenthevisionisaffectedorthecomplicationsoccurred.42廣西醫(yī)科大學(xué)第一臨床醫(yī)學(xué)院眼科Preventionandtreatmentofblindne

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