KATARAK

Definition

The crystalline lens is a transparent structure. Its transparency may be disturbed due to
degenerative process leading to opacification of lens fibers. Development of an opacity in the lens is
known as cataract.

Etiological

1. Congenital and development cataract

Heredity
Use of drugs
infection
Idiopathic

2. Acquired cataract

Senile cataract
Metabolic cataract
Complicate cataract
Traumatic cataract

Classification

A. generalized cataracts

Cataract coronarius. This type of cataract is very common and is the most common form of
developmental cataract occurring at puberty; this cataract involves a layer of adolescent lens
nuclei or a deep cortical layer. Because the opacity is in the peripheral part, the vision will
usually not be disturbed.

Blue spot cataracts. This type of cataract is also commonly referred to as cataracta -
punctata - caerulea. Cataracts of this type usually form in the first two decades of life. This
cataract is stationary and does not affect vision.
Total congenital cataracts. It is a frequent variation of cataracts and may be unilateral or
bilateral. In many cases there may also be a hereditary character. One other important cause
of this cataract is maternal rubella infection, which occurs during the first trimester of
pregnancy. Usually, children will be born with white nuclear cataracts. This type of cataract
is a progressive type.
 Congenital membranous cataract. The patient may be misdiagnosed with congenital afakia.
This condition can be attributed to Hallermann-Streiff-Francois Syndrome.

B. cataract senile

Insipient cataract. The initial opacification of the lens with the patient's visus still reaches
6/6.
Immature cataracts. The lens has partial turbidity. In immature cataracts will be able to
increase the volume of the lens due to increased osmotic pressure of degenerative lens
materials.

Mature cataracts. The lens has total turbidity.

hypermature cataracts. Cataracts shrink and anterior capsule wrinkles due to water leaks
and lenses
Morgani cataract. Liquefaction of the cortex of hypermature cataract lenses resulted in the
nucleus falling inferiorly.

Clinical manifestations

Due to lens opacity changes, there are various impairments in vision including:
1. The vision sharp decline slowly
2. Decreased contrast sensitivity; patients complain about the difficulty of seeing objects outdoors in
bright light
3. The shift towards myopia. Normally, elderly patients will complain of hyperopia changes, but
cataract patients experience changes in lens refractive index.
4. Monocular diplopia. This is because of differences in refractive index between one part of the lens
that has turbidity with other lens parts
5. Glare sensation. Lens opacity results in a sense of glare because light is refracted due to changes
in the lens refractive index

Diagnosis

Diagnosis is made through anamnesis as well as ophthalmological examination

1. The patient's disease history travel history. Patients come with decreased vision complaints slowly
as covered in smoke / fog. Complaints accompanied by the size of the womb is increasing, glare and
difficult to read.
Risk factor :
a. age over 40 years
b. systemic diseases such as diabetes mellitus
c. regular use of steroid eye drops
2. Physical examination
a. decreased visus
b. pupillary reflexes and normal intra-ocular pressure
c. not found corneal turbidity
d. there is a more apparent lens opacity after dilated pupils with tropicamide drops 0.5%
e. examination of the anterior segment with a flashlight or slit lamp obtained lens opacity.
Examination shadow test (+) which means cataract is still immature. While shadow test (-) indicates
the cataract is mature

Treatment

The main treatment of cataracts is surgery. There is no benefit of nutritional supplementation

or pharmacological therapy in preventing or slowing the progression of cataracts.

A commonly chosen surgical method for adult or large-cataract adults is to leave the posterior
portion of the lens capsule so that it is known as extracapsular cataract extraction. Intraocular lens
planting is part of this procedure. Incisions are made to the limbus or peripheral cornea, the superior
or temporal portion. A channel is made in the anterior capsule, and the nucleus and cortex of the lens
are removed. Then the intraocular lens is placed on an empty "capsular bag", supported by a complete
posterior capsule.

In the extracapsular cataract extraction of the nuclear expression form, the lens nuclei are
removed intact, but this procedure requires a relatively large incision. The lens cortex is removed by
manual or automatic suction. Currently, phacoemulsification is the most commonly used
extracapsular cataract extraction technique. This technique uses a handheld ultrasonic vibrator to
destroy the hard nucleus until the nucleus substance and cortex can be aspirated through an incision
of about 3 mm in size. The size of the incision is sufficient to include a foldable intraocular lens. If
rigid intraocular lenses are used, the incision should be dilated to about 5 mm. The benefits of small-
incision surgery are more controlled intraoperative conditions, avoidance of sutures, faster wound
repair with lower degrees of corneal distortion, and reduced postoperative intraocular inflammation
- all of which result in rehabilitation a shorter vision. The phacoemulsification technique, however,
poses a higher risk of shifting the nucleus material to the posterior via a posterior capsule tear; this
event requires complex vitreoretin surgery. After any extracapsular cataract surgery there may be a
secondary turbidity in the posterior capsule requiring the side using a YAG laser: neodymium. The
extraction of the lens through the pars plana during the posterior vitrectomy procedure is called the
pars plane's lensectomy or fakofragmentation. This cataract-lifting method is usually performed
simultaneously with the opaque or grated vitreous removal.

Intracapsular cataract extraction, an action of lifting the entire lens following its capsule, is
rarely done at this time. The incidence of postoperative retinal ablatio- tions is much higher with
these measures compared with extracapsular postoperative; however, intracapsular surgery remains
a useful procedure, especially when there is no facility for extracapsular surgery.
counseling and education
1. Tell the family that cataracts are impaired vision problems
2. notify the family for regular control if already diagnosed with cataracts in order to avoid
complications

refrensi :

Riordan, Paul. 2009. Vaughan & Asbury: oftalmologi umum ed.17. Jakarta: EGC. Hal.169-177

Tanto, cris. 2016. Kapita selekta kedokteran ed.4. Jakarta: media Aesculapius. Hal.388-390

Khurana, A. 2014. Comprehensive Opthalmology ed.4. India: publishing for one world. Hal.170-204