Welcome Home

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Welcome Home
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THEORY

• LECTURES reduced from 80 --- 40 hours
• 2 x per week Tues and Fri.
• In 7th semester there will be no lectures BUT in
  your case it is going to be an exception
• because of Electives in JUNE
• Cover all major topics

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• Text books Khurana , Parsons Diseases of the
  Eye
• Reference books Kanski
• Reading on your own and consistent
• No more spoonfeeding
• Attendance 75

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Practicals or clinical posting

• Reduced from 10 weeks to 4 weeks
• 4 weeks meaning morning and afternoon
• In the 7th Semester in H. Melaka. You may do a
  rotation in other hospitals such as in Muar or
  Terendak

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Practicals or clinical posting

• Log book - 5 cases
• Instruments - torchlight and ophthalmoscope
• Dress code in hospital
• No jeans, slippers , tee- shirts , hipsters
• Skirts below knee level
• Males - proper shoes, shirts with ties
• Hair- neatly combed nto hanging over your
  face bor BOTH
• Language -courteous
• Behaviour - professional

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Examinations

• 6th semester Midsemester 5o marks
• -- Sessional
• 7th semester -Midsemester
• -Sessional
• -EPT
• -OSCE
• Eligibility for University Examinations
  attendance and internal asssesment

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LENS

• Development ectodermal
• Transparent
• Avascular
• Spherical
• Location between the iris and vitreous
• Suspended by zonules

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ANATOMY

• cortex

nucleus
capsule
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Anatomy

• Capsule Thicker anteriorly especially at the
  equator.
• Cuboidal cells form the ant. subcapsular
  epithelium It is not present on the post.lens
  epithelium . Becomes columnar at the equator---
  Lens fibres.
• Lens fibres arise from the anterior epithelial
  cells.
• Nucleus
• In children it is soft
• In adults it is firm
• In older age it looses transparency and it is
  flat on both surfaces.

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PHYSIOLOGY

• Nutrition from aqueous vitreous
• 66 of water 34 of proteins 85 are soluble
  proteins
• Traces of mineral
• Glutathione Ascorbic acid
• Reduces with age cataract formation
• Carbohydrates-- energy
• Amino Acids ---structure
• Metabolism ---Low metabolism and utilisation
  of O2 and glucose.
• CarbohydratesHMP- shunt, glycolysis, citric acid
  cycle
• Amino acids and fatty acids via the citric acid
  cycle in the mitochondria of lens epithelium.

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Classification of cataract

• Aetiological Congenital / developmental
• Acquired
• Morphological location and configuration

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Acquired causes

• Senile Age
• Complicated Uveitis , R.D, endophthalmitis
• Traumatic
• Metabolic D.M., Wilsons disease
  ,galactosemia
• Maternal infections TORCHES
• Drugs Toxic Steroids
• Radiation Gamma rays ,X-Rays,
  Microwave???
• Dermatogenic Atopic dermatitis
• Cataract associated with syndromes e.g. Downs
  syndrome,
• 
  Dystrophia myotonica
• 
  

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Acquired causes

• Senile Age
• Complicated Uveitis , R.D, endophthalmitis
• Traumatic
• 
  

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Acquired causes

• Metabolic D.M., Wilsons disease
  ,galactosemia
• Maternal infections TORCHES
• Drugs Toxic Steroids
• 
  

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Acquired causes

• Radiation Gamma rays , X-Rays,
  Microwave???
• Dermatogenic Atopic dermatitis
• Cataract associated with syndromes
• e.g. Downs syndrome, Dystrophia myotonica
• 
  
  

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Morphological Classification

1. Capsular
2. Cortical
3. Nuclear
4. Polar

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Morphological Classification

1. Capsular
2. Cortical
3. Nuclear
4. Polar

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Cataract

• Is an opacity in a clear lens.
• Is the most common cause of painless visual loss
  in the elderly.
• Is the most common cause of preventable
  blindness.
• Normally the human lens converges the light rays.
• What happens when there is an opacity?

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What happens when there is a opacity in the lens ?
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Senile cataract

• Bilateral above 60 yrs
• Can occur at a younger agehereditary tendency
• Both sexes are equally affected
• Two forms Cortical
• Nuclear

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Development of senile cortical cataract

• Lamellar separation or presenile changes
• Incipient stage
• Intumuscent stage
• Mature cataract
• Hypermature cataract

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Stages of maturation in cortical cataract

• Lamellar separation
• Collection of fluid between
• the lens fibres.
• Change in refractionhypermetropic mild
• No symptoms
• 
  

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Stages of maturation in cortical cataract

• Incipient stage
• Cuneiform spokes in the periphery
• Cupuliform opacity in the posterior cortex
• Does the vision get affected ?

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Clinical features of the incipient form

• Change in refractive index of lens
• Polyopia
• Haloes
• Defective vision in the evening or night
• On examination they appear black against the red
  glow
• with the direct ophthalmoscope
• Or grey opacities

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• Intumuscent stage
• Progression of the hydration of the lens
  fibres
• Swelling and opacification of the lens
• Lens pushed forward
• A.C. shallow and Sec. Angle closure glaucoma
• Opaque lens
• Pupil in contact with the lens
• No iris shadow
• What do you think the vision is ?

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Stages of maturation in cortical cataract

• Mature cataract
• Loss of fluid
• Entire cortex is opaque
• ?? visual acuity

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• Hypermature Cataract
• Signs of hypermature cataract
• Wrinkled capsule / calcification
• Iridodonesis
• Ac may be deep
• Subluxation due to
• weak zonules
• Sclerotic cataract
• Morgagnian cataract

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Calcification of the capsule in hypermature
cataract
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• Cortex liquifies
• Hard nucleus sinks

nucleus
Morgagnian cataract
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Nuclear cataract

• Progressive sclerosis in the nucleus
• Brown brunescent
• refractive index
• Myopic
• Seldom becomes hypermature

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