By James C. Bobrow MD
Stories the anatomy, body structure, embryology and pathology of the lens. Covers the epidemiology, overview and administration of cataracts; provides an outline of lens and cataract surgical procedure; and explores the problems and exact occasions of cataract surgical procedure. final significant revision 2008 2009.
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Additional resources for 2011-2012 Basic and Clinical Science Course, Section 11: Lens and Cataract (Basic & Clinical Science Course)
CHAPTER 5: Patho logy. 45 l ens 00". 6JC-,~o © CIBA. I Figure 5-2 Nuclear Sclerosis Nuclear ca taract vi ew ed with diffuse ill umination (A) and w ith a slit beam (8) . e, Sch ematic of nuclear cata ract. (Courtesy of CIBA Pharmaceurical Co .. division of CIBA-GEIGY Corp. Repro- duced wirh permission from Clinica l Symposia . Illustration b y John A. ) Cortical Cataracts In contrast to nuclear cataracts, cortical cataracts are associated \vith the local disruption of the structure of mature fiber cells.
CRAIC-"o B © CIBA I ~ SWOli en le~s: anteroposterior diameter increased Figure 5-4 A , Cort ica l cataract view ed by retro illumination. a, Schematic of immature cort ica l cataract . , division of elBA-GEIGY Corp. Reproduced with permission from Cli nical Symposia. Illus tration by J ohn A . ) and are usually axial (Fig 5-8). The first indication of PSC formation is a subtle iridescent sheen in the posterior cortical layers visible with the slit lamp. In later stages, granular opacities and a plaquelike opacity of the posterior subcapsular cortex appear.
This mechanism depends on the breakdown of adenosine triphosphate (ATP) and is regulated by the enzyme Na+,K+-ATPase. This balance is easily disrupted by the specific AT Pase inhibitor ouabain. Inhibition of Na+,K+-ATPase leads to loss of cation balance and elevated water content in the lens. Whether Na+,K+-ATPase is depressed in the development of cortical cataract is uncertain; some studies have shown reduced Na+, K+ -ATPase activity, whereas others have shown no change. Still other studies have suggested that the passive membrane permeability to cations is increased with aging and cataract development.