1.

Mekanisme terbentuknya katarak

2. Mekanisme kerusakan pada retinopati diabetikum

3. Faktor resiko katarak dan retinopati diabetikum

4. Algoritma retinopati diabetikum

5. Klasifikasi dan grading katarak
6. Fisiologi lensa mata
7. Katarak
 Etiology
o EYE INJURY
o SUN EXPOSURE
o SMOKING
o HYPERTENSION
o KIDNEY DISORDERS
o DIABETES MILLETUS
o LONG TERM USE OF STEROIDS
o TOXIC SUBSTANCES
o HEREDITARY
 Classification of cataract

a. Morphological classification
o Subcapsular cataract
- Anterior subcapsular cataract
- Posterior subcapsular cataract
o Nuclear cataract involves the nucleus of lens.
- Yellow to brown voloration
- Degenerative changes occurring as nuclear sclerosis
- Increase in water insoluble proteins,
- compaction of nucleus resulting in a hard cataract.
- Disturbance of lamellar arrangement in fibres
o Cortical cataract
- wedge shaped or radial spoke-like opacities.
- Denaturation and coagulation of lens proteins.
- Decrease level of aminoacids and protein systhesis
- Increased hydration brought by decrease in potassium due to
reversal of Na/K pump mechanism.
o Polar cataract
b. Classification according to maturity

o An immature cataract
o A mature cataract
o A hypermature cataract
 o A morgagnian cataract
c. Etiological classification
o Congenital and developmental cataract
Congenital cataract develops from some disturbance to normal
development of lens .
- The disturbance occurs before the birth
- The opacity may limit to embryonic or foetal nucleus.
Developmental cataract occurs from infancy to adolescence.
- The opacity involves infantile or adult nucleus.
3 children out of 10,000 live births.
- Two third of the cases are bilateral.
o Acquired cataract
Senile cataract
- Common and bilateral above the age of 50 years.
- Male: Female::1:1
- Etiology
Hereditary : Incidence, age of onset and maturation
Ultravoilet radiation : More exposure to UV-rays = early
maturation.
Dietary factors : Poor diatery factors eg, lack of certain
aminoacids, Vitamines (Vitamin E, Vitamin C, riboflavin) and
essential minerals.
Dehydrational crisis : Prior episode of severe dehydration due
to diarrhea and cholera.

Traumatic cataract
Complicated (secondary) cataract . eg, uveitis, pathological
myopia, glaucoma, retinal detachment, retinitis pigmentosa
etc,
Metabolic cataract . Eg, Diabetes, hypocalcaemia, Wilsons
disease, Lowes syndrome
Electric cataract
Radiational cataract
Drug induced cataract eg, corticosteroid, copper, iron,
Chlorpromazine, Busulphan, Allopurinol, Amiodarone, etc,
Cataract associated with skin diseases . Eg, atopic dermatitis,
scleroderma, etc,
Cataract with miscellaneous syndromes . Eg, Dystrophica
myotonica, Downs syndrome etc,
d. Age of onset classification
1.CONGENITAL
 2.INFANTILE

3.JUVINILE
4.PRE-SENILE
5.SENILE
Signs and Symptoms
o Signs :
Opacification of the normally clear lens seen through the pupil
Indistinct on retina examination
Red reflex may be dim
No afferent pupillary defect
Myopic shift
o Symptoms :
Blurred vision
 Painless progressive visual loss
Glare

Reduced color perception

Color haloes
Uniocular diplopia
Based on the location and density
Grading
 GRADE 0: CLEAR LENS
GRADE 1: SWOLLEN FIBRES AND SUB CAPSULAR OPACITIES
GRADE 2: NUCLEAR CATARACT AND VISIBLE LENS FIBRES
GRADE 3: STRONG NUCLEAR CATARACT WITH PERINUCLEAR AREA
OPACITY
GRADE 4: TOTAL OPACITY

8. Indikasi dilakukan operasi katarak

9. Teknik operasi pada katarak