Cataract


Article Author:
Adnan Nizami


Article Editor:
Arun Gulani


Editors In Chief:
Chaddie Doerr


Managing Editors:
Avais Raja
Orawan Chaigasame
Carrie Smith
Abdul Waheed
Khalid Alsayouri
Kyle Blair
Trevor Nezwek
Radia Jamil
Erin Hughes
Patrick Le
Anoosh Zafar Gondal
Saad Nazir
William Gossman
Hassam Zulfiqar
Navid Mahabadi
Hussain Sajjad
Steve Bhimji
Muhammad Hashmi
John Shell
Matthew Varacallo
Heba Mahdy
Ahmad Malik
Sarosh Vaqar
Mark Pellegrini
James Hughes
Beata Beatty
Daniyal Ameen
Altif Muneeb
Beenish Sohail
Nazia Sadiq
Hajira Basit
Phillip Hynes
Komal Shaheen
Sandeep Sekhon


Updated:
6/3/2019 2:14:29 PM

Introduction

A cataract is a clouding or opacification of the lens (normally clear) of the eye or its capsule (surrounding transparent membrane) that obscures the passage of light through the lens to the retina of the eye. This blinding disease can affect infants, adults, and older people but it predominates the latter group. It can be bilateral and vary in severity. The disease process progresses gradually without affecting daily activities early on, but with time, especially after fourth or fifth decade, the cataract will eventually mature making the lens completely opaque to light interfering with routine activities. Cataracts are a significant cause of blindness worldwide. Treatment options include correction with refractive glasses only at earlier stages and if cataract mature enough to interfere with routine activities, surgery may be advised, which is very fruitful.

Etiology

Multiple factors responsible for developing cataracts include the following:

Congenital Cataract: Can be unilateral or bilateral - studies have documented a close association between congenital cataract and maternal nutrition, infections (rubella & German measles) and deficiency of oxygenation due to placental hemorrhage.

Age-related (Senile Cataract): Most common type of cataract

Traumatic Injury[1][2]: Most common cause of unilateral cataract in young adults

  • Perforating trauma
  • Blunt trauma: causing a characteristic flower-shaped opacity
  • Electric shock:  a rare cause of cataract, causing diffuse milky-white opacification and multiple snowflakes like opacities, sometimes in a stellate subcapsular distribution
  • Ultraviolet radiation: if intense may rarely cause true exfoliation of the anterior lens capsule and cataract
  • Ionizing radiation: usage for ocular tumor treatment and in cardiological interventions may cause posterior subcapsular opacities
  • Chemical injuries: naphthalene, thallium, lactose, galactose

Systemic Diseases:

  • Myotonic dystrophy
  • Atopic dermatitis
  • Neurofibromatosis type 2

Endocrine Diseases[3]:

  • Diabetes mellitus
  • Hypoparathyroidism
  • Cretinism

Primary Ocular Diseases:

  •  Chronic anterior uveitis: the most common cause of secondary cataract
  •  Acute congestive angle closure: may cause small anterior grey- white subcapsular or capsular opacities, glaukomflecken
  •  High myopia: may cause posterior subcapsular lens opacities and early-onset nuclear sclerosis, worsening the myopic refractive error
  •  Hereditary fundus dystrophies: i.e., retinitis pigmentosa, Leber congenital amaurosis, gyrate atrophy and Stickler syndrome, may cause posterior and anterior subcapsular lens opacities

Drugs: Corticosteroids and anticholinesterase inhibitors can cause both posterior and anterior subcapsular opacities respectively

Poor Nutrition[4]: a diet deficient in anti-oxidants and vitamins

Alcohol Abuse

Smoking

Epidemiology

Prevalence and Incidence

Many studies in 2010 reveal that cataracts are most common in the White American race, where prevalence ranges from 17 to 18% per 100 people. Blacks were the second highest affected by cataracts with a 13% prevalence rate followed by Hispanics with a prevalence rate of almost 12%.

Age

Onset is gradual and progressive commonly in old age group, typically in the fifth and sixth decade, though cases have been reported in children and the elderly as well.

Sex

Recent studies reveal that the disease is more common in women than men, with a male to female ratio of 1 to approximately 1.3.

Pathophysiology

The lens is a transparent structure made up of fibers (modified epithelial cells) enclosed in a membranous structure called lens capsule. Lens matter consists of two main parts:

  • Cortex (superficial part) - containing younger fibers
  • Nucleus (deeper part) - containing older fibers

Many degenerative processes denature and coagulate lens proteins present in lens fibers by different mechanisms which result in loss of transparency and ultimately cataract formation.[5] The various mechanisms involved are as follows:

  • Disturbances occurring at any level of lens growth (congenital cataract)
  • Fibrous metaplasia of lens epithelium (subcapsular cataract)
  • Cortical hydration between lens fibers (cortical cataract)
  • Deposition of certain pigments, i.e., urochrome (nuclear cataract)

All these processes ultimately lead to an opaque lens behind the pupil making it extremely difficult for the patient to carry on with routine activities.

History and Physical

History

The patient may present with one of the following symptoms:

  • Decrease or blurring in vision: gradual and painless; unilateral or bilateral depending upon the eye being affected without and at mature stages even with glasses
  • Diplopia or polyopia: mostly uniocular but can be binocular- this is due to multiple refractions through clear areas between the opacities
  • Colored halos around the light: Rainbow halos; possibly due to the collection of water drops between layers of lens fibers acting as a prism splitting light into its seven colors
  • Sensitivity to glare: especially headlights of automobiles and sunlight 
  • Increased frequency to change refractive glasses: as the cataract matures, a person may visit his ophthalmologist more often for refraction
  • Disturbance in color vision: fading or yellowing of objects

Physical Findings

Following findings can be noticed during a thorough ophthalmic examination depending upon the part of the lens involved:

      Visual Acuity

  • Decreased unilaterally or bilaterally depending upon the affected eye

      Cortical Cataract

  • Wedge-shaped opacity with clear areas of lens matter mostly present at the periphery (Incipient cortical cataract)
  • Well-developed wedge-shaped opacity (Progressive cortical cataract)
  • Advanced opacity with a greyish lens, clear cortex, and an iris shadow (Immature cortical cataract)
  • Findings of the immature stage but with a swollen lens due to the accumulation of fluid making anterior chamber shallow (Intumescent cortical cataract)
  • The entire opaque cortex with the absence of iris shadow (Mature cortical cataract)
  • Milky fluid bag with lens nucleus present at the bottom due to liquefaction of the cortex without an iris shadow and a shallow anterior chamber (Hypermature cortical cataract)

      Nuclear Cataract

  • Dark brown or black lens with an iris shadow
  • No fundal view due to dark opacity in the center against a red glow
  • No fourth Purkinje image

      Systemic Diseases

  • Diabetes mellitus: classic snowflake cortical opacities 
  • Myotonic dystrophy: Christmas tree cortical cataract which later evolves into wedge-shaped cortical and subcapsular opacities resembling a star-like in conformation 
  • Atopic Dermatitis: characteristic shield-like dense anterior subcapsular plaques 
  • Neurofibromatosis type 2: mixed opacities; can be subcapsular, capsular or cortical

Evaluation

Cataracts can be evaluated by a number of steps as follows:

History

  • The chief complaint of the patient, i.e., a decrease of vision
  • Past ophthalmic history
  • Any systemic disease causing or aggravating the symptoms

Comprehensive ophthalmic examination

  1. Visual acuity: can be assessed by Snellen chart to identify the severity of the disease and limitations in routine activities of life
  2. Refraction: Important factor to plan management
  3. Cover test: poor vision caused by cataract can be a reason for a divergent squint
  4. Slit Lamp Examination
  • Pupillary responses: to check the shape of the pupil, afferent and efferent pathways and relative afferent pupillary defect
  • Adenexal examination: a thorough examination is needed to exclude any adnexal pathology, i.e., dacryocystitis, blepharitis, chronic conjunctivitis, lagophthalmos, ectropion, entropion, and tear film abnormalities - these conditions may predispose to endophthalmitis, so their diagnosis and optimization are necessary to treat cataract
  • Cornea: important to asses whether cornea will able to handle operative trauma - arcus senilis is an important finding because it can obstruct the operative field clarity
  • Anterior Chamber: a shallow anterior chamber can make cataract surgery extremely difficult
  • Lens: part of the lens involved can be an important factor to plan our surgical technique - nuclear cataract is harder while cortical cataract is softer in consistency
  • Fundus Examination: any pathology in the fundus, i.e., age-related macular degeneration can be an important factor to determine visual outcome after surgery that is why a thorough fundal examination is critical

Investigations

The following investigations can help diagnose and plan the management of the disease:

  • Intraocular pressure: to rule out glaucoma
  • Dark Room Tests: direct and indirect ophthalmoscopy
  • Fundoscopy: to rule out any vitreous or retinal pathology
  • Biometry: for intraocular lens (IOL) placement during surgery
  • Peripheral Retinal Assessment: testing the projection of light in all quadrants
  • Macular function test: like cardboard test (two-point discrimination), Maddox rod test, the laser interferometry, foveal electroretinogram, photo stress test
  • Ultrasound scan: B-scan is advised to see retinal detachment or any vitreous pathology
  • Systemic diseases: Blood glucose levels, electrocardiography, echocardiography, ultrasonography
  • Baseline tests: Complete blood count, liver function test, renal function test, bleeding profile, Hep B & C screening, chest X-ray

Treatment / Management

The treatment choice depends upon the degree of opacity sufficient enough to cause difficulty in performing essential daily activities. Following treatment modalities are available:

  1. Medical: If visual acuity is 6/24 or better, pupillary dilatation with 2.5% phenylephrine or refractive glasses are enough to carry on routine activities, and surgery is not required. Cyclopentolate and atropine can also be useful. Recently, there are also cataracts drops under trial which can dissolve cataract.
  2. Surgery: If visual acuity is worse than 6/24 or there is a medical indication (phacolytic glaucoma, phacomorphic glaucoma, retinal detachment) in which a cataract is adversely affecting the health of the eye, surgery is always needed.
  • Congenital Cataract: No treatment is necessary if visual acuity is more than 6/24 and a patient can carry out their normal routine activities. Refractive glasses can be advised for the blurring of vision or diplopia. If visual acuity falls below 6/24, surgery is needed and the surgeon can opt one of the following surgical procedures depending upon patients complaints and severity of the disease.[6]
    • Irrigation and aspiration of the lens
    • Irrigation and aspiration of the lens with IOL implantation
    • Irrigation aspiration of the lens with IOL, anterior vitrectomy and primary posterior capsulotomy
  • Senile Cataract: Treatment options are the following[7][8]:
    • Medical: No medical treatment is effective once the cataract has become mature.
    • Surgical: Mature cataract has a very hard nucleus, and one of the following methods are used to extract lens:
      • Extracapsular cataract extraction: a procedure of choice
      • Intracapsular cataract extraction: an old technique not used frequently due to complications 
      • Phaco-emulsification: a modification of ECCE with less astigmatism and early visual recovery
      • Laser phacolysis: a recent advancement under trial
  • Management of general conditions before surgery: There are many general health conditions which require optimization before surgery for the better results.
    • Diabetes mellitus
    • Hypertension
    • Myocardial Infarction
    • Angina
    • Respiratory Infection
    • Stroke
    • Leg ulcer
    • Viral hepatitis
    • AIDS
    • Epilepsy
    • Parkinson disease
    • Rheumatoid arthritis

Differential Diagnosis

The differential diagnosis of cataract includes many disorders such as:

  • Glaucoma
  • Refractive errors
  • Macular degeneration
  • Diabetic retinopathy
  • Corneal dystrophies and degenerations
  • Optic atrophy
  • Retinitis pigmentosa

Prognosis

Prognosis of cataract depends upon multiple factors such as:

  • The degree of visual impairment
  • Type of cataract
  • Timing of intervention
  • Mode of intervention
  • Quality of life
  • Unilateral or bilateral involvement of the eye
  • Presence of another systemic disease

In most cases, surgery restores vision very effectively. Presence of another systemic disease, time of intervention, and mode of surgery can be instrumental in determining the visual outcome. Recent studies reveal that in most of the cases the prognosis is excellent after surgery almost 70 to 80%. Most patients show excellent results after surgery if they strictly follow postoperative instructions and medication regimens advised by their ophthalmologist.[9] A routine eye examination is advisable which will detect any cataract development in the other eye. Many patients with a monofocal IOL may require refractive glasses to achieve their best visual acuity after surgical cataract removal.[10] Gradual opacification of the posterior capsule can develop in a large number of patients that can affect the patient's vision (secondary cataract).

Complications

Cataract cause multiple complications discussed as follows:

Congenital Cataract: These can be disease related or surgery related[11]:

  • Disease-related complications: corneal ulcer, corneal perforation (acquired anterior capsular cataract), blindness
  • Surgery-related complications: uveitis, posterior capsular thickening, aphakia, after cataract, growth-related refractive changes, glaucoma, retinal detachment

Acquired Cataract: These can be disease related or surgery related:

  • Disease-related complications: acute congestive glaucoma (Intumescent stage), phacolytic glaucoma, iritis, subluxation of the lens, secondary glaucoma(hyper mature stage), blindness
  • Surgery-related complications: these are classified as follows:
    • During Surgery: posterior capsular rupture, hyphaema, expulsive hemorrhage, corneal burn, nucleus drop in vitreous
    • Post Surgery[12][13]: iris prolapse, delayed anterior chamber formation, infections like endophthalmitis or panophthalmitis, striate keratitis, malpositioning of IOL, pseudophakic glaucoma, cystoid macular edema, dysphotopsia, ptosis, retinal detachment, posterior capsular thickening, and opacifications

Deterrence and Patient Education

The patients should receive education about:

  • Risk factors of the disease
  • Complications of the disease
  • Treatment options of the disease
  • Complications of the surgery
  • The regular need for a follow-up

Visual acuity charts and slit lamp examination should be used on regular bases at every follow-up to detect any impairment in visual acuity, after cataract or any complication of the surgery. The patient should be advised to wear spectacles in the sunlight to avoid damage by ultraviolet rays. A thorough systemic evaluation is advisable to rule out any systemic disease which may affect the outcome of the treatment.

Enhancing Healthcare Team Outcomes

Anytime a patient visits a clinic or emergency department for symptoms of visual impairment the primary care provider should be responsible for quick referral of the patient to an ophthalmologist.[14] The management of cataract differs based on the severity of disease, visual impairment, and age of the patient. The mainstay of treatment is usually surgical cataract extraction. Patients who have mild symptoms can receive treatment as an outpatient with refractive glasses and pupillary dilatation. Those with more severe disease or with advanced age should be advised elective surgery as a day-case procedure.[15]

Response to refractive glasses in the early stage of cataract is usually satisfactory. If outpatient therapy by refractive glasses and pupillary dilatation fails to show improvement, patients should undergo hospitalization for surgical cataract removal with intraocular lens implantation. No studies have revealed any link between prescription of systemic steroids or steroids eye drops and the recurrence or complication of cataract, and thus steroids are not routinely prescribed. For most patients who obtain prompt treatment, the results are excellent, but for those who have a delay in treatment or have a mature or complicated disease, there may be steady or poor vision following recovery.

Diagnosis and treatment of cataracts require an interdisciplinary team approach, to include primary care providers (physicians, PAs, NPs), specialists (ophthalmologists, ophthalmic surgeons), and nursing support. This approach helps to ensure timely and effective patient care and optimal outcomes. [Level V]


Interested in Participating?

We are looking for contributors to author, edit, and peer review our vast library of review articles and multiple choice questions. In as little as 2-3 hours you can make a significant contribution to your specialty. In return for a small amount of your time, you will receive free access to all content and you will be published as an author or editor in eBooks, apps, online CME/CE activities, and an online Learning Management System for students, teachers, and program directors that allows access to review materials in over 500 specialties.

Improve Content - Become an Author or Editor

This is an academic project designed to provide inexpensive peer-reviewed Apps, eBooks, and very soon an online CME/CE system to help students identify weaknesses and improve knowledge. We would like you to consider being an author or editor. Please click here to learn more. Thank you for you for your interest, the StatPearls Publishing Editorial Team.

Cataract - Questions

Take a quiz of the questions on this article.

Take Quiz
What does the absence of the red reflex suggest?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A patient with cataracts will complain of which of the following?

(Move Mouse on Image to Enlarge)
  • Image 4202 Not availableImage 4202 Not available
    Contributed by Wikimedia Commons, Rakesh Ahuja, MD (CC by 2.0) https://creativecommons.org/licenses/by/2.0/
Attributed To: Contributed by Wikimedia Commons, Rakesh Ahuja, MD (CC by 2.0) https://creativecommons.org/licenses/by/2.0/



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A newborn has absence of red reflex at only one eye. What is the most likely diagnosis?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A mother comes with her six months baby boy with a complaint that her baby does not respond to her and there is something whitish in his both eyes associated with watering which was present at the time of birth. She gives a history of gestational diabetes and high-grade fever with hospital admission in her 15th week of pregnancy. On examination, there is a white reflex present bilaterally. Which of the following diseases may cause congenital cataracts in a newborn?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following is not true about congenital cataracts?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 50-year-old white American male with diabetes mellitus for the last ten years is on oral hypoglycemics with poor glycemic control presents with a complaint of a decrease in vision and diplopia in both eyes for the last three months. Visual acuity is 6/36 in both eyes and on slit lamp examination bilateral lens opacities are seen. Which of the following can be a mechanism involved in cataract formation in patients with diabetes?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 25-year-old male normotensive, with diabetes mellitus for one year and is on insulin therapy with a good glycemic control presents with a chief complaint of bilateral decrease of vision which is painless gradual, and progressive associated with watering and diplopia. He also gave a history of road traffic accident and trauma to both eyes three months ago. On examination, visual acuities are 6/36 and 6/60 in the right and left eyes respectively. On slit lamp examination there are bilateral lens opacities. What is the most common cause of bilateral cataracts in adolescence and youth?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What symptom is associated with cataracts?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which is true about nuclear cataracts?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 24-year-old patient presents with cloudy vision and halos around lights in his right eye. He reports having had to change his glasses prescription in the right eye only a few weeks ago. What is the most common cause of this patient's symptoms?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A patient presents in the outpatient department with chief complaints of diplopia and blurring of vision for the last five months. On examination, visual acuity in the right eye is 6/60 and left eye in 6/18, and opacity is seen behind the lens in the right eye on slit-lamp examination. Which one of the followings mechanisms is a cause of this patient's finding?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A patient presents to the clinic with complaints of progressively decreasing visual acuity and inability to see at night. The patient denies any ocular pain. For the past year, she reports frequent visits to her eye doctor for changes in her glasses prescription. On physical examination, there is some haziness seen in the pupils bilaterally. Where is the most likely site of pathology?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A patient presents with sudden vision loss, extreme pain, and redness of her left. Past medical history shows the patient underwent intraocular lens placement in her left eye 2 days ago. On examination, there is chemosis, corneal haziness, and hypopyon. What is the most likely diagnosis?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 30-year-old normotensive and normoglycemic woman with a past medical history of COPD presents with a complaint of the bilateral decrease in vision. On examination, her visual acuity is 6/36 in both eyes. IOP is 14 in the right and 12 in the left eye. The red reflex is absent in both eyes, and opacities are noted in the anterior chamber. What is the best next step in treatment for this patient?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A patient presents to the clinic with reports of foggy vision. He has a history of hypertension and diabetes, both of which are well-controlled. He had cataract surgery in the left eye four months ago. Currently, he is experiencing excessive watering of his eyes, but no pain. His vital signs are within normal limits. On examination, there is posterior capsular thickening noted in the left eye. Which of the following is the ideal management for this patient?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 70-year-old female patient presents to the clinic with a chief complaint of blurring and decreased vision with diplopia and glare in both eyes for three months. She has a history of diabetes, well-controlled on oral hypoglycemics. The decrease in vision was painless, gradual, and progressive associated with watering from both eyes. She is diagnosed as a case of bilateral cataract and planned for surgical removal of the cataract with Intraocular lenses (IOL) implantation. During surgery by phacoemulsification of the lens, the surgeon experienced a sudden deepening of the anterior chamber, momentary pupillary dilatation, falling away of the nucleus, vitreous aspirates on phaco tip and vitreous gel. Which of the following is the most likely complication that has occurred during the surgery?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up

Cataract - References

References

Rong X,Rao J,Li D,Jing Q,Lu Y,Ji Y, TRIM69 inhibits cataractogenesis by negatively regulating p53. Redox biology. 2019 Mar 2;     [PubMed]
Takata T,Matsubara T,Nakamura-Hirota T,Fujii N, Negative charge at aspartate 151 is important for human lens αA-crystallin stability and chaperone function. Experimental eye research. 2019 Mar 5;     [PubMed]
Chew FLM,Qurut SE,Hassan I,Lim ST,Ramasamy S,Rahmat J, Paediatric cataract surgery in Hospital Kuala Lumpur - A 5-year review of visual outcomes. The Medical journal of Malaysia. 2019 Feb;     [PubMed]
Ren Y,Fang X,Fang A,Wang L,Jhanji V,Gong X, Phacoemulsification With 3.0 and 2.0 mm Opposite Clear Corneal Incisions for Correction of Corneal Astigmatism. Cornea. 2019 Mar 5;     [PubMed]
Vlastra W,Claessen BE,Beijk MA,Sjauw KD,Streekstra GJ,Wykrzykowska JJ,Vis MM,Koch KT,de Winter RJ,Piek JJ,Henriques JPS,Delewi R, Cardiology fellows-in-training are exposed to relatively high levels of radiation in the cath lab compared with staff interventional cardiologists-insights from the RECAP trial. Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation. 2019 Mar 6;     [PubMed]
Yanshole VV,Yanshole LV,Snytnikova OA,Tsentalovich YP, Quantitative metabolomic analysis of changes in the lens and aqueous humor under development of age-related nuclear cataract. Metabolomics : Official journal of the Metabolomic Society. 2019 Feb 26;     [PubMed]
Katargina LA,Kruglova TB,Trifonova OB,Egiyan NS,Kogoleva LV,Arestova NN, [Refraction in pseudophakic eyes after surgical treatment of congenital cataracts]. Vestnik oftalmologii. 2019;     [PubMed]
Gürsel Özkurt Z,Balsak S,Çamçi MS,Bilgen K,Katran İH,Aslan A,Han ÇÇ, Approach of Family Physicians to Pediatric Eye Screening in Diyarbakır Turkish journal of ophthalmology. 2019 Feb 28;     [PubMed]
Sugawa H,Matsuda S,Shirakawa JI,Kabata K,Nagai R, [Preventive Effects of Aphanothece sacrum on Diabetic Cataracts]. Yakugaku zasshi : Journal of the Pharmaceutical Society of Japan. 2019;     [PubMed]
Aly MG,Shams A,Fouad YA,Hamza I, Effect of lens thickness and nuclear density on the amount of laser fragmentation energy delivered during femtosecond laser-assisted cataract surgery. Journal of cataract and refractive surgery. 2019 Feb 27;     [PubMed]
Grzybowski A,Kanclerz P,Muzyka-Woźniak M, Methods for evaluating quality of life and vision in patients undergoing lens refractive surgery. Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie. 2019 Mar 1;     [PubMed]
Lee MD,Chen SP,Chen TA,Leibold C,Li Z,Fisher AC,Lin CC,Singh K,Chang RT, Characteristics of cataract surgery patients influencing patient satisfaction scores. Journal of cataract and refractive surgery. 2019 Feb 26;     [PubMed]
Shute TS,Varma DK,Tam D,Klein T,Moinul P,Ahmed IIK,Sheybani A, Seasonal Variation in the Incidence of Malignant Glaucoma after Cataract Surgery. Journal of ophthalmic     [PubMed]
Comba OB,Pehlivanoglu S,Bayraktar Z,Albayrak S,Karakaya M, Pantoe Agglomerans Endophthalmitis after Phaco Surgery: The First Case in Literature. Ocular immunology and inflammation. 2019 Feb 27;     [PubMed]
Zhuang M,Fan W,Xie P,Yuan ST,Liu QH,Zhao C, Evaluation of the safety and quality of day-case cataract surgery based on 4151 cases. International journal of ophthalmology. 2019;     [PubMed]

Disclaimer

The intent of StatPearls is to provide practice questions and explanations to assist you in identifying and resolving knowledge deficits. These questions and explanations are not intended to be a source of the knowledge base of all of medicine, nor is it intended to be a board or certification review of Nurse-Child Health PN. The authors or editors do not warrant the information is complete or accurate. The reader is encouraged to verify each answer and explanation in several references. All drug indications and dosages should be verified before administration.

StatPearls offers the most comprehensive database of free multiple-choice questions with explanations and short review chapters ever developed. This system helps physicians, medical students, dentists, nurses, pharmacists, and allied health professionals identify education deficits and learn new concepts. StatPearls is not a board or certification review system for Nurse-Child Health PN, it is a learning system that you can use to help improve your knowledge base of medicine for life-long learning. StatPearls will help you identify your weaknesses so that when you are ready to study for a board or certification exam in Nurse-Child Health PN, you will already be prepared.

Our content is updated continuously through a multi-step peer review process that will help you be prepared and review for a thorough knowledge of Nurse-Child Health PN. When it is time for the Nurse-Child Health PN board and certification exam, you will already be ready. Besides online study quizzes, we also publish our peer-reviewed content in eBooks and mobile Apps. We also offer inexpensive CME/CE, so our content can be used to attain education credits while you study Nurse-Child Health PN.