diseases of the crystalline...
TRANSCRIPT
Diseases of the crystalline lens
Zoltán Nagy
Department of Ophthalmology, Mária utca
Budapest
Anatomy of the crystalline lens
Physiology of the lens
Development of lens
Diseases of the lens
Anatomy of the crystalline lens
Cataracta
Primary cataracts
– Congenital cataract
– Zonular cataract
– Anterior polar cataract/Posterior polar
– Juvenile cataract
– Senile cataract
– Cortical cataract
– Nuclear cataract
Cataracta
Consecutive catarcts (associated with other eye
diseases
– Complicated or Secondary cataract
• Iridocyclitis
• Heterochromic iridicyclitis
• Degeneratio pigmentosa retinae
• Glaucoma fere absolutum
• Inveterated
– Cataracta in oculo glaucomatoso
– Traumatic cataract
Cataracta
Cataract with general diseases
– Metabolic dieseases
• Diabetic cataract
• Tetanic cataract
• Galactosemic cataract
• Myotonic cataract
• Cortison (steroid) cataract
– Dermatologic diseases
• Cataracta dermatogenes
– Irradiation: Rtg, radium, electric current
– Poisons
• C-, D-vitamin insufficiency, selene overdosage
History
The history of cataract surgery can be
followed during 2600 years
The first written history by Susruta
Anatomical and pathological description
Types of cataracts
„Reclinatio lentis” according to Celsus was
performed until the XVIII th century
History
Among ancient Egyptian and antique Greek historical description there was no mention about cataract surgery
However, in Kos and Samos island knives were found, suitable for cataract surgery (reclination)
Hippokrates: cataract is a discharge in the anterior chamber, was kept until the XVIII th century
History
Celsus: the Indian (Susruta) knows the
cataract surgery from the Alexandrian
school (reclination)
With a special knife a wound was created
and the lens was pushed back into the
vitreous
– Herophilost
– (344-280 yr BC) and Philoxenest (250 yr BC)
were mentioned by names
History
The Medieval Arabic ophthalmology
followed the Alexandrian and Roman
traditions.
Two mentiones were found about cataract
surgery, but these descriptions contained
no new information.
History of the quality assurance
Hammurabi’s Law (XVIII.century
BC) „If a physician make a large incision with the operating
knife, and kill him, or open a tumor with the operating
knife, and cut out the eye, his hands shall be cut off. ”
(Outcome measurement)
History
Europe
Stephan BLAUKAART (The Netherland),
performed a corneal wound
Michel Pierre BRISSEAU 1705, in the
Academy of Sciences in Paris proved that
cataract is caused by the opacification of the
crystalline lens and not a discharge
History
Jaques DAVIEL 1748 (Paris)
– ECCE (extracapsularis cataracta extractio)
Samuel Sharp (London)
– ICCE (intracapsularis ctaracta extractio), he
exprimated the lens by his thumb
PAGENSTECHER (1871) removed the lens
with a special forceps
History
WILLIAMS (1867): sutured the wound
KOLLER (1884): cocaine eye drops foranesthesia
ELSCHNIG (1928): retrobulbaranesthesia
VÖRÖSMARTY, KETTESY: Oculopressure
History
KRAWITZ (1961): Kryoextractio lentis (ICCE)
GYŐRFFY István (1939): he proved for the firt
time that plexi material is biocompatible
Harold RIDLEY (1949) artificial lens from
plexi (war eye injuries)
STRAMPELLI (1953): anterior chamber lens
BINKHORST: iris fixated lens
History
HARMS és McKENSEN (1953):
operating microscopy
Charles KELLMANN (1967):
Phacoemulsification as a historical
landmark
Foreign body in lens
Marfan syndrome
Ectopia lentis
Mesenchymal diseases
– Marfan syndrome
– Marchesani syndrome
– Homocystinuria
Role of trauma
Treatment of the cataract
Extractio lentis intracapsularis
Extractio lentis extracapsularis
Phacoemulsification
– Foldable intraocular lens
– Accomodative and pseudoaccomodative lenses
Postoperative capsular fibrosis and
treatment (YAG capsulotomy)
Treatment of after cataract with
YAG capsulotomy
Accomodative lenses
Crystalens 1 CU Synchrony
Sarfarazi elliptical accomodative lens
Pseudoaccomodativ lenses
Acrysof Restor
Tecnis multifocal intraocular lens
Lenses of the future
Calhoun lens
Future lenses
Injectable polymers
Summary
Great development in treatment of refractive errors by refractive procedures or by the modern lens surgery
Treatment range has been widened, today all kind of refractive errors can be treated surgically.
New tasks: restoration of accomodation and prevention of PCO.
Thank you for your attention!