CATARACT Written by Dr. Mukesh Dhiman

CATARACT

Definition
It is the development of an opacity in the lens the crystalline lens is a transparent structure. Its transparency may be disturbed due to degenerative process leading to opacification of lens fibres.

Classification
A. Etiological Classification
i. Congenital and developmental cataract.
ii. Acquired Cataract

1. Senile cataract.
2. Traumatic cataract
3. Complicated cataract
4. Metabolic cataract.
5. Electric cataract
6. Radiational cataract
7. Toxic Cataract.

 

• a. Corticosteroid induced cataract
• b. Miotics induced cataract
• c. Copper (in chalcosis) and iron (in siderosis) induced cataract.

8. Cataract associated with osseous diseases
9. Cataract associated with skin diseases (dermatogenic cataract).
10. Cataract with miscellaneous syndromes

• a. Dystrophica Myotonica
• b. Down’s syndrome
• c. Lowe’s syndrome
• d. Treacher-collin’s syndrome.

1. Morphological classification
Capsular cataract it involves the capsule and may be

• i. Anterior Capsular cataract.
• ii. Posterior capsular cataract.

2. Sub capsular cataract: It involves the superficial part of the cortex (just below the capsule) and includes.

• i. Anterior sub capsular cataract
• ii. Posterior Sub capsular cataract.

3. Cortical cataract : It involves the major part of cortex.

4. Supranuclear cataract: It involves only the deeper parts of cortex (just outside the nucleus).

5. Nuclear cataract : It involves the nuclear of the crystalline lens
.
6. Polar cataract: It involves the capsule and superficial part of the cortex in the polar region only and may be:

• i. Anterior pole cataract.
• ii. Posterior pole cataract.

Congenital and Developmental cataracts
These occur due to disturbance in the formation of lens fibres i.e. instead of clear, opaque fibres are produced. Congenital cataract:
This type of cataract develops when there is disturbance in the normal growth of the lens before birth. Therefore, in congential cataract the opacity is limited to either embryonic or foetal nucleus.

Developmental Cataract
It can occur from infancy to adolescence. Therefore, such opacities may involves infantile or adult nucleus, deeper parts of cortex or capsule.

Clinical types

1. Congenital capsular cataracts

• i. Anterior capsular cataract.
• ii. Posterior capsular cataract.

2. Polar cataract

• i. Anterior polar cataract.
• ii. Posterior polar cataracts.

3. Nuclear cataract
4. Lamellar cataract
5. Sutural and axial cataracts

• i. Floriform cataract
• ii. Coralliform cataract
• iii. Spear shaped cataract
• iv. Anterior axial embryonic cataract.

6. Generalized cataracts

• i. Coronary cataract.
• ii. Blue dot cataract
• iii. Total congenital cataract.
• iv. Congenital membranous cataract.

Acquired Cataract
Here, the opacification occurs due to degeneration of the already formed normal fibres. Any factor which disturbs the critical intracellular and extra cellular equilibrium of water and electrolytes within lens fibres, tends to bring about opacification.
Senile Cataract
It is also called as age related cataract. This is commonest type of acquired cataract affecting equally persons of either sex usually above the age of 50 years. The condition is usually bilateral, but almost always one eye is affected earlier than the other.

Types

• 1. Cortical (Soft cataract)
• 2. Nuclear (hard Cataract)

Cortical senile cataract

• a. Cuneiform cataract (more common)
• b. Cupuliform cataract.

Metabolic Cataract : These cataract occur due to endocrine disorders and biochemical abnormalities.

Types
1. Diabetic cataract
2. Galactosaemic cataract
3. Hypocalcaemic cataract
4. Cataract due to error of copper metabolism
5. Cataract in lowe’s syndrome

Complicated Cataract
It refers to opacification of the lens secondary to some other intra ocular disease.

Toxic Cataract
1. Corticosteroid-induced cataract.
Posterior subcasular opacities are associated with the use of topical as well as systemic steroids.
2. Miotics induced cataract
Anterior subcasular granular type of cataract may be associated with long term use of miotics.
3. Other toxic cataracts
Other drugs associated with fine toxic cataract are:
Amiodarone
Chlorpromazine
Busulphan
Gold
Allopurinal

Radiational Cataract
Exposure to almost all types of radiant energy is known to produce cataract by causing damage to the lens epithelium.

Types
1. Infrared (heat) Cataract
2. Irradiation cataract
3. Ultraviolet radiation cataract.

Electric cataract
It occurs after passage of powerful electric current through the body. The cataract usually starts as punctate subcapsular opacities which mature rapidly.
Corelation of Lingnash with Catarac
In Sushruta Samhita uttarardh chapter-3 Drishtigat Roga are described. Under these six types of Ling Nash are described
1. Vataj Ling Nash
2. Pittaj Ling Nash
3. Kaphaj or Shlaishmik ling nash
4. Raktaj Ling Nash
5. Tridoshaj or Sannipataj Ling Nash.
6. Sansargaj Timir or Parimlaikach.

Lingnash
It is a disease in which there is loss of vision. It appears when doshas enters the fourth patal. So, this ling nash is Co-related with the Cataract as both diseases involves the loss vision and affects the lens. Out of six types of Ling nash:
- Shlaishmik ling nash is sadhya i.e. curable with Shastra karma (Surgery).
- Other five types are Asadhya i.e. incurable.

Treatment of Lingnash, (Cataract) Shastrakarma Vidhi-

Surgical Procedure
Contra Indications
1. Any crescent shaped mark on Drishtimani (the lens).
2. A pearl or water drop like mark on the lens.
3. Any, firm, irregular, thin, painful and Reddish, lesion on Drishti (lens).
If these features are present, the Shastrakarma should not be performed in that Ling Nash.

SHASTRAKARMAVIDHI(SURGICAL PROCEDURE)

1 Before shastrakarma (surgery) Snehan and Svedan karma should be performed on patient .
2 Then during favourable conditions make the patient stable.
3 Ask the patient to see towards his own nose This causes the Krishanmandal (cornea) to come medially .
4 After that divide the white of eye into three equal parts.
5 Then towards the Apangpradesh (lateral canthus)
In well opened eye and at the site without blood vessles, neither very high nor very low and neither laterally but after two parts confidentely with middle finger, index finger and thumb make a puncture with Yav vakra shalaka.
6 If right eye is to be punctured then left hand should be used and if left eye is to be punctured the right hand should be used.

SAMYAG VEDHAN LAKSHAN (FEATURES OF SUCCESSFUL SURGERY)
1 A specific type of sound is heard.
2 A water drop like substance oozes out from the site of puncture.
3 Drishtimandal looks clear like the sky without clouds.
4 Absence of pain.

PASHCHAT KARMA (POST SURGICAL PROCEDURE)
1 Irrigation of punctured site with human milk.
2 Svedan after covering the opened eyes with Vatanashak hot Erand patra coated with Ghrit(Ghee).
3 After svedan, for the removal of remaining doshas the Lekhan karma should be performed with the distal end of Shalaka at Drishtimandal.
4 Every third day the eyes should be washed with Vatanashak Kashaya and svedan should also be performed at third day.
5 Light food to eat.
6 Gehun, shalidhan Mung dal, Shasti, Ghee, Jangal Mans, Triphala, Draksha, Aakashodak.
7 Chatra, Juta, Dosha Nirharan.

Apathya 1. Udgara Kasa, Spitting, Jerking movement should not be performed immediate after surgery.
2. Diet same like as that in the persons after snehpan.