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What is cataract???
What is the need to know
about it ?????????
62.6%
“BURDEN OF
CATARACT “
Global urban blindness
- 50 million in 2000
Will grow to
- 75 million by 2020 unless special efforts to arrest / reverse this
THIS BURDEN IS HEAVIER FOR A DEVELOPING COUNTRY LIKE OURS
WHYYY???????
poor uptake ofservices due to llack
Projected in population of pt information
the burden becomes heavier
in our countryOccurs a decade earlier
life expectancy
TREATABLE
CAUSE
OF BLINDNESS
•
VISION 2020 - RIGHT TO SIGHT
ANATOMY – LENS &ETIOPATHOGENESIS OF CATARACT
Who said …….. “ UNION IS AN ONION “
We can say…….
“ LENS IS AN ONION “
A REGULAR RECORD OF OUR AGE !!!
zonules
Do you know…!!!!!!!!!…
organ that grows through out life..???
Thickest basement membrane in our body..??
Least hydrated organ in our body…??
Structure with Highest protein content…….??
Blood supply of lens………. ??
CAPSULE : BY THE – Lens Epithelium FOR THE – Accommodation OF THE - Type 4 collagen
Capsule arround the lens is not uniform in thickness !! Thickest - para equatorial region Thinnest - at poles esp posterior pole
THICKNESS OF CAPSULE AT VARIOUS PARTS :-
EPETHELIUM : single layer of epithelium just beneath the ant. capsule , it forms
CapsuleLens fibers (ant. Preequatorial region)
That’s why,Oldest lens fibers are - DeepestOldest capsule is - Most superficial
EPETHELIUM : single layer of epithelium just beneath the ant. capsule , it forms
CapsuleLens fibers (ant. Preequatorial region)
That’s why,Oldest lens fibers are - DeepestOldest capsule is - Most superficial
EPETHELIUM : single layer of epithelium just beneath the ant. capsule , it forms
CapsuleLens fibers (ant. Preequatorial region)
That’s why,Oldest lens fibers are - DeepestOldest capsule is - Most superficial
EPITHELIUM : single layer of epithelium just beneath the ant. capsule , it forms
Capsule - anteriorlyLens fibers - posteriorly
(ant. Preequatorial region)
That’s why,Oldest lens fibers are - DeepestOldest capsule is - Most superficial
Post.capsule
Epithelium Cortex
Ant.capsule Nucleus
epithelium maturing to lens fiber
ANTERIOR POSTERIOR
ANTERIOR POSTERIOR
CORTEX & NUCLEUS: No cells (lens fibers) are lost As new fibers laid down – it crowds &
compacts the previously formed fibers
thus……., Center to periphery embryonic nuclei fetal nuclei infantile nuclei adult nuclei cortex BUT SURGICAL NUCLEUS & CORTEX????
As you travel from capsule towards nucleus through LENS
Age of fiber Density Protein conc. Enzyme conc. Glutathione O2 Conc.
Na+ K+ Amino acid
Inositol Ca2+ Glucose
LACTIC ACID
Active
Passive
NOTE :
O2 not allowed into the lens
Lactic acid from anaerobic metabolism –high conc. With in lens , so passively diffuses out
Aqueous is the only source of glucose,so it passively diffuses in
GLUCOSE
G – 6 – P
Triose – P
Pyruvate
Sorbital
FructosePOLYOL PATHWAY
CO2 + Acetyl CoA
KREB’S CYCLE CO2 CO2
NADP GSH
HMP Path (15%) NADPH GSSG Pentoses
Lactate
GLYCOLYSIS (50%) (Anerobic)
Aldose reductase
Reactive O2 species :- superoxide O 2
- H2O2 Hydroxyl ion.OH -
Inflamation Mitochondrial e- transport chain 2O2
- + 2H+
SOD
H2O2
GPX GSHAt cytoplasm 2 H2O
(HMP) NADPH GSSG PSH GR TT NADP GSH PSSG
Fenton’s reaction
At cell membrane Catalase H2O + ½ O2
LENS OPACITY Capable of causing some visual loss, measured as acuity loss
FUNCTIONAL CATARACT:
Len opacity causing visual loss sufficient to produce functional disability
CONGENITAL
METABOLIC
ACQUIRED TRAUMATIC
COMPLICATED
TOXIC
SENILE
INFECTIOUS
DIABETICMETABOLIC
Most common type of cataract,
Out of people aged bt,
52 – 64 yrs 4.6 % 65 – 74 yrs 18 % are with 75 – 85 yrs 46 % cataract
CATARACT IS ALWAYS,
But 3 mechanisms of great importance :-
OXIDATIVE STRESS PHOTOOXIDATION GLYCATION
2O-2 + 2H+
SOD
H2O2
GPX GSH
H2O GSSG
HMP NADPH PSH FREE RADICAL GR TT
NADP GSH PSSG
2
1 2
1
2
3
GSHwith aging Deterioration of mech. that protect against oxidative damage
CHROMOPHORE ???? Proteins & DNA are the chromophores in
lensLIGHTS ABSORBED, UVA UVB VISIBLE LIGHT All cells of our body are equally exposed to Light but why damage specifically occur in Lens…??????????
CHROMOPHORE
Direct photochemical Photosensitised
chemically changed chemically unchanged bt chromophore can cause it in another molecule eg. tryptophan
free radicals
LYCATION a condensation reaction bt amino grp of protiens &reducing sugars
GLYCATING AGENTS :- GLUCOSE G – 6 – P Ribose DHA (Oxidised ASA)
DIABETIC
Protien – NH2 + Glucose
EG Pdt (MORE IN CORTEX)
AGE Pdt (MORE IN NUCLEUS)
Crosslinking with protiens
conformational change aggregation
BrownPigmentation
To summaries as we grow older…….
Mitochondrial func.
Superoxide production
Loss of UV filters in nucleus
UV absorption
Photosensitisers
Total no: of photons absorbed
Every 5 th person visiting a physician is diabetic
Amount of AGEs
CORTEX – NUCLEUS interface develops
INDIA - DIABETIC CAPITAL OF THE WORLD
11.6% of urban indians are diabetic
3 to 4 fold increase in incidence of cataract in diabetic pts under 65 yrs,
High Diabetic age Poor control
Invites cataract earlier
Do You Think A Person Above 50 Is Going To come With Problem of cataract
Alone…….??????
CATARACT is always MULTIFACTORIAL
GSH PROTEIN MODIFICATION CATARACT
↓ GSH
↓Free a.a
↓Protein syn. loss of enzymes↓Glycolysis
↓ ATP
DIABETES
↑Glucose Sorbital
↓NADPH ↑G-6-P fructose
PROTEIN MODIFICATION
Croslinkng bt proteins
Aggregation of proteins
Na+-K+ ATPase
Ionic imbalance
↑Ca2+ osm shock
proteolysis
Malnutrition DIARRHOEA FAILURE
↑ Urea
↑ Cyanate
STEROID
↑Glucose Sorbital
↓NADPH ↑G-6-P fructose
↓ GSH PROTEIN MODIFICATION
Croslinkng bt proteins
Aggregation of proteins
Ionic imbalance
OTHER FACTOR INFLUENCING CATARACT :-
CONGENITAL
ACQUIRED
METABOLIC
TRAUMATIC
COMPLICATED
TOXIC
SENILE
INFECTIOUS
14% Of all cases of childhood blindness
20% - RUBELLA20% - HEREDITARY . DOMINANT 6% - WITH OCCULAR ANOMALIES35-50% - SPORADIC
5 % EACH
TAKE HOME……
Senile Cataract Is always multifactorial….
Poor control & high diabetic age…..
Congenital cataract – rubella,again is preventable
Public education- can result better utility of services
And…