By James C. Bobrow, MD

This part underwent significant revision for the 2008-2009 version. part eleven studies the anatomy, body structure, embryology, and pathology of the lens. It additionally covers the epidemiology of cataracts and their assessment and administration in adults. furthermore, an summary of lens and cataract surgical procedure is supplied, problems of cataract surgical procedure are mentioned, and cataract surgical procedure in precise events is explored. includes many new photographs.

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Extra info for 2008-2009 Basic and Clinical Science Course: Section 11: Lens and Cataract (Basic and Clinical Science Course 2008-2009)

Sample text

In support of this theory, an anteroposterior gradient was found for both ions: potassium was concentrated in the anterior lens; sodium, in the posterior lens. Conditions such as refrigeration that inactivate the energy-dependent enzyme pumps also abolish these gradients. Most of the Na+,K+-ATPase activity is found in the lens epithelium and the superficial cortical fiber cells. The active transport mechanisms are lost if the capsule and attached epithelium are removed from the lens but not if the capsule alone is removed by enzymatic degradation with collagenase.

The wedge-shaped opacities may spread to adjacent fiber cells and along the length of affected fibers, causing the degree of opacity to increase and extend toward the visual axis. When the entire cortex from the capsule to the nucleus becomes white and opaque, the cataract is said to be mature (Fig 5-5). In mature opacities, the lens takes up water, swelling to become an intumescent cortical cataract. A hypermature cataract occurs when degenerated cortical material leaks through the lens capsule, leaving the capsule wrinkled and shrunken (Fig 5-6).

The ciliary muscle is a ring that, upon contraction, has the opposite effect from that intuitively expected of a sphincter. When a sphincter muscle contracts, it usually tightens its grip. However, when the ciliary muscle contracts, the diameter of the muscle ring is reduced, thereby relaxing the tension on the zonular fibers and allowing the lens to become more spherical. Thus, when the ciliary muscle contracts, the axial thickness of the lens increases, its diameter decreases, and its dioptric power increases, producing accommodation.

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