By James C. Bobrow, MD
This part underwent significant revision for the 2008-2009 variation. part eleven studies the anatomy, body structure, embryology, and pathology of the lens. It additionally covers the epidemiology of cataracts and their review and administration in adults. additionally, an summary of lens and cataract surgical procedure is supplied, problems of cataract surgical procedure are mentioned, and cataract surgical procedure in designated occasions is explored. comprises many new pictures.
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Additional resources for 2008-2009 Basic and Clinical Science Course: Section 11: Lens and Cataract (Basic and Clinical Science Course 2008-2009)
The normal intracellular level of calcium in the lens epithelial cells is approximately 100 nanomolars, whereas the exterior calcium level is close to 1 mM. This large transmembrane calcium gradient is maintained primarily by the calcium pump (Ca2+-ATPase). The lens cell membranes are also relatively impermeable to calcium. Free calcium levels in lens fiber cells are much higher, averaging 10 micromolars. Loss of calcium homeostasis can be highly disruptive oflens metabolism. Increased levels of calcium can result in many deleterious changes, including depressed glucose metabolism, formation of high-molecular-weight protein aggregates, and activation of destructive proteases.
Chemical modification oflens nuclear proteins also increases pigmentation, such that the lens increasingly takes on a yellow or brownish hue with advancing age (Fig 5-1). Other age-related changes include decreased concentrations of glutathione and potassium and increased concentrations of sodium and calcium in the lens cell cytoplasm. A very common cause of visual impairment in older adults is age-related cataract, the pathogenesis of which is multifactorial and not completely understood. There are 3 main types of age-related cataracts: nuclear, cortical, and posterior subcapsular.
A laser iridotomy may also be useful in relieving angle closure in patients with microspherophakia. ) Aniridia Aniridia is an uncommon panocular syndrome in which the most dramatic manifestation is partial or nearly complete absence of the iris (Fig 4-8). Aniridia has been linked to the loss of one allele of the PAX6 gene, a transcription factor that is important for the development Figure 4-8 Cataract in aniridic patient. 34 . Lens and Cataract and function of the cornea, lens, and retina. Associated findings include corneal pannus and epitheliopathy, glaucoma, foveal and optic nerve hypoplasia, and nystagmus.
2008-2009 Basic and Clinical Science Course: Section 11: Lens and Cataract (Basic and Clinical Science Course 2008-2009) by James C. Bobrow, MD