眼科学教学课件：晶状体病

LensDisease

晶状体病

Dioptricmedia

屈光介质lensAnatomybiconvex双凸、flexible有弹性、avascular无血管,nutritionisderivedfromaqeuoushumor.LocationBetweenirisandvitreousbddySupportCiliaryzonuleAnatomy

Capsular晶状体囊膜AnteriorCapsularepithelial前囊下上皮Cortex皮质Nuclecs核Cataract

白内障Lensopaque(浑浊）

causedbyanyreasonsClassificationPathogenesis病因Senile老年性Traumatic外伤性Metabolism代谢性Toxic中毒性Developmental发育性After后发性………Time时间

CongenitalAcquiredOpaqelocation部位

CorticalNuclearsubcapsularOpaqeform形态Punctate点状Coronary冠状Lamella板层Degree程度

Immature未熟Mature成熟Hypermature过熟Senilecataract老年性白内障

Agerelatedcataract年龄相关性白内障Pathogen：haverelationshipwithoxidativedamage(氧化损伤)SymptomBlurpainlesslyandgradually

ClinicalfeatureSignlensopaque

Senilecataract

classification皮质性白内障corticalcataract

核性白内障nuclearcataract囊膜下白内障subcapsularcataract

Stagesofcorticalcataractincipientstage初发期空泡水裂板层分离楔形混浊呈轮辐状intumescentstage肿胀期晶体混浊加重，晶体内水分增加，晶体膨胀，前房变浅maturestage成熟期晶体完全混浊，晶体内水分及分解物逸出囊膜，晶体回复原形状，前房恢复hypermaturestage过熟期晶体水分继续丢失，体积缩小，囊膜皱缩晶体核下沉

白内障相关分级LocsII分级N0-3C0-5P0-4

Emery分级I-V度nuclearcataract

核性白内障

Onset:youngProgressslowlyStartfromfetalnucleusoradultnucleusMyopiasubcapsularcataract

囊膜下白内障

location:superficalcortexofpoteriorcupsularSmallcavityCrystallineparticleAffecteyesightearlyTreatmentSurgeryFirstchoiceDruguncertaintCtaractSurgeryOperationopportunity:

early:mature

now:accordingtopatient’sneedsOperationchoice:IntracapularcataractextrationICCE(白内障囊内摘除）Extracapularcataractextration

ECCE（白内障攮外摘除）Phcoemulsification

Phaco

（超声乳化）

Congenitalcataract

先天性白内障

lensopacificationatbirthorlensbecomesopaqueoneyearafterbirth.

hereditary遗传Virusinfection病毒感染Drugorradioactiveray药物或放射线Systemicdisease全身性疾病Congenitalcataract

Classificaion

anteriorpolarcataract前极性白内障posteriorpolarcataract后极性白内障coronarycataract冠状白内障punctatecataract点状白内障

perinuclearcataract绕核性白内障nuclearcataract核性白内障

totalcataract全白内障

membranecataract膜性白内障Congenatalcataract临床特点

多双眼长期静止视力情况与晶体混浊程度相关低视力表现

PoorfixationNystagmus(眼球震颤）Amblyopia（弱视）Leukocoria（白瞳症）治疗

目的：恢复视力，减少弱视方法：

对视力影响小或无影响：观察

对视力影响明显：尽早手术

Traumaticcataract

外伤性白内障

LensopaquecausedbytraumaTraumaticcataract

classification

penetratingcataract眼球穿通伤所致白内障contusivecataract眼部挫伤所致白内障radiatingcataract辐射性白内障

红外线性电离辐射性（X-ray、-ray）微波性等Metaboliccataract

代谢性白内障

lensopaquecausedbymetabolicdisease病情严重的青少年糖尿病患者双眼发病进展迅速，数天至数月晶体完全混浊前后囊下点状及雪片状混浊至完全混浊治疗：

积极治疗糖尿病病变早期，混浊可部分消退影响视力及时手术积极治疗糖尿病视网膜病变

Diabeticcataract糖尿病性白内障

Metaboliccataract

Galactosecataract半乳糖性白内障

常染色体隐性遗传，半乳糖代谢障碍。给予无乳糖和半乳糖饮食。Tetanycataract手足搐搦性白内障

先天性甲状腺功能不足，血清钙低，影响晶体代谢。补钙；影响视力手术。

Complicatedcataract

并发性白内障

lensopaquecausedbydiseaseinsidetheeye.

应治疗原发病，影响视力手术。Uveitis葡萄膜炎Pigmentarydegenerationofretina视网膜色素变性RetinaldetachmentGlaucomaHighmyopiaIntaoculartumorDrugtoxiccataract

药物中毒性白内障

corticosteroidcataract皮质类固醇性白内障mioticcataract缩瞳剂性白内障chlorpromazinecataract氯丙嗪性白内障trinitrotoluencecataractTNTcat三硝基甲苯性白内障2023/3/10

Aftercataract

后发性白内障

posteriorcapsuleropacitiesaftercataractoperation,PCO

posteriorcapsulotomy后囊膜切开

luxationoflens晶体脱位Pathogens

lenszonuledysplasia

traumasurgery

intraocularinflammationSignstotalluxation

subluxationTreatment:removedislocatedlens

CataractsurgeryDevelopment：

Couchingcataract—ICCE—ECCE—PhacoemusificationIncision：

large—small—minimalVisualquality：benolongerilliteratehighqualityvision

Naturevisionintracapsularcataractextraction

白内障囊内摘除CapsularextactedNoneedmicroscopeIncision12mmIOLcannotbeimplanted白内障囊外摘除

extracapsularcataractextractionCapsularreservedNeed

MicroscopeIncision7mmImplantIOLPhacoemulsification

白内障超声乳化CapsularreservedNeed