最新白内障幻灯片.ppt

打一疾病 不红不痛渐昏朦，薄雾轻烟渐渐浓。 初时一眼先昏暗，数日逐渐障双瞳。 千金难买药见效，金针一拨当日空。 cataract 胜利医院 林雪媛 教学目的 了解白内障的发生原因及其分型。 掌握老年性白内障各型的特点。 掌握白内障的手术适应症及白内障术后矫正视力的方法。 了解先天性白内障和代谢性白内障的分型及特点。 了解晶状体脱位的分型及临床表现。 What is cataract? A cataract is an opacity(or cloudy changes) of the lens that can cause vision problems. 任何先天性或后天性因素引起的晶状体 混浊使其透明性下降，称为白内障。 LENS The lens is surrounded by a thick lens capsule which is the basement membranae of the lens epithelial cells. 晶状体囊是一层包绕整个晶状体的透明囊状基底膜。 Epithelial cells at the lens equator continue to be produced throughout life,so that older lens fibers are compressed into a central nucleus; younger fibers around the nucleus make up the cortex. 位于晶状体赤道部囊下的上皮细胞终生增殖，不断形成晶状体纤维，将旧的纤维挤向中心的核，核外较新较疏松的纤维构成皮质。 causes Aging most common Long-term ultraviolet (UV) light, especially from sunlight Diabetes or other systemic disease Past eye infections, injuries or surgery Smoking Long-term use of certain medications (such as steroids) heredity Pathogenesis The lens is made mostly of water and protein. The protein is arranged to let light pass through and focus on the retina. Sometimes some of the protein clumps together. This can start to cloud small areas of the lens, blocking some light from reaching the retina and interfering with vision. 晶状体主要由水和蛋白组成。发生白内障的晶状体特征性改变是蛋白之间的交联形成聚合物，使光线散射增强，晶状体透明度下降。 自由基引起的氧化损伤 晶状体上皮细胞氧化损伤——膜蛋白降解——细胞膜通透性增加——晶状体内渗透压增高、肿胀；晶体蛋白之间二硫键形成增多——蛋白交联形成高分子量聚合物——光散射增强，晶状体混浊。 细胞凋亡及其调控 Clinical Findings Symptoms Blurring or dimness of vision 视力下降 colors appear faded 色觉改变 Sensitivity to light and glare 眩光 Double or multiple vision 复视或多视 Change in refraction 屈光改变 Eye Exam Vision acuity test Slit lamp Ophthalmoscope In most cases, eye drops are used to dilate (widen) pupils before the exam. Tonometry classification 判断晶状体混浊范围和程度 将瞳孔充分散大，采用裂隙灯和后照法，区别晶状体混浊的类型 核性（N）、皮质性（C）、后囊下（P）、核的颜色（NC） 晶状体核硬度分级标准 （据 NC） Ⅰ度：透明，无核，软性； Ⅱ度：核呈黄白色或黄色，软核； Ⅲ度：核呈深黄色，中等硬度核； Ⅳ度：核呈棕色或琥珀色，硬核； Ⅴ度：核呈棕褐色或黑色，极硬核。 Age-related c