Ophthalmology Department of Peking Union Medical College Hospital
TraumaticcataractMost of the injuries are complicated, and their morphological characteristics are also complicated.Most cases can describe obvious traumatic history. However, in infants, traumatic cataract without clear trauma must not be ignored.After the lens is turbid at the injured part, it will soon hydrate and form vacuolesedema。The turbidity quickly spreads to the periphery of the crystal, and finally leads to the turbidity of the whole crystal.
Foreign name
traumatic cataract
Visiting department
Ophthalmology Department
Multiple population
teenagers
Common location
eye
Common causes
Crystal injury, especially perforation injury
common symptom
After the lens is turbid at the injured part, it will soon hydrate, forming vacuoles, edema, etc
After lens injury, especially perforation injury, aqueous humor enters the lens from the break of capsule membrane. A large number of water-soluble proteins, especially γ - crystallin, are lost in the lens, glutathione is significantly reduced, and DNA synthesis and cell division are slowed down.After the lens is turbid at the injured part, it will soon hydrate and form vacuolesedema。The turbidity quickly spreads to the periphery of the crystal, and finally leads to the turbidity of the whole crystal.
Sometimes after blunt trauma, typicalcataractChange.Blunt contusioncataractIt can occur alone or combined with subluxation or complete dislocation of lens.The earliest change is the posterior subcapsular opacification directly facing the pupil area, which is similar to the complicationcataractStar shaped appearance or chrysanthemum like turbidity.In most cases, bluntcataractComplicated with traumaIridocyclitis, posterior pupillary adhesion, and secondary iris swelling in severe casesglaucomaPerformance.
2. Cataract caused by eyeball perforation
If the wound of capsule rupture is very small, the lens remains intact, and only local turbidity occurs.After penetrating injury, the lens cortex was in the "bath" of aqueous humor for a long time and was continuously absorbed.When most of the cortex is finally absorbed, the anterior and posterior capsule walls attach, forming a cataract caused by the so-called ocular perforation injury.
3. Lens rust and copper rust
What is of special significance is the long-term retention of copper and iron that are prone to oxidation in the eye, resulting in the so-called "lens copper rust" and "lens iron rust".The former is mostly in sunflower like appearance with copper green reflection;The latter, as part of the degeneration of the whole eye tissue, has a yellow lens opacity.
4. Shock cataract
Sometimes cataracts can occur in both eyes, and their shape is similar to that of blunt cataract.In most cases, the opacity is still and does not develop. In some cases, the rate of development is fast. In a few weeks or even days, the lens is completely opaque.
inspect
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1. Lighting inspection method
Illuminate directly with light to see if the crystal is turbid and dislocated.
2. Projection method
The fine light is projected from the edge of the pupil to the crystal at an oblique angle of 45 degrees. If the crystal turbidity is located in the core, there is a crescent shaped transparent area between the turbid area and the edge of the pupil. The heavier the turbidity, the narrower the shadow.If the crystal is completely turbid, the crescent shadow will disappear completely.
3. Mirror penetration method
Put the light into the pupil area. Normally, a uniform red shadow can be seen. If the crystal or refractive stroma is cloudy, black spots or black blocks can be seen in the red shadow. During the examination, the patient can rotate his eyes to see if the black shadow moves.
4. Lamp inspection method
The slit lamp was used for optical section inspection. From front to back, many light and dark layers were visible, representing the lens nucleus at different periods. The transparency of each layer was not completely consistent, and the anterior capsule, the anterior surface of the adult nucleus, and the posterior surface of the embryo were relatively clear.
diagnosis
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Combined with medical history and examination, the diagnosis was clear.
