A complicated cataract refers to lens opacification caused by underlying ocular diseases.
Etiology
The condition results from disturbances in lens nutrition or metabolism due to ocular inflammation or degenerative changes. It is commonly associated with uveitis, retinitis pigmentosa, retinal detachment, glaucoma, intraocular tumors, and high myopia.
Clinical Features
Patients exhibit symptoms of the primary ocular condition, and the cataract may occur in one or both eyes. When caused by anterior segment diseases, opacification often begins in the anterior cortex. When caused by posterior segment diseases, early changes manifest as granular gray-yellow opacities in the posterior pole of the lens capsule and subcapsular cortex, accompanied by the formation of numerous vacuoles. These changes gradually extend toward the central nucleus and peripheral areas of the lens in a radial pattern, leading to a rose-like opacity. The opacification may subsequently spread to the anterior cortex, eventually resulting in a fully opaque lens. Over time, water absorption decreases, the lens capsule thickens, the lens shrinks, and calcification may occur. Cataracts associated with glaucoma often originate in the anterior cortex and nucleus, while those caused by high myopia are typically nuclear cataracts.
Diagnosis
The morphology and location of lens opacities can assist in diagnosis. Additionally, accurately diagnosing the underlying disease is critical for the diagnosis and management of complicated cataracts.
Treatment
Treatment of the primary ocular condition is fundamental.
Complicated cataracts that interfere with work or daily life may require surgical removal, provided the affected eye demonstrates accurate light localization and normal red-green color perception. Decisions regarding intraocular lens implantation following cataract extraction should be made cautiously, based on the status of the underlying disease.
Complicated cataracts associated with inflammatory conditions may have variable responses to surgery, with some cases resulting in severe postoperative complications. Surgical intervention should be considered only after ensuring adequate control of ocular inflammation, depending on the type of primary disease.
Postoperative use of topical or systemic glucocorticoids should involve adjustments to dosage and duration based on disease progression and clinical response.