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Important Forms of Age-Related Cataract

  • Overview of symptoms
  • Nuclear Sclerotic
    • Opacification of the lens nucleus
    • Often associated with myopia
    • Initial yellow, later brown changes of the lens nucleus
    • Grading: Nuclear sclerosis according to BCN 10 (Nuclear Cataract Grading)¹
  • Cortical
    • Can affect anterior, posterior, or equatorial cortex
    • Initial fissures and vacuoles, then typical wedge-shaped or radial, spoke-like opacities
    • Often causes glare
  • Posterior Capsular Opacification
    • Well-visible in retroillumination
    • Opacity located directly in front of the posterior capsule
    • Vacuolated, granular, or plaque-like appearance
    • Often causes glare


  • Immature Cataract: Lens partially opacified
  • Mature Cataract: Lens completely opacified
  • Hypermature Cataract: Shrunken and wrinkled capsule due to water leakage from the lens
  • Morgagnian Cataract: Hypermature cataract where liquefaction of the cortex causes the nucleus to sink downward

Risk Factors

  • Steroid therapy, trauma, UV light, smoking, diabetes, myopia

Postoperative Follow-up Day 1

  • Visual acuity not obligatory
  • Corneal edema?
  • Anterior chamber:
    • Deep? If shallow: Seidel test
    • Cells/flare/fibrin/blood/hypopyon?
    • IOL positioned correctly? Is the posterior capsule intact?
    • Round/distorted pupil? If teardrop-shaped: Vitreous in the anterior chamber?
  • IOP
    • < 5mmHg: Seidel test
      • If anterior chamber is shallow and Seidel test positive -> Bandage contact lens (16mm diameter), Floxal UD 4x/d, Dexafree 4x/d, follow-up after 1-2 days
      • If anterior chamber is collapsed: Inform senior physician/surgeon
    • 5 – 25mmHg: Treatment and follow-up as planned
    • 26 – 35mmHg: Lower IOP
      • Known glaucoma and glaucoma drops not taken yet: Re-administer own glaucoma drops first, follow-up after 1-2 days
      • No known glaucoma: Diamox 250mg 2×1 tbl./d, follow-up after 1-2 days
    • >35mmHg: Inform senior physician/surgeon
      • Viscoelastic in anterior chamber? (little/no convection)
        • Consider releasing pressure via paracentesis
  • Retinal examination only if symptoms of detachment

Postoperative Complications


  • EyeWiki Cataract
  • EyeWiki Morgagnian Cataract
  • EyeWiki Cataract Surgery Complications
  • ¹Barraquer R, I, Pinilla Cortés L, Allende M, J, Montenegro G, A, Ivankovic B, D’Antin J, C, Martínez Osorio H, Michael R: Validation of the Nuclear Cataract Grading System BCN 10. Ophthalmic Res 2017;57:247-251. doi: 10.1159/000456720
  • The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilkins; 7th Edition (2016)
  • Kanski’s Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8th Edition (2015)