By James C. Bobrow MD
Studies the anatomy, body structure, embryology and pathology of the lens. Covers the epidemiology, overview and administration of cataracts; offers an summary of lens and cataract surgical procedure; and explores the problems and targeted occasions of cataract surgical procedure. final significant revision 2008 2009.
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Additional resources for 2011-2012 Basic and Clinical Science Course, Section 11: Lens and Cataract (Basic & Clinical Science Course)
The lens substance is most malleable during childhood and the young adult years, progressively losing its ability to change shape with age. After approximately 40 years, the rigidity of the lens nucleus cli nically reduces accommodation because the sclerotic nucleus cannot bulge anteriorly and change its anterior curvature as it could before. Recent studies have shown that, throu ghout life, the hardness or stiffness of the human lens increases more than 10aO-fold. According to the classic theory of von Helmholtz, most of the accommodative change in lens shape occurs at the central anterior lens surface.
In so me cases, blunt trauma causes both dislocation and cataract formation. Perforating and Penetrating Inju ry A perforating or penetrat ing injury of the lens often results in opacification of the cortex at the site of the rupture, usually progressi ng rapidly to complete opacification (Fig 5-12). Occasionally, a small perforating injury of the lens capsule may heal, resultin g in a stationary focal cortical cataract (Fig 5-13) . Radiation Ionizing radiation The lens is extre mely sensitive to ionizing radiation; however, as much as 20 years may pass after exposure before a cataract becom es clinically appare nt.
Still other studies have suggested that the passive membrane permeability to cations is increased with aging and cataract development. Pump-leak Theory The combination of active transport and membrane permeability is often referred to as the pump-leak system of the lens (Fig 3-1). According to the pump-leak theory, potas- Anterior Posterior (aqueous humor) (vitreous humor) Passive K+ ( ____ _ _ diffusion Inward active K+pump Outward active Na+transport Passive Na+ diffusion Inward active Ca 2 + pump <--- -----) <-<-<-- ) ---- - - -) ____) Passive diffusional exchange of H,O and solutes Inward active .