Eye
Lens and vitreous
Cataract

Author: Nat Pernick, M.D. (see Authors page)

Revised: 10 May 2018, last major update February 2014

Copyright: (c) 2004-2018, PathologyOutlines.com, Inc.

PubMed Search: Cataract [title] lens pathology review[ptyp]

Cite this page: Pernick, N. Lens and vitreous: cataract. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/eyelenscataract.html. Accessed December 9th, 2018.
Definition / general
  • Defined as progressive opacity of crystalline lens that decreases visual acuity
  • Usually develops in older individuals, rarely in infancy or childhood
  • Associated with systemic diseases (galactosemia, diabetes mellitus, Wilson disease, atopic dermatitis), corticosteroids, radiation (ultraviolet light or radiation therapy), trauma, glaucoma, uveitis, retinitis pigmentosa, steroids
  • Age related cataract is due to opacification of lens nucleus, which becomes brown and distorts perception of blue color
  • Changes occur in lens nucleus, cortex and subcapsular regions
  • Nuclear changes due to progressive crosslinking and insolubility of crystalline proteins
  • Cortical changes begin as small peripheral water clefts and diffuse degenerative changes that coalesce into dense bands of opaque cortical material
  • Anterior lens epithelial cells may undergo fibrous metaplasia, creating a thick fibrous plaque between the anterior lens capsule and the anterior epithelial cells
  • Congenital cataract:
    • Becomes apparent within first 6 months of life
  • Posterior subcapsular cataract:
    • Migration of lens epithelium posterior to lens equator
  • Morgagnian cataract:
    • Long standing cataract that undergoes liquefaction of lens cortex with sinking of nucleus into fluid filled sac and clinical brown nucleus
  • Soemmering ring cataract:
    • Peripheral donut or ring shape due to loss of lens nucleus and much of anterior and posterior cortex
    • Also proliferating lens epithelial cells in periphery and equatorial region of lens
Treatment
  • Often high frequency sound waves are used to disintegrate the lens (phacoemulsification), then lens contents aspirated and disposed of (not submitted for examination)
  • Lens capsule is intact
  • Then placement of prosthetic intraocular lens
Gross description
  • Senile cataracts are yellow-brown
Microscopic (histologic) description
  • Homogenous eosinophilic lens fibers, vacuolization of superficial cortical fibers, extracellular clefts and eosinophilic globules of variable size (morgagnian globules) between lens fibers