COMPLICATED CATARACT

It refers to opacification of the lens secondary to
some other intraocular disease. Some authors use the
term secondary cataract for the complicated cataract.
Many authors use the term secondary cataract to
denote after cataract. Therefore, to avoid confusion
and controversy, preferably, the term secondary
cataract should be discarded.
Etiology
The lens depends for its nutrition on intraocular
fluids. Therefore, any condition in which the ocular
circulation is disturbed or in which inflammatory
toxins are formed, will disturb nutrition of the
crystalline lens, resulting in development of
complicated cataract. Some important ocular
conditions giving rise to complicated cataract are listed
here.
1. Inflammatory conditions. These include uveal
inflammations (like iridocyclitis, parsplanitis,
choroiditis), hypopyon corneal ulcer and
endophthalmitis.
2. Degenerative conditions such as retinitis
pigmentosa and other pigmentary retinal dystrophies
and myopic chorioretinal degeneration.

3. Retinal detachment. Complicated cataract may
occur in long-standing cases.
4. Glaucoma (primary or secondary) may sometimes
result in complicated cataract. The underlying
cause here is probably the embarrassment to the
intraocular circulation, consequent to the raised
pressure.
5. Intraocular tumours such as retinoblastoma or
melanoma may give rise to complicated cataract
in late stages.
Clinical features
Typically the complicated cataract starts as posterior
cortical cataract. Lens changes appear typically in
front of the posterior capsule. The opacity is irregular
in outline and variable in density. In the beam of slitlamp
the opacities have an appearance like ‘breadcrumb’.
A very characteristic sign is the appearance
of iridescent coloured particles the so-called
‘polychromatic lustre’ of reds, greens and blues. A
diffuse yellow-haze is seen in the adjoining cortex.
Slowly the opacity spreads in the rest of the cortex,
and finally the entire lens becomes opaque, giving
chalky white appearance. Deposition of calcium is
common in the later stages.