Acquired cataract: treatment

When identifying the initial symptoms of age-related cataract treatment should start with conservative therapy to prevent the progression of cataracts.

The drug treatment of cataracts is divided into two groups:

1. Means that affect the metabolic processes are used to dissolve the existing turbidity. These drugs contain cysteine, ascorbic acid, glutamine, potassium iodide, calcium, diopine, glycerin;
2. substances affecting the metabolic processes: vitamins C, D1, B2, B6, PP.

You can also use: katain, quinaps in drops, 5% cysteine solution in electrophoresis; vicinal, vitayodourol and vitayodafalk, methyluracil, metacid - in tablets 0.5 g 3 times a day, three courses per year; 4% solution of taurine, tandine - in tablets of 0.5 g 3 times during the year.

Domestic ophthalmologists recommend the use of nicotinamide in combination with reflexotherapy and cocarboxmase for the treatment of initial cataracts along with the installations of vitamin nyl droplets. With age in senile cataract, vitamins of groups B, C, R are useful.

The results of conservative cataract treatment are not always effective. Rare forms of initial cataracts can resolve, if the treatment of the disease that caused the formation of turbidity in the lens was started in time.

The main method of cataract treatment remains surgical - removal of the cloudy lens (or extraction of cataracts).

Indications for surgical treatment are medical and professional.

Medical indications for surgery for cataracts:

• overripe cataract, especially with secondary glaucoma;
• swollen cataract;
• subluxation and dislocation of the lens;
• pupil block.

Professional indications for surgery for cataracts: a drop in vision from 0.4 to 0.1 depending on the profession. If binocular vision is required, even at 0.4 the patient can be operated.

It is better to remove cataracts in the mature stage, when all surgical fibers are cloudy and easily separated from the capsule of the lens. However, the main indication for cataract surgery is the state of vision of both eyes, and not the degree of cataract maturity. If the cataract ripening is slow, and the sight in both eyes has fallen so much that a person can not perform normal work, then, in spite of the immaturity of the cataract, one must operate. Currently, both mature and unripe cataracts are successfully operated.

With a one-sided mature cataract and maintaining a good vision function of the second eye with surgery, you can not rush. After removal of the cataract on one eye with good functions of the second eye, a very large difference in refraction is obtained, which makes correction impossible. Even without correction, the operated eye sometimes interferes with the healthy eye.

Methods of surgical cataract treatment.

1. Reclination of the lens. Indications: general severe somatic condition of the patient, old age, mental illness.
2. Intracapsular extraction (PEC) - tweezers, vacuum suction cup (erythofakia), electrode from diathermocoagulator (electrodiafakia); cryogenic (in 1961, carbon dioxide and dry ice were used).

Complications of intracapsular lens extraction:

• corneal germination at the time of lens removal;
• hernia of the vitreous, leading to keratopathy;
• detachment of the choroid.

3. Extracapsular extraction (EEC).

Indications:

• mature cataract;
• the only eye in the patient;
• expulsive bleeding on the other eye;
• high blood pressure;
• combination with high myopia and glaucoma.

At EEK the back capsule is saved, therefore the vitreous body does not drop out.

It is difficult to get good vision, as often secondary cataracts develop. The capsule of the lens has a high regenerative capacity, like the lens masses (they start to grow, become turbid).

Secondary cataracts are subject to surgical treatment. Discision is made (knife, laser). But the cataract can again stick together (remove its pieces).

False secondary cataracts may occur with intracapsular lens extraction. This is the consolidation of the anterior vitreous layers. There is no apparent clouding, the fundus is visible, there is no high vision. The anterior surface of the vitreous body resembles a homogenized substance, its optical density sharply increases. Treatment practically does not lend itself to treatment.

1. Phacoemulsification - on 10 million operated in 200 thousand (ie, in 5% of cases) there are complications that lead to blindness.

Complications arising during the operation:

1. loss of the vitreous humor - in 11%, In 1/3 of patients after that vision is lost. There may be keratolatia, iridocyclitis, etc. Prevention of these complications is the maximum decrease in intraocular pressure before the operation, the correct conduct of anesthesia, sparing manipulations of the surgeon;
2. hemorrhage. Prophylaxis is hemostasis. Treatment - washing, removal of clots. Expulsive bleeding occurs in 0.2% of cases, usually at the end of the operation. Intraocular pressure rises, everything shifts forward. Treatment - scleral perforation in several areas for the flask of blood. Vision is then lost.

Postoperative complications:

1. wound infiltration. Causes - a small anterior chamber, edema of the conjunctival flap, hypotension. Saidel's test is the laying of 1% fluorine, its dilution. Treatment - the application of additional sutures;
2. abruption of the choroid (observed in 2-3%). It can be during filtration, leads to corneal dystrophy, faceting the anterior chamber, the formation of primary synechia and secondary glaucoma. Treatment - back trepanation sclera to release fluid;
3. pupillary block - secondary glaucoma develops (usually in the interval from 1.5-2 weeks to 2 months after the operation). Treatment - mydriatica;
4. corneal dystrophy. The reason is the contact of the endothelium with the vitreous body, manipulation in the anterior chamber, which leads to damage to the endothelium. Denervation with corneoscleral incision. It is difficultly treated;
5. Irvine-Gass syndrome in 24% in 2-3 weeks. The eye is not changed, vision is lowered, in the macular area the retina is edematic, gray in color. The cause is vitreous tract traction, an inflammatory process that is caused by the loss of the vitreous body and its infringement in the rumen, the action of toxic factors that accumulate in the eye after the operation;
6. ingrowing of the epithelium as a result of the lack of tightness of the postoperative wound. A gray film crawls on the back of the cornea - secondary glaucoma develops. Practically it is not treated, but it is possible to apply X-ray therapy;
7. a purulent infection. After 4-5 days after surgery, there is a purulent infection. Causes: exogenous (entrance gates - postoperative wound, purulent exudate and infiltration of the edges of the suture, corneal edema, hypopion, resulting in endophthalmitis) and endogenous infection (wound condition is satisfactory, the clinic is from the outer shells).

Treatment of cataracts with a laser. In 1995, for the first time in the world, a group of domestic ophthalmologists

SN Fedorova developed a technology for the destruction and removal of cataracts of any degree of maturity and hardness with the help of laser energy and a vacuum installation. The operation is performed through two punctures near the limbus. Before the operation, the pupil is expanded, then the lens capsule is opened in the form of a circle, a laser (0.7 mm in diameter) and an aspirating tip (1.7 mm) are injected into the eye. The tips barely touch the surface of the lens in the center. Under the action of laser energy, within a few seconds the nucleus of the crystalline lens "sorts" out, a deep bowl is formed, the walls of which dissolve into separate parts. When they are destroyed, they reduce energy. Soft and medium-density cataracts are destroyed in the period from a few seconds to 2-3 minutes, to remove dense lenses it takes 4 to 6-7 minutes. The removal of cataracts with a laser extends the age range, since this method is less traumatic. The laser tip does not heat up during operation, so you do not need to inject a large amount of isotonic sodium chloride solution. In patients younger than 40 years, even without the inclusion of laser energy, it is possible to suction the soft substance of the lens only with the help of a powerful vacuum system of the device. Wound openings during the operation are tightly plugged with the tips. In order not to expand the incision with the introduction of an artificial lens, the introduction of soft folding nitraocular lenses is used. Stitches after operation do not impose. Currently, laser extraction of cataracts is already widely used in clinical practice, it owns the future.

[1], [2], [3], [4]