Acquired Cataracts - Treatment

When the initial symptoms of age-related cataracts are detected, treatment should begin with conservative therapy to prevent the progression of cataracts.

Drug treatment of cataracts is divided into two groups:

1. To resolve existing opacities, agents that affect metabolic processes are used. These preparations contain cysteine, ascorbic acid, glutamine, potassium iodide, calcium, diopine, glycerin;
2. substances that affect metabolic processes: vitamins C, D1, B2, B6, PP.

You can also use: kataine, quinaps in drops, 5% cysteine solution in electrophoresis; vicein, vitaiodurol and vitaiodfacol, methyluracil, metacid - in tablets 0.5 g 3 times a day, three courses per year; 4% taurine solution, bendalin - in tablets 0.5 g 3 times during the year.

Domestic ophthalmologists recommend using nicotinamide in combination with reflexotherapy and cocarboxylic acid for the treatment of early cataracts along with vitamin Nyl drops. With age, vitamins of groups B, C, P are useful for senile cataracts.

The results of conservative treatment of cataracts are not always effective. Rare forms of initial cataracts can resolve if therapy for the disease that caused the formation of opacities in the lens is started in a timely manner.

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

Indications for surgical treatment can be medical and professional.

Medical indications for cataract surgery:

• hypermature cataract, especially in secondary glaucoma;
• swollen cataract;
• subluxation and dislocation of the lens;
• pupillary block.

Professional indications for cataract surgery: vision loss from 0.4 to 0.1 depending on the profession. If binocular vision is necessary, then even at 0.4 the patient can be operated.

It is better to remove cataracts at a mature stage, when all surgical fibers are cloudy and easily separated from the lens capsule. However, the main indication for cataract surgery is the state of vision in both eyes, not the degree of maturity of the cataract. If the maturation of the cataract is slow, and the vision in both eyes has dropped so much that the person cannot perform normal work, then, despite the immaturity of the cataract, it is necessary to operate. Currently, both mature and immature cataracts are successfully operated.

In case of unilateral mature cataract and preservation of good vision function of the second eye, there is no need to rush with the operation. After removal of cataract in one eye with good function 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 treatment of cataracts.

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

Complications of intracapsular lens extraction:

• freezing of the cornea at the time of lens removal;
• vitreous hernia leading to keratopathy;
• choroidal detachment.

3. Extracapsular extraction (ECE).

Indications:

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

With EEC, the posterior capsule is preserved, so the vitreous body does not fall out.

It is difficult to obtain good vision, as secondary cataracts often develop. The lens capsule has a high regenerative capacity, as do the lens masses (they begin to grow, become cloudy).

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

False secondary cataract may occur with intracapsular extraction of the lens. This is a compaction of the anterior layers of the vitreous body. There is no obvious opacity, the fundus is visible, there is no high vision. The anterior surface of the vitreous body resembles a callused substance, its optical density increases sharply. It is practically untreatable.

1. Phacoemulsification - out of 10 million operated patients, 200 thousand (i.e. 5% of cases) experience complications that lead to blindness.

Complications that arise during surgery:

1. vitreous prolapse - in 11%, in 1/3 of patients vision is lost after this. Keratolatia, iridocyclitis, etc. may occur. Prevention of these complications - maximum reduction of intraocular pressure before surgery, correct anesthesia, gentle manipulations of the surgeon;
2. hemorrhages. Prevention - hemostasis. Treatment - washing, removal of clots. Expulsive hemorrhage occurs in 0.2% of cases, usually at the end of the operation. Intraocular pressure increases, everything shifts forward. Treatment - perforation of the sclera in several areas to drain the blood. Vision is lost after this.

Postoperative complications:

1. wound infiltration. Causes - shallow anterior chamber, conjunctival flap edema, hypotension. Seidel's test - placing 1% fluofin, washing it out. Treatment - applying additional sutures;
2. choroidal detachment (occurs in 2-3%). It can occur during filtration, leading to corneal dystrophy, shallowing of the anterior chamber, formation of primary synechiae and secondary glaucoma. Treatment - posterior trepanation of the sclera to release the fluid;
3. pupillary block - secondary glaucoma develops (usually in the interval from 1.5-2 weeks to 2 months after surgery). Treatment - mydriatics;
4. corneal dystrophy. Cause - contact of the endothelium with the vitreous body, manipulations in the anterior chamber, which leads to damage to the endothelium. Denervation with corneoscleral incision. Difficult to treat;
5. Irvine-Gass syndrome in 24% after 2-3 weeks. The eye is unchanged, vision is reduced, in the macular area the retina is edematous, gray. The cause is traction of the vitreous body, an inflammatory process that is caused by the loss of the vitreous body and its infringement in the scar, the effect of toxic factors that accumulate in the eye after surgery;
6. ingrowth of epithelium as a result of the lack of tightness of the postoperative wound. A gray film creeps along the back surface of the cornea - secondary glaucoma develops. It is practically incurable, but X-ray therapy can be used;
7. purulent infection. A purulent infection occurs 4-5 days after surgery. Causes: exogenous (entry gate - postoperative wound, purulent exudate and infiltration of suture edges, corneal edema, hypopyon appear, which leads to endophthalmitis) and endogenous infection (the wound condition is satisfactory, the clinical picture - from the side of the outer membranes).

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

S. N. Fedorova developed a technology for the destruction and removal of cataracts of any degree of maturity and hardness using laser energy and a vacuum unit. The operation is performed through two punctures at the limbus. Before the operation, the pupil is dilated, then the anterior capsule of the lens is opened in the form of a circle, a laser (0.7 mm in diameter) and an aspiration (1.7 mm) tip are inserted into the eye. The tips barely touch the surface of the lens in the center. Under the action of laser energy, the lens core "melts" within a few seconds, a deep bowl is formed, the walls of which disintegrate into separate parts. When they are destroyed, the energy is reduced. Soft and medium-density cataracts are destroyed in a period from a few seconds to 2-3 minutes, while dense lenses require 4 to 6-7 minutes to remove. Laser cataract removal expands the age range, since this method is less traumatic. The laser tip does not heat up during operation, so there is absolutely no need to introduce a large amount of isotonic sodium chloride solution. In patients under 40 years of age, even without turning on the laser energy, it is possible to suck out the soft substance of the lens only with the help of a powerful vacuum system of the device. During the operation, the wound openings are tightly tamponed with tips. In order not to widen the incision when introducing an artificial lens, soft folding nitraocular lenses are introduced. Sutures are not applied after the operation. Currently, laser cataract extraction is already widely used in clinical practice, it belongs to the future.

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