Sight is a necessary feeling for every person. Reducing its severity entails a lot of problems, ranging from the difficulties associated with the implementation of labor activity, and ending with domestic difficulties. There are many eye diseases that are successfully treated in various ways. In some cases, surgical intervention guarantees partial or even complete restoration of vision. We will find out if cataract surgery can significantly affect vision and significantly improve the clinical picture.
What is a cataract?
Ophthalmologists diagnose such a disease in case of clouding of the lens, which has the functions of a specific lens. It is located in the center of the eyeball and helps light reach the retina. Blurring interferes with visual acuity, and in the future can lead to blindness.
At the initial stage of developmentdisease, the patient notices flies in the eyes, and later a peculiar veil appears or, as some say, they see through the fog.
Reason for development
For the most part, cataracts are an acquired disease. In the world there are only 3% of patients with a congenital pathology of this kind, which occurs even in utero due to diseases suffered by the mother during pregnancy or her chronic ailments. The prerequisites for the appearance of cataracts in a newborn may be:
- rubella;
- toxoplasmosis;
- diabetes mellitus;
- calcium deficiency;
- hypothyroidism.
In children, the disease usually does not progress, if not combined with other serious illnesses, and vision drops to 0.3 and remains so for a long period. In some cases, cataract surgery is indicated for babies, but this decision is made by the doctor together with the baby's parents.
Acquired clouding of the lens develops at a fairly mature age and progresses rapidly. About 90% of pathologies are associated with the aging of the whole organism, and 10% are due to external factors such as trauma or radiation.
The most common causes of cataracts in adults are:
- ultraviolet or radiation;
- age;
- injuries affecting the lens;
- infectious diseases;
- autoimmune pathologies;
- thyroid problems;
- ophthalmic comorbidities;
- eyeball surgery;
- long-term corticosteroid treatment;
- effect of toxic substances.
Disease development
Before deciding on a surgical intervention, it is necessary to undergo an examination and find out at what stage of development the cataract of the eye is currently at. Surgery may be delayed until other treatments are tried. The disease can progress in different ways. For some, therapeutic treatment may be enough to stop the clouding of the lens, and for others, it will be operated on as soon as possible.
There are four stages of cataract development:
- Initial, when the lens becomes cloudy in distant areas. The patient does not experience discomfort, does not notice the disease, there is a slight decrease in vision, sometimes double vision. If therapy is started at this stage, then the transition to the second stage may take 10-20 years or not happen at all.
- Immature cataract is characterized by a significant deterioration in vision. The lens becomes inhomogeneous, and the pressure inside the eye leads to glaucoma, followed by atrophy of the optic nerve. At this stage, cataract surgery is considered the most effective treatment.
- Mature cataract is manifested by poor vision, when a person already has difficulty seeing contours and hardly distinguishes colors. In this case, cataract surgery should be performed as soon as possible to restore vision.
- Overmature (Morganiev) cataract is characterized by complete disintegration of the lens, which canfor some moments, partially return the ability to see the outlines of objects. However, the destruction of the so-called lens can lead to the release of the contents and the complete destruction of the entire eye.
Patient preparation
First, you need to run diagnostics, which includes the following:
- Visometry is a manipulation that determines visual acuity according to tables.
- Tonometry - measurement of intraocular pressure.
- Ophthalmoscopy - study of the optic nerve, retina and choroid.
- Binocularity - an assessment of the quality of simultaneous vision with both eyes.
- Biomicroscopy - a study of the lens, the degree of its change, the size of the nucleus and its density.
- Perimetry - the study of the boundaries of the visual fields.
Also, the doctor may prescribe a number of special procedures, such as refractometry, ophthalmometry, or apply electrophysiological methods to determine the pathology.
A few days before the cataract surgery, you need to get the results of laboratory tests of urine and blood. If the urine test is general enough, then the blood should be donated:
- for hepatitis B and C;
- on RW;
- for prothrombin according to Quick;
- for platelets;
- to the level of sugar.
The patient should know that the results of these studies are valid from ten days to one month. In addition, it is necessary to do an electrocardiogram no earlier than two weeks beforecataract surgery. To be admitted to a hospital, you must have a fluorography on your hands.
It is also obligatory to visit a therapist who will give an opinion on the general condition of the patient and the possibility of surgical intervention. It is also advisable to visit doctors such as a dentist, gynecologist, urologist, otorhinolaryngologist to identify possible infections in the body that can cause complications after cataract surgery.
What can not be done before surgery? Here the requirements are standard and apply to any operations:
- It is unacceptable to exert yourself physically.
- Do not drink alcohol or drugs.
- From the evening of the day before the intervention, you should refuse to eat.
- Liquids should be kept to a minimum.
- Medications for chronic diseases should be agreed with the surgeon and anesthetist.
Procedures on the day of surgery
When a patient enters the clinic, he must be examined by an ophthalmologist. In some medical institutions, blood is taken from the patient in order to separate the plasma. After surgical procedures, it is administered to the patient to speed up the recovery of the body. Usually, the operated person is given a sedative a few hours before the intervention. Also, before entering the operating room, he is given drops that dilate the pupil.
The patient is offered a sterile set of clothes that he puts on himself. After changing, he goes to the operating room, where he is placed on the table. As mentioned above, the whole procedure will lastfrom 15 to 40 minutes. The time depends on the lens replacement method.
Types of surgery
There are several methods of surgical treatment of cataracts. We will find out which operations are the most popular and less traumatic today by studying each type separately. The general list of types of operations includes:
- Extracapsular extraction.
- Intracapsular extraction.
- Ultrasonic phacoemulsification.
- Laser phacoemulsification.
The main opinion of doctors and patients, in short, is that the first method is the most affordable in terms of financial costs, and the latter is considered the most gentle, but expensive.
Extracapsular extraction
Performed in patients with particularly dense lens tissue and retinal angiopathy. This operation allows you to save the back of the lens capsule. Experts call the advantage of the method the remaining natural barrier between the anterior part of the eye and the vitreous substitute. However, the minus of the method is considered to be the high traumatism of the cornea of the eye, since the incision is the largest. As a result of the operation, an artificial lens is placed to replace the natural one. Cataract surgery in this case is performed as follows:
- The surgical field is being processed.
- Painting solution is instilled.
- Injection of mydriatics to dilate the pupil and solutions for disinfection into the conjunctival sac.
- Cut in progresscornea, which is usually 7 to 10 mm.
- Open and remove the anterior capsule.
- The lens is removed.
- Clean the cavity from the remnants of the lens.
- The artificial lens is installed in the capsular bag.
- Suturing.
After this kind of intervention, inflammation of the remaining back of the capsule or the development of a film cataract is possible.
Intracapsular extraction
The method is based on the complete removal of the capsule with the lens inside, which saves the patient from cataracts. Reviews of this kind of operation are different. Both positive and negative opinions are posted on the Web. Doctors are not very fond of this method. Despite the fact that complications in the form of a film cataract are excluded with this method, there is a risk of the lens with a bag falling out, which can lead to vascular damage, retinal detachment and hemorrhages.
Design the main stages of surgical intervention:
- The first three steps are identical to extracapsular extraction.
- Perform a wide corneal incision.
- Move the iris.
- Expose the extreme part of the lens.
- Fix (freeze) the tip of the cryoextractor to the part to be removed.
- The lens is removed.
- An artificial substitute is fixed in the anterior chamber or pupillary opening.
- Sew up the incision.
In modern ophthalmology, this method is rarely used, usually in case of damage to the lens, and is not used at all until the patient's 18th birthday.
Ultrasonicphacoemulsification
This is the preferred option for great results and good reviews. Cataract surgery of this level is considered the gold standard. The first three stages are carried out in the same way as in other interventions. Then a small incision is made, which does not exceed 3 mm. After that, a hole is made in the anterior lens capsule and a special fluid is injected through it. The next step is the crushing of the vitreous body using ultrasound. Small fragments are removed through a phacoemulsifier, and the doctor removes the remaining tissue. After that, a new lens is installed in place of the lens, and the incision is pulled together using seamless technology.
This method has a lot of advantages. After cataract surgery using ultrasound, complications are observed in only 1% of cases and they most often consist of retinal detachment.
Laser phacoemulsification
This is the most modern technique for cataract surgery. The replacement of the lens here takes place in the same way as in the previous version, but the removal of the damaged body in a different way. First, the surgical field is processed, anesthesia and the introduction of the necessary fluids. Next, an incision and a hole are made, after which parts of the fiber-optic system are inserted into it. With the help of a laser beam, the natural lens is destroyed, the tissues of which are excreted in the form of an emulsion through special tubes. After polishing the back of the capsule, a new artificial vitreous body is installed instead of the old lens. The cut alsopull together without using seams.
This method should not be used on overripe cataracts and corneal clouding.
Duration of surgery
The time of cataract surgery depends on its type. Extracapsular and intracapsular extraction can last up to 40 minutes. Surgical manipulations performed using a laser or ultrasound reduce the total duration by half. Such operations last 15-20 minutes.
Contraindications for cataract removal
You can not do the operation if the patient has:
- Oncological problems of an ophthalmic nature.
- Common infectious diseases.
- Eye infections.
It is recommended to carry out the intervention with caution and strictly follow the doctor's prescriptions in the postoperative period if there are the following chronic pathologies:
- Diabetes mellitus.
- Renal and liver failure.
- Hypertension.
Possible Complications
After cataract surgery, the feedback that patients give is accompanied by a description of unpleasant symptoms and problems that have arisen. Let's analyze each state separately:
- Corneal edema is the safest symptom and usually resolves on its own within 3-4 days.
- A retinal detachment caused by surgery is no good and may lead to another operation.
- Secondary cataract, when deposits form onlens and its clouding. You can get rid of the problem with a laser, without re-replacing the vitreous body.
- Increased intraocular pressure appears when the lens is displaced or with partially remaining liquid after the operation. Therapy is carried out with special eye drops.
- Infection can occur during any operation, but in this case it is treated with a course of antibiotics.
How to behave after changing the lens?
Any surgical intervention requires a subsequent rehabilitation period. What can not be done after cataract surgery, and what manipulations should be carried out, we will consider further. The recommendations doctors give to patients are as follows:
- Do not put pressure on the eye and rub it.
- It is necessary to use antiseptic drops prescribed by the doctor.
- A gauze bandage should be worn for several nights to protect the damaged surface.
- Sleep on your back or on the opposite side of your operated eye.
- Limit stress, avoid reading, watching TV, working and relaxing using the computer.
- You should avoid getting tap water in your eyes, but rinse them daily with sterile water.
- From visiting the sauna, swimming pool, sports and gym, drinking alcohol should be abandoned for several weeks.
- Do not bend over, lift weights.
- Temperature fluctuations should be avoided.
- If you feel comfortable, you can usedark glasses, as the artificial lens lets in more light than you are used to.
- Do not drive until you are sure that there is no danger caused by getting used to a new vision of the world around you.
- Impaired vision, redness or pain in the eye are signs that require an early consultation with a specialist.
- Also, the doctor should be visited at regular intervals. He will indicate the frequency of examinations for you when you come to the clinic the day after the operation for routine control.
How long is the rehabilitation period?
Of course, it depends on the method of the operation. Experts are talking about a full recovery within six months. Significant factors that can affect the extension of the period are age, general well-being, the stage of development of the disease, compliance with the postoperative regimen and doctor's recommendations. It is believed that the fastest recovery occurs after the laser method of getting rid of cataracts.
Do surgery?
Cataract is a complex disease leading to unpleasant consequences. If it is not treated, then a person is guaranteed blindness in the future. However, the decision to have surgery is not easy for many. Experts say that it is necessary to undergo a comprehensive study. And if his results alerted you, you need to contact another specialist. Perhaps you will be convinced of the correctness of the diagnosis and the need for surgery in the first minutes of the visit, or the doctor will suggest an alternative method.therapy.
In any case, going to the doctor is the first step towards treatment. Modern medical equipment allows you to identify the problem and deal with it at an early stage.
If all the doctors you consulted have diagnosed cataracts, you should immediately begin treatment or prepare for surgery. Listen to the opinion of the ophthalmologist and find out what way out of this situation he suggests.
The patient should be aware that clouding of the lens is an irreversible process that requires the intervention of doctors. The consequences of the development of the disease are not only the loss of transparency of the vitreous body, but also its increase in size, which makes it difficult for the outflow of intraocular fluid. This leads to an increase in blood pressure and the development of glaucoma.
Doctors' opinion
Doctors lean towards surgery, explaining their choice as follows. The process of clouding of the lens cannot be reversed. So the only way is surgery. Domestic specialists already have vast experience in radical treatment. The operation does not take long and is usually performed using local anesthesia, which leads to a reduction in the load on the heart. Improvement in vision occurs immediately after the operation. It should be noted that the result depends not only on the skillful hands of ophthalmologists and equipment, but also on the implanted lens.
The choice of the vitreous is important. This is usually done by a specialist, but he can take into account your wishes. Be sure to tell the doctor about your current occupation. This will help the doctor make the right choice, and you will not be disappointed after installing the lens. Cataract surgery can significantly change vision and improve the clinical picture.
