Cataract is a pathological condition in which clouding of the lens of the eye occurs, leading to progressive loss of vision. When a certain age is reached, some changes occur in the human lens, which are reflected in the compaction of the nucleus and its delimitation from the cortical zone. An immature cataract in the ICD-1010 is encrypted with the code H 26.
The first signs and diagnosis of cataracts
It is accepted to divide the process of cataract maturation into 4 stages, as well as into 2 main forms: cortical and nuclear. Cortical cataract is manifested by opacity, starting from the periphery and going to the center, accompanied by a progressive drop in visual acuity.
The main complaints, in addition to a drop in visual acuity, will be:
- feeling of a veil before the eyes;
- blurred vision;
- frequent change of glasses without much effect.
Diagnosis of cataracts is carried out by biomicroscopy (that is, examining the eye with a slit lamp). The doctor can determine which cataract is present, andalso determine its stage. In its development, a cataract goes through several stages:
- Initial cataract is characterized by the appearance of flat opacities. Opacities located on the periphery of the lens have greater intensity. When the opacification is in the cortex, there may not be a decrease in visual acuity with an initial cataract.
- Immature age-related cataract - opacities move in all directions, capturing an increasing surface of the lens and becoming more intense. Visual acuity may decrease to tenths and hundredths of values.
- Mature cataract is detected when the entire cortex is already cloudy. Vision with such clouding can be reduced up to light projection (as a rule, correct light projection, in view of the preserved function of the retina).
- Overmature cataract is the degeneration and decomposition of the lens fibers. There is a liquefaction of the substance of the lens, in connection with which the folding of the capsules appears. The color of the bark changes to milky. The nucleus, being a dense and heavy formation, can sink down and only its upper edge will be visible during biomicroscopy.
Conservative treatment
Conservative treatment is a controversial issue in ophthalmology, some authors note an objective slowdown in the progression of cataracts, while others, on the contrary, talk about the lack of effect from the drugs used.
However, the following groups of drugs for the treatment of cataracts are present on the pharmaceutical market:
- Drops containing s alts K, Mg, Ca, Li, J and others necessary for normal water and electrolyte metabolism.
- Means that correct the metabolism of the lens, which include biological products, hormones and vitamin complexes.
- Preparations containing organic compounds that help normalize metabolic reactions.
- Vitamins: riboflavin, glutamic acid, ascorbic acid, cysteine, tauphone or taurine.
Surgical treatment
Only cataract surgery can cure the patient. It consists in the removal (extraction) of the clouded lens with the further installation of an artificial lens in its place. There are several types of cataract extraction:
- Removal of the lens is done together with the capsule (IEC). Part of the anterior lens capsule is removed, then the nucleus is crushed, aspirated, after which all other masses are aspirated. The posterior capsule is not damaged. (EEC)
- Removal of the lens through a small incision using an ultrasonic emitter (US FEC).
- Destruction of the nucleus and cortex using laser energy and removing them using vacuum (LEK).
Aphakia correction
After the operation of an immature cataract, namely the removal of the lens, the patient's vision also remains low, due to the lack of a natural lens of 19 diopters. Such an eye is called aphakic and has certain signs:
- deep frontcamera;
- trembling of the iris - iridodenesis;
- hypermetropic refraction.
This situation can be solved in several ways:
- spectacle correction (converging lenses);
- contact correction (soft contact lenses);
- correction with an intraocular lens.
An intraocular lens (IOL) is an artificial converging lens made from inert materials and placed inside the eyeball to correct aphakia. The main parts of the IOL are the optics and haptics.
Complications of surgical treatment
In most cases, at the present stage of development of microsurgical techniques, operations on the lens are safe, however, complications, although not often, still occur. The vast majority of operations are performed for cataracts using the ultrasonic method of destruction of the nucleus. The ultrasonic wave emanating from the emitter can damage the surrounding tissues. In order to avoid this, manipulations inside the anterior chamber of the eye are carried out with the introduction of viscoelastic. It is a liquid with a very high viscosity. This feature allows it to well dampen the waves emanating from the emitter.
The most common non-specific complication of immature cataracts is a postoperative inflammatory reaction. Any operation is accompanied by an inflammatory reaction of varying severity, as a natural response of tissues to damage.
Possible consequences
Clinical manifestations of postoperative inflammation include:
- false cellular precipitates;
- clouding of the posterior lens capsule;
- transient postoperative hypertension, glaucoma;
- hyphema, cystic macular edema;
- sluggish fibroplastic uveitis;
- formation of posterior synechiae; pupillary membrane.
Specific complications of such an operation for immature cataracts will be problems at any stage of its implementation. Complications are possible at the stage of cutting the cornea, when the nucleus is separated from the entire lens, when creating a window in the anterior capsule of the lens, the nucleus goes into the anterior or posterior chamber of the eye, problems when setting up the IOL.
