I. Clinical manifestations and treatment of senile cataract.
Definition of senile cataract: just like the lens of a camera is mixed, exact term: age-related cataract. 1982 WHO proposed that the diagnostic criteria for cataract are: visual acuity <0.7, clouding of the lens, and no other eye diseases that cause vision loss
Onset: Mostly seen in people over 50 years of age, the prevalence rate is about 50% in people over 60 years of age, and up to 100% in people over 80 years of age.
Main symptoms: The main symptom is loss of visual acuity. In addition, there is a reduction in presbyopia, myopia, monocular diplopia, glare, color vision changes, and decreased contrast sensitivity. The symptoms of cataracts are not the same in different areas and forms.
Major risk factors and prevention: Various factors. Such as age, gender, genetic factors, ultraviolet radiation, occupation, diabetes, hypertension and nutritional status (excessive smoking and alcohol consumption), etc.
Treatment: includes medication and surgery. The former includes many kinds of drugs, such as antioxidant drugs (glutathione), aldose reductase inhibitors (bendazacin-salbutamol), quinone-related academic drugs such as leukodystrophy, carlin-U, etc., Chinese herbal medicine such as musk pearl eye drops, cataracts, etc. However, these drugs are not yet effective in stopping or reversing cataracts.
Surgery is currently the main treatment for cataracts.
Indications for surgery: In the past, it was thought that the mature stage was the best for surgery. However, with advances in surgery and equipment, cataract surgery has the potential to improve vision when corrected visual acuity is 0.5 or less; or when visual function no longer meets the patient’s needs; when cataract prevents optimal treatment of posterior segment disease; when the lens causes severe inflammation (lens lysis, lens allergic reaction, etc.); when the anterior chamber angle is closed and closed angle glaucoma cannot be controlled by medications; when the lens is foreign body, etc.
Surgical procedure: Ultrasonic cataract extraction combined with IOL implantation. Most of them can be done with surface anesthesia, that is, eye drops with anesthetic, and no anesthetic needle is needed. The incision is small, about 2-3 mm, and usually does not require sutures. The surgery takes 10-30 minutes.
Pre-operative: This includes a general physical examination and an eye examination. Control of systemic diseases, such as hypertension, diabetes, etc. The eye examination needs to exclude red eye, severe impingement or chronic lacrimal sac infection. Antibiotic eye drops need to be ordered for 1-3 days before surgery.
Post-operative: Gauze and eye patch are routinely worn for one day, and the next day the gauze can be removed and the eye patch or flat glasses can be worn directly to see. Postoperative anti-inflammatory and antibiotic eye drops are still needed to prevent infection. Patients must pay attention to eye hygiene and must not rub their eyes or get dirty water into their eyes. In the event of redness and pain in the eye with loss of vision, prompt medical attention is required.
The outcome of the surgery: It mainly depends on the patient’s fundus condition, especially the function of the optic nerve and macula.
About IOL: Currently, IOLs are mainly imported, but China has also developed and produced some on its own, and the results are also good. They are injected into the eye through a folding injector. There are many types of IOLs to choose from, including monofocal and multifocal, spherical and aspheric, and astigmatism-correcting crystals, etc.
II. Possible misconceptions of elderly cataract patients.
1. Diagnostic misconception: treating pterygium as cataract.
The flesh that grows from the white of the eye to the black eye is called a “pterygium”. There are many black shadows floating in front of the eye, “vitreous turbidity”.
2. Why do I have to undergo so many tests to open a cataract?
Pre-operative cataract tests include: blood tests (fasting), electrocardiogram, blood pressure, intraocular pressure, tear duct irrigation, IOL measurement and calculation, corneal endothelial count, corneal topography, ocular ultrasound, macular OCT, and depending on the condition of each patient, some other tests may be required. The purpose of the above tests is to confirm whether the patient is able to tolerate cataract surgery, to exclude contraindications to surgery, and to make an assessment of the postoperative outcome.
Poor vision in the elderly does not necessarily mean only age-related cataracts, but may also be combined with other age-related degenerative pathologies. There are various causes of poor vision in elderly patients, especially those over 70 years of age, such as senile cataract, age-related macular degeneration, idiopathic macular fissure, idiopathic macular anterior membrane, closed-angle glaucoma, etc. Poor vision is not necessarily a simple senile cataract. If you do not go to the hospital for this reason, it is likely to delay the best treatment time for other diseases.
3.If cataract surgery is done but no IOL is implanted, is the surgery a failure?
In some special cases, IOLs need to be reimplanted after surgery. For example, if a patient’s lens suspensory ligament is loose due to advanced age or other eye diseases, or if the lens is found to be semi-dislocated during surgery and the capsule is not sufficient to support the IOL, it is best not to implant the IOL at this time and wait for the second stage surgery.
4. On the first day of postoperative examination, I still cannot see, and the doctor said that the cornea is edematous, is there a problem with the surgery?
Early postoperative corneal edema is a common phenomenon after ultrasound emulsification. The main reason is that the ultrasound energy used to crush cataracts during surgery will also cause some damage to the cornea. Patients with severe sclerotic cataract and low corneal endothelial cell count are prone to corneal edema. After medication, it can generally return to normal in about 3 days to 1 week after surgery.
5. Although the postoperative vision is good, the eyes always feel uncomfortable and the foreign body sensation is strong.
Post-operative foreign body sensation is also a common symptom after cataract surgery, and many patients complain about the discomfort with their doctors during post-operative visits. Post-operative foreign body sensation is mostly caused by dry eyes. Many elderly people have dry eyes before surgery, and this is exacerbated by the damage to the corneal limbal stem cells caused by the surgical incision and the use of postoperative eye drops. Treatment can be done with preservative-free artificial tears to relieve the symptoms, and most patients have dry eye symptoms relieved or disappeared after 1 month.
6. It is very clear to see far away after surgery, but it is still difficult to see close.
The biggest defect of artificial lens is that it can’t be focused as freely as our clear lens to see far and near. If designed to let patients see far clearly after surgery, they have to wear presbyopic glasses to see near; if designed to retain myopia after surgery, let patients see near clearly and wear myopic glasses to see far. Therefore, correct optometry is needed in January after cataract surgery. Of course, there are also multifocal IOLs available, which can be used to see far and near clearly, but they are three times more expensive than ordinary IOLs and also have certain indications and limitations. If you have such a need, you can discuss with your surgeon the possibility of implanting such an IOL to make a personalized choice. In addition, for patients with preoperative keratogenic astigmatism, we can also choose to implant a TORIC IOL to correct astigmatism and obtain better vision after surgery.
7. Since my fundus is not good, why did the doctor give me cataract surgery, and as a result, I still can’t see after opening the cataract.
In some patients, due to the blockage of cataract (especially severe nuclear cataract or total white cataract), preoperative examination of the function of macula and optic nerve in the fundus is not comprehensive, and OCT examination of macular area cannot be done. Although preoperative ultrasound examination will be done, it can only reveal the presence of retinal detachment and other serious fundus diseases, some of which cannot be detected by ultrasound and can only be detected by fundus examination after cataract surgery. Therefore, patients with combined fundus disease should not wait until they can’t see at all and then go to the doctor. This will affect the doctor’s judgment of the postoperative effect and increase the difficulty of surgery.
8, I can see very well with a good incision, so I don’t need to review.
Early post-operative review is very important, the doctor needs to observe whether there is infection in the operated eye and other abnormalities, sometimes the infection does not feel anything strange at first. If the eye becomes red and painful and vision decreases, it is necessary to see a doctor promptly for treatment and be alert to the occurrence of postoperative intraocular infection.
9. After cataract surgery, why did the doctor say I need other treatment?
For patients with other combined eye diseases, such as glaucoma before surgery, it is necessary to follow up the IOP frequently after surgery to see if anti-glaucoma drops should be used at the same time; for some patients with combined diabetic retinopathy before surgery, it is necessary to dilate the pupil in time to check the fundus after surgery, and laser treatment should be performed if necessary.
10.Will cataract grow back after surgery?
The incidence is about 30%-50% after surgery. The treatment is relatively simple.
11.Does the IOL need to be replaced?
Usually not, except for special cases such as IOL displacement, miscalculation or difficulty in adapting to multifocal IOLs.