I. What is cataract
A cloudy lens is a cataract. The main symptom of cataract is visual impairment.
Types of cataracts and their symptoms
1.Age-related cataract
It is a clouding of the lens that begins to occur in middle and old age, and the prevalence increases significantly with age. Since it mainly occurs in the elderly, it is also called age-related cataract. There are three categories: cortical, nuclear and posterior subcapsular. The main symptom is progressive and painless vision loss.
2. Congenital cataract
It is a common blinding eye disease in children. It is a clouding of the lens that occurs at birth or within the first year of life and can be familial or disseminated; it may or may not be accompanied by other eye abnormalities or hereditary or systemic diseases. It is caused by heredity, intrauterine viral infection in the first trimester of the mother’s pregnancy, the application of some medications, and the presence of metabolic diseases. There is a white clouding in the pupil and sometimes the eye is accompanied by tremors. The development of vision is worse than that of normal infants, and there is no active grasping response to bottles and toys in front of the eyes.
3.Traumatic cataract
Traumatic cataracts are caused by contusions, penetrating injuries and explosive injuries to the eye. If the lens in the pupil area is injured, vision is quickly diminished. In addition to visual impairment, it may be accompanied by inflammation of the anterior segment of the eye or secondary glaucoma.
4.Metabolic cataract
Lens clouding caused by metabolic disorders is called metabolic cataract, and the most common one is diabetic cataract. Many patients mistakenly believe that diabetic cataracts cannot be operated, but it is actually wrong to think so. Patients with diabetic cataracts should have surgery as early as possible to keep their blood sugar under proper control to facilitate observation and treatment of fundus lesions.
(1) Complicated cataract
Clouding of the lens caused by intraocular diseases. It is common in uveitis, retinitis pigmentosa, retinal detachment, glaucoma, intraocular tumor, high myopia and low intraocular pressure.
(2) Drugs and toxic cataracts
Long-term application or exposure to drugs or chemicals with toxic effects on the lens can lead to lens clouding. Common drugs include glucocorticoids, chlorpromazine, pupil shrinkers, etc. Chemicals include trinitrotoluene, dinitrophenol, mercury, etc. Some cataracts can be recovered by stopping the use of drugs, but once cataracts have occurred in most patients, the clouding does not disappear easily.
(3) Radioactive cataract
Cataracts caused by radiation. They are mainly caused by infrared rays, ionizing radiation and microwaves.
5.Posterior cataract
It refers to the clouding of the posterior capsule of the lens formed after cataract extraction or partial cortical absorption of traumatic cataract.
Cataract surgery and IOL surgery
(A) Indications for surgery
1.Visual reasons: When cataract causes vision loss and affects work and life, surgery can be performed.
2.Medical reasons: When cataract causes other eye lesions, such as lens-derived glaucoma, or affects the diagnosis and treatment of other eye diseases, such as diabetic retinopathy requiring laser treatment, cataract surgery should be performed.
3. Cosmetic reasons: Although the affected eye has lost vision, mature or overripe cataract makes the pupil area white and affects cosmetology.
(II) Surgical methods
1.Intracapsular cataract extraction (ICCE)
2.Extracapsular cataract extraction (ECCE)
3.Echoemulsification cataract aspiration (Phaco)
IV. Post-cataract surgery vision correction
1.Implantation of artificial lens
2.Frame glasses
3.Corneal contact lens
V. Precautions
(I) Pre-operative
1. The patient’s blood pressure should be controlled at or near the normal range.
2.For diabetic patients, blood glucose should preferably be controlled below 8.5mmol/L and glycosylated hemoglobin below 8.5mmol/L.
3, Children should have chest fluoroscopy before surgery. Only when normal is indicated can the surgery be performed under general anesthesia. Pay attention to the prevention of colds.
(B) Postoperative and discharge guidance
1.Postoperatively, there is generally no need to restrict the position, you can move slightly, avoid strenuous exercise, avoid bending down and talking loudly, keep the stool unobstructed, constipation force is strictly prohibited (especially the elderly who have the habit of constipation).
2, no dietary restrictions, a balanced diet, (except for diabetic patients), avoid spicy and hard food, avoid contact with tobacco, alcohol and other stimulants.
3.If there are symptoms of glaucoma secondary to elevated intraocular pressure after surgery, headache, eye distension, nausea and vomiting, etc., immediately inform the medical staff for treatment.
4.Eye shields should be worn after surgery because they are supported by the orbital peripheral bone and any external force and accidental squeezing during sleep at night will not hurt the eye. In order to avoid eye collision, goggles should be worn during the daytime according to the situation, and protective eye shields should be worn at night when sleeping.
5. After discharge from the hospital, strictly follow the doctor’s instructions to punctuate the eyes and take medication on time. Wash your hands, gently pull open the patient’s lower eyelid, ask the patient to look upward, put in 1 to 2 drops, and gently close the eyes for 5 to 10 minutes before applying eye drops. If drops are mixed with eye drops such as Dimethoate or Flomax, shake well before use. Pay attention to eye hygiene, prevent sewage from entering the eye, and prohibit hand rubbing of the eye.
6. Follow up on time, if there is any change in the condition, such as eye pain, eye redness, vision loss, etc., you should consult the doctor at any time to avoid delaying the condition.
7.The recommended time for lens prescription is 1 to 3 months after surgery. The refractive status will not change much 1 month after the small incision ultrasound emulsion surgery, and ECCE needs 3 months after surgery to be stable. Patients with special needs can be fitted with glasses in advance, but they should be retested and fitted with glasses according to the change of refractive status in time.
8.Actively treat the original disease, such as hypertension, diabetes, heart disease, etc.