Diabetes is a common chronic disease. With the improvement of people’s living standards, the aging of the population and the increase of the incidence of obesity, China has become the second largest country in the world with diabetes, currently there are 30 million people with diabetes, the prevalence rate of 2% to 4%, of which middle-aged people are the most prevalent group, the average age of onset is 45 years old, and the trend of increasing youth. In clinical practice, many diabetic patients do not pay much attention to the diagnosis and treatment, especially ignoring the various ophthalmic complications caused by diabetes, such as cataract, corneal ulcer, glaucoma, vitreous hemorrhage, optic neuropathy, etc. Among them, diabetic cataract is the most common and most easily neglected complication, which will lead to vision loss, damage and even blindness.
Causes of diabetic cataracts How do diabetic cataracts occur? Under normal conditions, the lens absorbs nutrients from the atrial water through the capsule and eliminates metabolites. When suffering from diabetes, the osmotic pressure of the lens increases, absorbing water and swelling; coupled with impaired protein synthesis, this eventually leads to lens clouding and long-term chronic hyperglycemia causing cataracts over time.
Treatment of diabetic cataract Since the factors causing poor vision may be caused by fundus lesions in addition to cataract, patients with diabetic cataract should first go to the hospital for detailed eye examination, examine the lens and fundus in detail through dilated pupil, clarify the degree of cataract and diabetic fundus stage, and do fundus fluorescence imaging if necessary.
Treatment for diabetic cataract patients should be selected according to the stage of fundus lesions and the degree of cataract lens clouding: whether cataract surgery should be done first, or fundus lesions should be treated first, or both at the same time: if diabetic fundus lesions are the main problem, fundus lesions should be treated first, and patients who have developed to the degree that laser treatment is needed can have laser treatment first; if the degree of cataract clouding degree is heavy and affects laser treatment, cataract surgery can be done first; if the fundus lesion reaches stage V or above and cataract affects fundus biosurgery, combined cataract surgery and fundus laser treatment can be done.
If cataract surgery is done first, the surgeon will make a larger continuous annular tear capsule, polished anterior and posterior capsules of the crystal, and choose a suitable lens for the patient during the operation. This is to prepare for the laser treatment later, and a close follow-up plan such as fundus fluoroscopy and fundus laser treatment will be made in time after the surgery. Through these, patients with diabetic cataract can avoid the occurrence of neovascular glaucoma, so that their fundus lesions can be treated at the same time as cataract. At the same time, endocrinologists should be asked to adjust the medication and control blood sugar for the patients.
Misconceptions of awareness Clinically, some diabetic cataract patients have some misconceptions about treatment.
For example, some patients think that they cannot have cataract surgery because they have diabetes, or they think that surgery is ineffective and give up surgical treatment. Diabetic patients usually have high blood sugar, low blood zinc, harder wound healing and less dilated pupils, etc. If they wait for cataract to develop to an advanced stage before surgery, it will greatly increase the difficulty and risk of surgery; this period also greatly increases the chance of complications, such as the occurrence of complications like uveitis and neovascular glaucoma, which can reach the level of blindness in serious cases and eventually lose the chance of surgical treatment.
In addition, some patients think that high blood sugar value cannot do cataract surgery, which is also a misunderstanding. As long as diabetic patients control their blood sugar well, cataract surgery can be performed smoothly and most of them can achieve good postoperative vision. Clinically, fasting blood glucose value is one of the important reference indicators for surgical treatment, and surgical treatment can be chosen within the range of Q8.9mmol/L. Usually patients with visual acuity around 0.3 are more suitable for surgery.
Diabetes treatment is a long-term and arduous process. Patients should pay attention to various complications, early detection, early diagnosis and scientific treatment while “keeping their mouths shut and legs open to control blood sugar”. Patients with diabetic cataracts should go to the hospital for timely examination and necessary cataract surgery treatment in order to return a bright world to you.