In the specialist clinic, among the many cataract patients, the doctor said to an old lady, “Your eye disease has been delayed, and it is difficult to regain your sight after cataract surgery, but only to relieve the pain of your eyes. It turned out that the old lady had gotten cataract a few years ago, and when she was treated at the local medical station, she was told that she had to wait until she could not see anything before she could have surgery. A checkup at the hospital revealed that acute glaucoma had occurred in this eye, resulting in the current malignant eye disease. The daughter of the old lady asked, “When is the most appropriate time for cataract surgery?”
The doctor explained, “The cataract surgery you heard is a traditional saying because in the past, cataract surgery was performed by intracapsular removal method without microscopic operation or IOL implantation, so you have to wait until the cataract is completely mature and turns white.” He went on to say, “The volume of the lens expands during the mature stage of cataract, which often makes it easy for glaucoma to occur and cause the condition to deteriorate, thus losing the chance of restoring sight to the cataracted eye. Some people with cataracts also often develop other eye diseases such as chronic simple glaucoma, macular degeneration, uveitis, etc. during the long progression period, and untimely treatment can also reduce the chances of restoring sight to the eye.”
Cataracts affecting vision need surgery This is a scene that often occurs in ophthalmic emergencies. Why would an elderly person who is normally in good health and has only cataracts and no other eye disease suddenly develop severe glaucoma? This has to do with the fact that not much is known about how common cataracts can turn into very serious glaucoma in some patients.
Cataract has become the first modern eye disease causing blindness From an epidemiological survey in the early 1990s, it was first suggested that the main cause of blindness in China is not trachoma, but cataract. This is a change in the spectrum of blinding eye diseases brought about by the improvement in the standard of living of the Chinese people and the increasing aging of the population. Cataract is a clouding of the eye lens, which can be caused by congenital factors, trauma, systemic diseases, etc. The most common type of cataract is senile cataract. Cataracts are generally not easily preventable or medically curable, but surgery can restore normal vision to most people who have lost their eyesight due to cataracts. Restoring patients’ sight through cataract surgery can reduce and eliminate various negative effects and economic burdens brought by blindness to individuals, families and society.
At present, cataract ultrasound emulsification and IOL implantation, as a high technology, is being rapidly promoted and popularized in China, which has enabled many cataract patients to benefit from it and regain their sight. However, some cataract patients believe in the traditional custom that “cataract can be operated only after blindness is matured” and go to hospital for surgery only after they are completely blind. The cataract is a contraindication to cataracts, and we regret it too much.
In the process of cataract formation and development, as the patient ages, the lens expands and increases in size, pushing the iris forward, and in some patients with shallow anterior chamber periphery, the iris root is likely to block the anterior chamber angle, which is the structure for the outflow of atrial fluid in the eye. In another case, if a cataract patient fails to undergo surgery in a timely manner, the cloudy lens becomes “overripe”. The protein content of the clouded lens can leak out of the lens and cause an inflammatory reaction, which can also block the atrial outflow pathway and cause a glaucoma attack. Therefore, cataracts should be operated early when they affect vision to a certain extent.
The saying that “cataracts should be operated only when they are mature and invisible” is often spread among the elderly, but this was actually a concept 20 to 30 years ago because of the limitations of medical technology and surgery level at that time. At present, cataract ultrasound emulsification surgery is very mature, so there is no need to wait until the cataract is ripe before surgery. If the vision is below 0.5 when it affects life or work, it can be operated in time. If this concept is not changed in time, patients will miss the best time for surgery, and cataracts will not only become overripe, but even lead to acute glaucoma, resulting in irreversible blindness.
Three types of cataract patients are prone to glaucoma 1. People with farsightedness, family history of glaucoma, shallow anterior chamber, thin physique and short neck, whose vision in the morning is obviously better than that in the evening.
2, in the evening or dim light, easy to appear sore eyes, headache, iris vision (look at the light source with a halo or halo, in the evening look at the light bulb appears red and green aperture), and even appear headache, nausea, vomiting and other performance.
3. Patients with long-term hypertension, diabetes, anxious or worried temperament should go to the hospital for early examination and ask the ophthalmologist to help determine whether there is a risk of glaucoma attack.
If the glaucoma is caused by cataract expansion and overripening, also known as crystal-derived glaucoma, the patient’s disease is not very long and the damage to the visual field and optic nerve is not serious, early cataract surgery can solve both problems of cataract and glaucoma. If the disease develops further and there are atrial angle adhesions, a certain degree of atrial angle separation on top of cataract surgery can also solve the problem. However, if cataract and glaucoma have occurred for too long, resulting in irreversible atrial angle adhesions and inability to drain atrial fluid, as well as severe crystal clouding that has seriously affected vision, combined surgery for glaucoma and cataract is required to control intraocular pressure. All these require patients to go to the hospital for detailed eye examinations, and the doctor will make a comprehensive judgment with the medical history.