Cataract is a common blinding eye disease. Under normal conditions, it is transparent and light passes through it and some refractive interstitium to reach the retina in order to clearly see outside objects. Once the lens becomes cloudy for some reason, it can affect the retinal imaging and make it difficult to see. In other words, a cloudy lens that causes vision loss is a cataract. It is recommended that cataracts be treated promptly when they are discovered or diagnosed, and that long-term excessive eye use be avoided.
Definition
A cataract is a clouding of the lens in the eye that changes from clear to opaque, preventing light from entering the eye and thus affecting vision. In the early stage, the clouding is mild or small and does not affect vision, but gradually worsens to the point where vision is significantly affected or even blind. Vision loss due to cataract
Cataract surgery
It cannot be corrected by wearing glasses.
Cataracts are classified as developmental, traumatic, toxic, metabolic disorders, corticosteroid and posterior cataracts depending on their causes.
Developmental cataracts, also known as congenital cataracts, are both endogenous and exogenous.
Endogenous causes are related to fetal developmental disorders and are hereditary; exogenous causes refer to damage to the lens caused by maternal or fetal systemic pathologies, such as viral infections such as rubella, measles, chickenpox, mumps, hypoparathyroidism, malnutrition and vitamin deficiency in the first six months of pregnancy, all of which may cause it.
The main factors in the formation of senile cataracts are the degeneration of proteins, the increase of insoluble proteins, sodium and calcium, the decrease of potassium and vitamin C and the deficiency of glutathione. Water-soluble albumin can be transformed into insoluble protein, and the older you are, the more insoluble protein you will have; in addition, vitamin C deficiency, changes in crystal pH value and the infiltration of some toxic substances into the crystal can cause the degeneration of crystal protein and produce cloudiness. For the elderly, oxidative damage to the crystal is the initial factor in cataract formation. Risk factors for cataract formation include excessive alcohol consumption, excessive smoking, excessive childbirth in women and certain systemic diseases, etc. However, the causes of senile cataract formation are still not fully understood and need to be further studied.
Complicated cataract is the clouding of the lens caused by certain eye diseases themselves, such as iridocyclitis, chorioretinitis, retinal detachment, retinitis pigmentosa, glaucoma, high myopia and eye diseases such as septic corneal ulcer and old eye trauma can cause complications of cataract.
Traumatic cataracts include mechanical, radiation, and electric shock. Metabolic disorders cataracts are clinically more often seen as diabetic cataracts. Corticosteroid cataracts are caused by long-term heavy use of corticosteroids locally in the eye or systemically.
Posterior cataract is the clouding of the residual cortex and capsule after extracapsular extraction or linear extraction of cataract.
There are two major types of cataracts: congenital cataracts and acquired cataracts. The most common one is senile cataract, the onset of which is mostly around 50 years old and is caused by degenerative changes of the lens, which can develop in both eyes successively or at the same time; the clouding of the lens due to eye trauma is called traumatic cataract; in addition, diabetes, inflammation and hemorrhage in the eye can lead to concurrent cataract.
The ancient surgical method of cataract treatment is “golden needle plucking”, which means that the suspension ligament around the lens is broken with a needle, causing the dislocation of the lens, and the free crystal sinks into the vitreous cavity, so that the light originally blocked by the cloudy crystal can enter the eye. The gold needle can only temporarily solve part of the problem. Without the refractive action of the crystal, the patient is equivalent to about 19D (1900 degrees) of hyperopia, and after the crystal sinks into the vitreous cavity, inflammation will inevitably occur, eventually leading to complete loss of vision.
Preventive measures
1. Pay attention to mental regulation: take things in stride, be broad-minded, keep your emotions relaxed, and control your anger. Cultivate interest in raising flowers, birds, goldfish to cultivate sentiment, more conversations with young people, can distract the attention of unpleasant things, stimulate the enthusiasm for life, can play a role in stopping and delaying the progress of the disease.
2, strengthen eye hygiene, usually do not use hands to rub the eyes, do not use unclean handkerchiefs, towels to wipe the eyes, wash the eyes. After excessive use of the eyes should be properly relaxed, sedentary workers should get up at intervals of 1 to 2 hours for 10 to 15 minutes, raise the eyes and look far away, or do eye exercises. Have enough sleep to recover from fatigue in time.
3, active prevention and treatment of chronic diseases, including eye disorders and systemic diseases. In particular, diabetes is most likely to complicate cataracts, so it is necessary to control blood sugar in a timely and effective manner to prevent further development of the disease.
4, diet should be rich in protein, calcium, trace elements, more food containing vitamin A, B, C, D. Eating more fish can maintain normal vision and slow down the progress of the disease.
5. Smoking has been proven to be prone to cataracts, so you should quit smoking early.
Diet
(1) Eat more fresh vegetables and fruits rich in natural vitamin C, such as celery, cabbage, green vegetables, tomatoes, strawberries, oranges, fresh dates, etc.
(2) Eat more grains, green vegetables and lettuce, carrots and tomatoes, especially citrus fruits, grapes, lemons, bananas and apricots. Also eat calcium-containing foods regularly.
(3) Avoid drinking alcohol, smoking, and eating less animal fat and sugar.
Clinical manifestations
The main symptom of cataract is vision loss. Clinically, blurred vision, fixed black shadows in front of the eyes and diplopia appear in the initial stage. In the initial stage, there are blurred vision, fixed black shadows in front of the eyes, double vision, etc. When the vision loss is obvious, there is even only light perception. The duration of age-related cataracts varies from a few months to several years or even decades, or it may stop at a certain stage and become stationary.
Cataracts, especially senile cataracts, are one of the most common eye diseases, accounting for 25% to 50% of blindness-causing eye diseases. According to statistics, there are 15 million cataracts causing blindness in the world today, and according to our census, there are about 4 to 5 million cataract patients. The most effective method of cataract treatment is surgery, and the majority of patients can regain their vision through surgical treatment.
Surgical method
Natural crystals have a capsule, or lens capsule, which is divided into intracapsular and extracapsular extraction according to the relationship between the nucleus and the capsule during surgical removal. After removal of the cloudy lens, an IOL is often placed, which can be placed in the anterior or posterior chamber, and in the posterior chamber, which can be either intracapsular or extracapsular. In addition to restoring vision, placement of the IOL can also restore the anatomical relationships within the eye and prevent prolapse of the anterior vitreous, which may strain the retina if it prolapses from the vitreous cavity into the anterior chamber and adheres to the corneal or iris tissue.
Intracapsular cataract extraction (ICCE): A large incision is made to cut the corneoscleral rim, and the lens is frozen with a frozen head upon entry, pulling outward to cause rupture of the suspensory ligament and deliver the lens.
Extracapsular Cataract Extraction (ECCE): switch-type capsulotomy and delivery of the lens
Phaco: continuous circumferential capsulorrhexis, ultrasonic emulsification of the nucleus, irrigation and aspiration of the cortical lens, and implantation of an IOL
Cataract Ultrasonic Emulsification Technique
Since 1967, Dr. KELMAN invented the first ultrasonic emulsification instrument and used it in clinical practice. After more than 30 years of continuous improvement and refinement by many ophthalmologists, cataract ultrasonic emulsification technology has become a world-recognized, advanced and mature surgical procedure. Ultrasound emulsification is now popular in developed countries, and has been introduced and promoted in China since 1992. During the surgery, an ultrasound probe is inserted into a small incision in the cornea or sclera to break the cloudy lens and cortex into celiac disease, and then the celiac disease is sucked out with the help of a suction and perfusion system, while keeping the anterior chamber full. The ultrasonic emulsification technology truly achieves the surgical ideal of small incision, no pain, short operation time, no hospitalization, and rapid restoration of vision.
What are the features of cataract ultrasonic phacoemulsification IOL implantation
Compared with traditional surgery, cataract ultrasonic phacoemulsification IOL implantation has the following advantages.
1. Small surgical incision, 12MM for traditional surgery, but less than 3MM for this surgery.
2. Light postoperative reaction, fast healing of the incision, faster and better vision recovery.
3.The postoperative astigmatism is small and easier to correct or control.
4. Better control of surgery, safe and stable.
5.Surgery time is short, generally only about 15-30 minutes.
6. No hospitalization is required, and you can go home within one hour after surgery.
7.No need to wait for the cataract to mature before performing the surgery.
Why is it necessary to install an IOL after cataract extraction?
After cataract removal, the eye loses the essential structure of the lens, so the vision is still unclear. Under normal circumstances, IOL implantation can be used for a lifetime.
Indications
Cataract surgery has a wide range of indications and can be used for all types of cataracts that are suitable for sight restoration surgery:
1. Those with cloudy lens and visual acuity below 0.3, including corrected visual acuity.
2.Regardless of visual acuity, as long as the patient has high requirements for visual acuity, or has special occupational requirements.
3.Lens dislocation and semi-dislocation.
4.Highly myopic eyes combined with cataracts.
5.Congenital cataracts of all ages.
6.Cataract complicated by inflammation, must wait for intraocular inflammation to be controlled for more than six months.
7.Traumatic cataract.
8.Cataract combined with glaucoma, IOP control can be combined with surgery.
There is no absolute contraindication to cataract surgery, and some cataract patients with systemic diseases such as diabetes and hypertension can undergo cataract surgery as long as the primary diseases are controlled within the normal range.
1.Conventional examination
Eye examination before cataract surgery should include visual function (light perception, light localization, color vision). Routine slit lamp examination of the eye and intraocular pressure measurement. For suspected fundus lesions, visual electrophysiological examination, ultrasound examination of the eye and macular function examination can be performed. For those who have undergone eye surgery, corneal endothelial cell count measurement can be done as needed.
Based on the above examinations, we can generally evaluate the condition of the eye to be operated, estimate the recovery of visual function after surgery, and prepare for possible complications and risk factors during surgery.
There is no special rule for the timing of cataract surgery. In the past, cataracts were considered to be mature before surgery, but with the development of surgical techniques, immature cataracts can also be treated surgically. For those nuclear cataract patients with high visual acuity requirements, surgery can also be arranged for those with visual acuity of 0.3 or 0.5 or higher.
2. Special patient examination
Patients who have eye diseases at the same time should carefully decide the timing, mode or order of surgery. For example, patients with chronic dacryocystitis should undergo nasal lacrimal sac anastomosis or lacrimal sac removal first, and patients with glaucoma can be considered for combined glaucoma-cataract surgery.
Patients with cardiovascular disease should be controlled before surgery; intraoperative cardiac monitoring can be performed when available to ensure the safety of surgery.
For patients with diabetes mellitus, blood sugar should be controlled first and antimicrobial agents should be applied before surgery to prevent infection. In case of systemic or local acute and chronic inflammatory lesions, treatment should be given first.
Pre-operative precautions
1. If you have hypertension, diabetes or cough, you should consult an internist for diagnosis and treatment and wait until your condition is stable before performing cataract surgery.
2.If you are taking medications for hypertension, diabetes or cough, please continue to take them before and after surgery and on the day of surgery.
3.Do your personal hygiene (hair washing and bathing) the day before the surgery.
4.On the day of surgery, please wash your face clean and do not use any cosmetics.
5.You can eat a small amount of food before surgery.
6.Be sure to have a family member accompany you on the day of surgery.
Post-operative care
1.To go home by car after surgery, avoid bumps.
2.Take eye drops on time, wash your hands before ordering, and do not touch your eyes and hands at the mouth of the eye medicine bottle to prevent contamination. Use your hand to pull down the eyelid (the surgical incision is in the upper part, do not pull the upper eyelid) and put in the eye drops, if you need to use more than two kinds of eye drops, the interval is 10-15 minutes.
3.After surgery, you should quit smoking and avoid alcohol, do not eat spicy and stimulating food, eat more vegetables and fruits, and keep your bowels open.
4. The surgical incision should heal in about three weeks (diabetic patients should also extend the time appropriately). During this period, wash your face and hair and be careful not to let the sewage enter the operated eye to prevent infection.
5. Avoid coughing as hard as possible after surgery. External collision, pressure, head bowing and eye rubbing are strictly forbidden in the operated eye, and it is necessary to lie down or lie sideways to the non-operated eye during nap and night sleep, and wear an eye patch to prevent eye injury.
6. Avoid lifting heavy objects and strenuous exercise to prevent fluctuations in intraocular pressure.
7.When going out to prevent wind and sand, wear glasses, etc. to prevent foreign objects from entering the eye.
8.Avoid prolonged reading of books and newspapers during the recovery period to prevent eye fatigue.
9.People with high blood pressure and diabetes should adhere to their medication.
10.Post-operative review at the hospital according to the doctor’s prescription. If there is any sudden change of vision, redness, swelling, pain and other symptoms, you should immediately consult the doctor.
Post-cataract surgery complications
Several complications can occur after cataract surgery and must be treated symptomatically according to the causes of each complication.
(1) Superficial anterior chamber due to incisional leakage after cataract surgery;
(2) Choroidal detachment with incisional leakage;
(3) Pupillary block;
(4) persistent corneal edema;
(5) Small amount of anterior chamber blood or blood filled anterior chamber with high intraocular pressure;
(6) Poor prognosis with epithelial implantation in the anterior chamber;
(7) Uveitis after cataract surgery;
(8) Treatment of glaucoma after cataract surgery should be carried out with local and systemic hypotensive treatment along with etiologic treatment.
(9) If conservative treatment for abnormal IOL position is ineffective, surgical repositioning is usually performed, and if necessary, the IOL is removed or replaced;
(10) clouding of the posterior capsule of cataract;
(11) For retinal complications, macular cystoid edema;
(12) Retinal detachment.
Post-surgical eye spotting method
1.Patients first wash and dry their hands with soap and water, and preferably in a reclining position (sitting is also possible).
2. The cataract patient should tilt his head back slightly, pull down the lower eyelid with the index finger of one hand, and look upwards while the other hand orders the drops or ointment.
3. It is best to let go of the lower eyelid, gently close the eyes and rest for three minutes.
What foods do cataract patients eat
Cataract patients should eat more dark green, fresh vegetables and try to avoid the following foods.
1. fried foods as well as artificial fats, margarine, and animal fats, as these foods accelerate oxidation reactions and make people susceptible to cataracts.
2, whole milk powder, milk, cream, cheese, ice cream and other dairy products rich in lactose, such as lactose contained in milk, through the action of lactase, decomposed into galactose, and some people have a reduced ability to metabolize galactose in milk. In addition, galactose interferes with the utilization of vitamin B2 in dairy products, causing it to be deposited on the lens of the eyes of the elderly, and the protein is prone to denaturation, leading to a decrease in lens transparency, which can easily induce or aggravate cataract.
Surgical procedure
Take the example of ultrasonic emulsion lens extraction + IOL implantation.
Post-bulbar anesthesia, injection of 2% lidocaine 2.5 mL. routine disinfection of towel laying. Along the corneal margin, the cornea is incised from 11 to 12 o’clock. 2 mm outside the corneal limbus, 1/3-1/2 of the sclera was incised from 11 to 12 o’clock in the vertical lamina. The sclera was separated horizontally with a tunneling knife into the clear cornea to form a tunnel incision, and the anterior chamber was penetrated with a puncture knife at 11:30 to inject viscoelastic. The anterior chamber is punctured at 2:00 and the anterior capsule of the lens is punctured. Continuous circumferential tearing of the capsule. Water separation and water layer. Ultrasonic emulsification for crystal removal. Aspiration of the cortex and polishing of the anterior capsule. Implantation of IOL. Perfusion aspiration, removal of residual cortex and viscoelastic. Closure of the conjunctival wound. Subconjunctival injection of hormones and antibiotics. Routine postoperative application of glucocorticoids and non-steroidal anti-inflammatory eye drops.
Anesthetic modalities
For more than a century, cataract surgery has been performed with postbulbar or peribulbar anesthesia, but some potential complications can still occur, such as postbulbar hemorrhage, elevated intraocular pressure, optic nerve injury, punctured eye, and life-threatening accidental injection of anesthetic drugs into the skull. Both retrobulbar or peribulbar anesthesia take a long time to produce anesthesia and are painful to the patient during injection. Nowadays, a new type of anesthesia for cataract surgery has been created.
Cataract ultrasound-emulsification surgery with simple surface anesthesia, which has been adopted in recent years, is gradually gaining acceptance as a new technique. This method makes the surgery safer and avoids many complications of retrobulbar and peribulbar anesthesia; it is almost painless after surface anesthesia (there is sensation around the eye), which reduces the patient’s pain and the resulting fear and enhances the patient’s confidence in the surgery, and broadens the indications for the general condition of the operated patient, especially for elderly patients with systemic diseases such as cardiovascular diseases; in addition, this method has the characteristics of light postoperative reaction and rapid visual recovery. In addition, this method has the characteristics of light postoperative reaction and rapid recovery of vision. However, this surgical method is technically demanding and requires close cooperation between the patient and the doctor to complete the surgery successfully.
Three misconceptions about surgical treatment
Cataract is a common ophthalmological disease that may lead to blindness if not treated as soon as possible. Therefore, early cataract treatment is very important, and the best treatment for cataract is cataract surgery. However, there are still many people who have three major misconceptions about cataract surgery, which we will introduce to you today.
Some cataract patients are told to “wait until they can’t see before surgery”, so they wait patiently and don’t go to the hospital for regular checkups. As a result, they are not aware of other eye diseases, such as chronic angle-closure glaucoma, macular degeneration, fundus and vitreous hemorrhage, and so on.
When the vision is seriously impaired, the above diseases have developed to a more serious degree and the best time for treatment is missed. In this case, even if surgery is done, satisfactory vision cannot be restored.
2. In the past, the traditional concept was that surgery could only be performed when the cataract was mature, which was especially cruel to patients with cataract in both eyes, because these patients had to wait for a longer time in the hazy world to regain their sight, which made them lose many opportunities to work and enjoy life.
With the development of modern medicine, ophthalmic microsurgery has become very mature and common, and modern cataract extracapsular extraction as well as crystal ultrasound emulsification techniques can achieve good treatment results for immature cataracts. Therefore, in order to improve the quality of life, cataract patients can receive surgery when they feel that their visual impairment has affected their normal work or life, without having to wait until the cataract has matured.
3. Cataracts often occur unconsciously and develop slowly, and many elderly people do not go to the hospital for examination because they feel that they can see distant objects less clearly than before.