I. What is a cataract?
Clinically, the clouding of the lens that affects vision is called cataract. The lens is like a convex lens in the eye, equivalent to the lens of a camera. The lens can become cloudy gradually with age or due to trauma, drugs, radiation and ultraviolet rays. Cataract can be diagnosed when vision is below 0.7 and other eye diseases are excluded. Cataract surgery can be performed when vision is below 0.3. So far, there is no medicine in the world that can prevent and treat cataract. Surgery is the only way to treat cataract.
Precautions before cataract surgery
Patients with serious systemic diseases such as hypertension, diabetes, cardiovascular disease and cough should be treated and stabilized by an internal medicine physician before cataract surgery is performed.
The day before surgery, please wash your hair, take a bath, cut your nails, and change into clean inner and outer clothes.
No cosmetics should be used on the day of surgery.
Please cooperate by cutting eyelashes and flushing the conjunctival sac and tear duct in advance.
Please cooperate with injections, medication and eye drops before surgery.
On the day of surgery, you must be accompanied by a direct relative and go through the signing procedure, otherwise you cannot operate.
III. What are the risks of cataract surgery procedure
Patients should not cough or sneeze, talk as little as possible, and not move their head or body during surgery. Otherwise, there will be serious consequences.
During the surgery, the clear cortex of the lens may not be flushed out and posterior cataract may occur, but if it affects the vision, laser treatment or secondary surgery can be performed.
Very few patients have complications such as IOL inability to implant or IOL displacement or entrapment after implantation, which can usually be solved by secondary surgery or lens prescription to increase vision.
Serious complications such as glaucoma, uveitis, retinal choroidal detachment, large vesicular keratitis, intraocular hemorrhage, and endophthalmitis rarely occur after surgery. With early detection, early diagnosis and early treatment of the above complications, most of them eventually have good vision. Only a very small number of patients have serious consequences, about 1-2 per 1,000.
Patients may have cardiovascular, cerebrovascular, anesthesia, and drug allergy accidents during inpatient surgery due to old age or combination of serious cardiovascular, cerebrovascular, and systemic diseases. Once an unexpected accident occurs, it is necessary for patients and their families to actively cooperate with rescue or transfer to hospital for treatment.
IV. Precautions after cataract surgery
On the day of surgery, pain in the eye and foreign body sensation are normal reactions of individuals, and severe pain in the eye, headache and nausea rarely occur.
Do not open the bandages and dressings on the day of surgery, lie down in bed and rest, talk as little as possible, and walk slowly.
On the second day after surgery, change the medication and order antibiotics, hormones and eye dilating water as prescribed by the doctor, no bandage is needed.
After surgery, you should eat soft and easily digestible food, not to eat raw, cold, hard, brittle, tobacco, alcohol, spicy and irritating food for one month, to keep the bowel movement smooth, constipation timely medication, avoid excessive force, should rest more, can not speak loudly. Do not do heavy physical work and strenuous exercise for three months.
Coughing and sneezing after surgery are the most dangerous things in cataract surgery and the main cause of bleeding or wound splitting in the operated eye, therefore, if you find coughing you should take cough medicine in time. When coughing and sneezing, you should open your mouth and breathe in to reduce the shock to the operated eye and try to avoid catching a cold.
Apply hot compresses after 24 hours after surgery, three times a day, and postpone hot compresses if there is bleeding. Pay attention to personal hygiene, use towels alone and wash and dry them frequently.
The vision of the operated eye should be gradually improved after discharge. If you find vision loss, eye pain, headache, photophobia and tearing, foreign body sensation, etc., come to our outpatient clinic for examination and treatment at any time, and do not treat at home, otherwise it will cause serious consequences.
Patients should move slowly and live with someone for half a month. Outpatient observation and follow-up for three months.
V. How to order eye drops
Please wash your hands with soap and water and dry them first.
The patient should preferably be in a supine or sitting position with the head tilted back, pull the lower eyelid open with the index finger and look upward, with the eye drop bottle 3-5 cm away from the eye, and then put the eye drop or eye ointment into the conjunctival sac.
Release the lower eyelid, gently close the eyes and rest for 3-5 minutes.
Sixth, who have poor results after cataract surgery
Patients with diabetes, hypertension atherosclerosis, rheumatism.
Patients with high myopia combined with vitreous opacity and fundus changes.
Those who have had fundus disease. For example, retinopathy, optic neuropathy, retinal detachment or vitrectomy, laser surgery, etc.
Those who have had trauma to the eye. For example, penetrating eye injury, concussion injury, retinal optic nerve injury.
Those who have had acute and chronic uveitis, old uveitis with pupillary membrane closure and poor vision all the time.
Those who have had acute or chronic glaucoma or have had glaucoma surgery and have not recovered their vision.
Patients with congenital or unexplained poor vision or with nystagmus, strabismus, amblyopia, non-central fixation, poor color discrimination, or light localization.
Patients with congenital cataracts, traumatic cataracts, and concurrent cataracts have poorer results after surgery.
Patients with unexplained corneal opacities, cloudiness, mottled opacities, corneal vascular opacities, and pterygium of degree II or higher.
Patients with inverted eyelashes, ptosis, ectropion, lid adhesions, blepharitis, severe trachoma, dacryocystitis, tear duct inaccessibility, and long-term lacrimation.
Retinal detachment education
Retinal detachment refers to the separation of the neuroepithelium from the pigment epithelium of the retina. It is associated with high myopia, trauma, tumor and genetic factors. It is characterized by reduced visual acuity, visual distortion, visual field defects, fixed black shadows in front of the eyes, and flash phantom vision. Surgical repositioning is the main method of treating retinal detachment. In order to improve the success rate of surgery, patients should be properly instructed to master the general knowledge of ophthalmic surgery and the following precautions.
Psychological guidance
Eliminate depression, anxiety and pessimism, and maintain optimism. Because of the sudden loss of visual acuity after retinal detachment, it is difficult for patients to accept this fact for a while; and they are worried about the above-mentioned adverse psychological reactions because of no significant improvement of visual acuity after surgical reset. Therefore, we should comfort and guide the patient, encourage him to establish confidence to overcome the disease; explain that the purpose of surgical reset of retinal detachment is not only to improve the visual acuity of the affected eye, but more importantly, to prevent the total detachment of retina from causing secondary glaucoma, ocular atrophy and other complications leading to blindness, so as to relieve his ideological concerns and actively cooperate with the surgery.
Pre-operative guidance]
Wrap both eyes before surgery, rest in bed as much as possible, avoid strenuous movement and rotation of the eyes to prevent the expansion of the retinal detachment. Check the extent and height of retinal detachment and whether there are retinal fissures every day. If there are fissures, the location, size, shape and number of fissures should be clarified, and the surgical plan should be designed, and the patient should actively cooperate.
【Post-operative guidance
1.Absolute bed rest for 15 days, keep the bed position according to the doctor’s prescription, and move the head less, which is good for the retinal neuroepithelium and pigment epithelium to reset tightly and prevent the retina from detaching again.
2.When the retina has calmed down without floating, the patient can get up and move around in bed without dizziness, eye pain and other discomfort before getting out of bed. Someone should be there to support the patient when he/she starts to get out of bed to avoid postural fainting due to the long time of bed rest and weakness.
【Discharge instruction
1. After discharge, order atropine eye drops and keep the pupil dilated for one month. Order antibiotics and hormonal eye drops for three months.
2.Avoid physical labor and strenuous exercise for six months after surgery to prevent the reset retina from detaching again.
3.Patients should wear small hole glasses for 3 months after discharge to limit eye rotation and prevent retinal detachment again.
4. Come to the outpatient clinic for review after half a month. The appearance of black shadows in front of the eyes, double vision, flashing sensation, vision loss, and distortion of vision indicates that the retina is still not completely reset or new broken holes have appeared, so you should immediately take bed rest and go to the hospital.
Glaucoma knowledge dissemination
Glaucoma is an eye disease with pathologically elevated intraocular pressure with damage to vision, visual field and optic nerve. It is a combination of severe visual dysfunction and blindness due to persistent elevation of intraocular pressure and poor perfusion of blood to the optic papilla. The main treatment is to lower the IOP with medication and then perform surgery. In order for the patient to cooperate well with the treatment and care, the patient needs to be properly instructed about the following knowledge.
Psychological guidance]
Keep optimistic mood and avoid emotional excitement. When you get excited, the sympathetic nerve becomes excited and the pupil dilates due to the contraction of the pupil opening muscle. As the pupil dilates, the anterior chamber angle becomes narrower and the atrial water from the posterior chamber cannot flow smoothly into the anterior chamber through the anterior chamber angle, resulting in an increase in intraocular pressure. Therefore, maintaining an optimistic mood and avoiding emotional excitement can effectively prevent acute glaucoma attacks.
Preoperative guidance
1. Diet: reasonable structure, meat and vegetables should be matched. Special attention should be paid to more coarse fiber foods such as vegetables and fruits to promote intestinal peristalsis and keep the bowel movement smooth.
2. Ensure sufficient sleep to avoid sympathetic excitation caused by insomnia, which may lead to an increase in intraocular pressure.
Medication guidance]
Patients with primary angle-closure glaucoma should not use pupil-dilating eye drops such as atropine, neofolin and tropicamide before surgery to avoid dilating the pupil and triggering an acute attack of glaucoma.
Be cautious with Valium and tincture drugs to avoid raising IOP.
If side effects such as numbness, nausea, weakness, dizziness, etc. occur after taking acetylacetamide orally, tell your health care provider in time to adjust the medication.
When using hypertonic dehydrating agents such as mannitol and glycerol, pay attention to the presence of fatigue, dizziness, dizziness and abdominal distension to avoid excessive dehydration or hypokalemia.
[Prevention and health care guidance
(1) Do not smoke. Due to the stimulation of smoke, coughing can cause an increase in intraocular pressure and induce glaucoma. Therefore, it is necessary to quit smoking.
(2), do not drink alcohol, strong tea, coffee. Because wine, strong tea and coffee have the effect of excitation of sympathetic nerves, leading to the rise of intraocular pressure induced glaucoma acute attack, so we should try to avoid.
(3), do not drink a lot of water at one time to avoid a sharp increase in blood volume and excessive atrial aqueous formation, resulting in an increase in intraocular pressure.
(4) The collar should not be too tight, and do not work with the head down for a long time to avoid the obstruction of jugular venous reflux, which causes the atrial fluid circulation to rise.
(5) Do not stay in dark places for a long time. It is advisable to watch TV with the lights on to prevent the pupil from dilating due to increased light entering the eye in order to adapt to the dark environment, which may cause an increase in intraocular pressure due to obstruction of atrial circulation.
Postoperative discharge guidance
Keep an optimistic mood, do not get angry, do not get anxious, and do not stay up late to facilitate recovery.
Absolutely rest in bed for 1-2 days after surgery, and wait until the IOP stabilizes in the normal range (1.3-2.8 kPa, i.e., 10-21 mmHg) and there is no bleeding from the intraocular wound before getting up and moving around, avoiding prematurely getting out of bed and straining the wound to cause bleeding.
Patients with one eye operated on and the other eye not operated on should be kept lying down after ordering eye drops. Because the eye drops in the two eyes are completely different, so that the eye drops do not flow into each other.
Do not drink alcohol, strong tea and coffee, and do not drink a lot of water at one time and stay in too dark a place for a long time.
Exercise, strengthen your body, and prevent cold, cough, sneeze, and other factors that may trigger an increase in eye pressure.
Do not take eye drops such as atropine, novocaine, tropicamide, etc. in eyes that have not been operated on to avoid dilating the pupil and causing glaucoma attacks.
Come to the outpatient clinic for review once a week for 1-2 months. Follow up promptly when eye pain, vision loss and tearing occur.