The lens capsule is inherent elasticity. During the operation to remove cataracts, an artificial lens is placed in the eye, replacing the real one. At the same time, the posterior capsule supports the new intraocular lens. It happens that the capsule begins to cloud, which causes a phenomenon such as secondary cataract after replacing the lens. The treatment, the reviews of which are the most positive, is carried out in accordance with medical indications. The latest methods and high-quality equipment are applied.
Causes of the phenomenon
Where does secondary cataract come from after replacing the lens? The doctors' comments about this complication indicate that the exact causes of its occurrence are not disclosed.
The development of a secondary complication is explained by the growth of the epithelium localized on the surface of the posterior capsule. There is a violation of its transparency, which causes a decrease in vision. Such a process cannot be connected with the surgeon’s mistake during the operation. Secondary cataract after replacing the lens, the reasons for which lie in the reaction of the body at the cellular level, is a fairly common phenomenon. The lens epithelial cells turn into fibers that are functionally inferior, irregular in shape and opaque. When they move to the central part of the optical zone, clouding occurs. Visual impairment may be caused by fibrosis of the capsule.
Risk factors
Ophthalmologists have established a number of factors explaining why secondary cataracts appear after lens replacement. These include the following:
- The age of the patient. In childhood, cataracts after surgery are more common. This is due to the fact that tissues in the young body have a high level of ability to regenerate, which causes the migration of epithelial cells and their division in the posterior capsule.
- IOL form. A square intraocular lens allows the patient to significantly reduce the risk of damage.
- IOL material. Doctors have found that after the introduction of an acrylic-based IOL, secondary clouding of the lens occurs less frequently. Silicone designs provoke the development of complications more often.
- The presence of diabetes mellitus, as well as some common or ophthalmic diseases.
Preventative measures
To prevent the appearance of secondary cataract, doctors use special methods:
- Lens capsules are polished to maximize cell removal.
- A selection of specially designed designs is made.
- Applied medications against cataracts. They are buried in the eyes for the intended purpose.
Signs of secondary cataracts
In the early stages, secondary cataract after replacement of the lens may not manifest itself at all. The duration of the initial stage of the development of the disease can be from 2 to 10 years. Then obvious symptoms begin to appear, and the loss of objective vision also occurs. Depending on the area in which the lens was deformed, the clinical picture of the disease can vary significantly.
If a secondary complication manifests itself on the periphery of the lens, then it may not cause visual impairment. As a rule, pathology is detected at a routine examination by an ophthalmologist.
How does such a pathological process as secondary cataract after replacing the lens manifest itself? Treatment (symptoms and appropriate examinations should confirm the diagnosis) is prescribed for a persistent drop in visual acuity, even if it has been fully restored during surgery. Other manifestations include the presence of a veil, the appearance of light from sunlight or artificial light sources.
In addition to the above symptoms, monocular bifurcation of objects may occur. The closer to the center of the lens is clouding, the worse the patient’s vision. Secondary cataracts can develop both in one eye and in both. A distortion of color perception appears, myopia develops. Outward signs are usually not observed.
Treatment
Secondary cataract after lens replacement, the treatment of which is successfully carried out in modern ophthalmologic clinics, is removed through capsulotomy. This manipulation helps to clear the central zone of optics from clouding, allows light rays to enter the eye, and significantly improves the quality of vision.
Capsulotomy is performed both mechanically (instruments are used) and the laser method. The latter method has great advantages, since it does not require the introduction of a surgical instrument into the cavity of the eye.
Surgical intervention
How is secondary lens cataract eliminated? Treatment involves surgery. Such surgery involves dissecting or excising a clouded film with a surgical knife. Manipulation is indicated when a secondary cataract after a lens change has caused great complications, and it is likely that the patient will become blind.
During the operation, cruciform incisions are performed. The first is done in the projection of the visual axis. Typically, the hole has a diameter of 3 mm. It may have a larger indicator, if you need an examination of the bottom of the eye or photocoagulation is required.
Cons of surgery
The surgical method is used both in relation to adult patients and children. However, a fairly simple operation has a number of significant drawbacks, which include:
- penetration into the eye of an infection;
- getting injured;
- corneal edema;
- the formation of a hernia as a result of a violation of the integrity of the membrane.
Features of laser treatment
What innovative methods are used to eliminate such a problem as secondary cataract of the lens? Treatment is carried out using laser beams. This method has a high degree of reliability. It assumes accurate focusing and low energy costs. As a rule, the energy of the laser beam is 1 mJ / pulse, but if necessary, the value can be increased.
Intervention with a laser is called dyscysis. It has a high level of effectiveness. With this treatment, a hole is made in the back of the capsule by burning. A clouded capsule is removed through it. For this method, a YAG laser is used. In modern medicine, this method is preferred.
Patient reviews indicate that such an intervention does not require a hospital stay, the operation is very fast and does not cause pain or discomfort. Manipulations are performed using local anesthesia.
How is secondary cataract eliminated after lens replacement? Laser treatment for complications involves the following steps:
- Expansion of the pupil through medication. Eye drops are applied to the cornea to help dilate the pupils. For example, tropicamide 1.0%, phenylephrine 2.5%, or cyclopentolate 1-2% are used.
- To prevent a sharp increase in pressure inside the eye after surgery, apraclonidine 0.5% is used.
- The implementation of several laser shots using a special device mounted on a slit lamp causes a transparent window to appear in the cloudy capsule.
How does a person feel after eliminating with a laser a phenomenon such as secondary cataract after replacing the lens? Patient reviews indicate that after surgery they went home within a few hours. Sutures and dressings with this intervention are not required. Hormonal eye drops are prescribed to patients. Their use in the period after surgery will be the last step on the road to restoring vision.
After a week, the person who undergoes surgery will have a scheduled examination by an ophthalmologist to make sure that everything is going right.
Another examination is shown a month later. It is not considered planned, but its passage is desirable. So you can identify possible complications and eliminate them in a timely manner. It should be noted that the vast majority of complications occur within a week. Later they occur extremely rarely.
For the most part, secondary cataracts are eliminated through a single operation through a laser. Secondary intervention is extremely rare. The likelihood of complications from this kind of treatment is very low and is about 2%.
In what cases is dyscysis prescribed?
Dyscision of secondary cataract is applied if:
- damaged back stack of the capsule causes a sharp drop in vision;
- poor vision interferes with the patient's social adaptation;
- There are problems with the vision of objects in excessive or poor lighting.
Strict contraindications
Is it always possible to eliminate a complication such as secondary cataract after replacing the lens? Contraindications, no doubt, are available. Moreover, they can be absolute, excluding the possibility of any kind of manipulation. These include:
- the presence of puffiness or scar tissue in the cornea, which prevents the ophthalmologist from clearly seeing the intraocular structures during surgery;
- the occurrence of an inflammatory process in the iris of the eye;
- the presence of macular edema of the retina;
- clouding in the cornea;
- excess of the pupil membrane thickness of 1.0 mm.
Relative contraindications
Relative contraindications include conditions in which the risk of secondary complications is increased:
- the term of cataract surgery for artifact is less than six months, and for aphakia less than 3 months;
- full contact of the posterior capsule with the IOL;
- pronounced process of neovascularization of the pupil membrane;
- the presence of uncompensated glaucoma;
- the presence of inflammatory processes in the anterior segment of the eye.
The operation is carried out with great care if the patient has previously observed retinal detachment or rupture.
The laser method of treatment has its minus. Laser radiation can damage the optical part of the artificial lens.
Complications
What is the effect of the laser method in the treatment of such an ailment as secondary cataract after lens replacement? The consequences may be undesirable.
- After replacing the lens with secondary cataract, the appearance of black flies may occur, which is caused by damage to the lens structure during surgery. This defect has no effect on vision. Damage of this kind is caused by poor focusing of the laser beam.
- Rash retinal swelling is considered a dangerous complication. In order not to provoke its appearance, surgery should be carried out only six months after the previous operation.
- Regmatogenous retinal detachment . This phenomenon is extremely rare and is caused by myopia.
- IOP increase. Usually this is a fast-moving phenomenon and does not pose any threat to health. If it lasts a long time, then this indicates the presence of glaucoma in the patient.
- Subluxation or dislocation of the IOL is observed in rare cases. Such a process, as a rule, is caused by an IOL with a silicone or hydrogel base with a disk-shaped haptics.
- The chronic form of endophthalmitis is also rare. It is caused by the release of isolated bacteria into the vitreous region.
- Fibrosis (subcapsular opacification) is rare. Sometimes this process develops within a month after the intervention. An early form of complication can trigger a contraction of the anterior capsule and the formation of capsulophimosis. The development is influenced by the model and the material from which the IOL is made. Often, such a deviation is caused by silicone models with a haptic in the form of disks and less often IOLs, which consist of three parts. The basis of their optics is acrylic, and the haptic is made from PMMA.
To prevent complications after surgery, doctors are advised to regularly use eye drops that prevent the development of cataracts.
Conclusion
From the foregoing, it can be concluded that after surgery to remove the cataract, a complication such as secondary lens cataract often occurs. Treatment of the disease using modern methods gives good results, but adverse reactions are possible.