Vision is a necessary feeling for every person. Reducing its severity entails a lot of problems, ranging from the difficulties associated with the implementation of labor activities, and ending with domestic difficulties. There are many eye diseases that are successfully treated in various ways. In some cases, surgical intervention guarantees partial or even complete restoration of vision. We will find out whether cataract surgery can significantly affect vision and significantly improve the clinical picture.
What is cataract?
Ophthalmologists diagnose such a disease in case of clouding of the lens, which has the function of a specific lens. It is located in the center of the eyeball and contributes to the penetration of light onto the retina. Blurring obstructs visual acuity, and in the future can lead to blindness.
At the initial stage of the development of the disease, the patient notices flies in the eyes, and later a peculiar veil appears or, as some say, they see through the fog.
Development reasons
Most cataracts are an acquired disease. Only 3% of patients with this kind of congenital pathology occur in the world, which occurs even in utero due to diseases or their chronic ailments suffered by the mother during pregnancy. The prerequisites for the appearance of a cataract in a newborn can be:
- rubella;
- toxoplasmosis;
- diabetes;
- calcium deficiency;
- hypothyroidism.
In children, usually the disease does not progress if it is not combined with other severe ailments, and vision drops to 0.3 and remains so for a long period. In some cases, babies are indicated for cataract surgery, but such a decision is made by the doctor together with the baby's parents.
Acquired clouding of the lens develops at a fairly mature age and progresses rapidly. About 90% of pathologies are associated with the aging of the whole organism, and 10% arise due to external factors, such as injuries or radiation.
The most common causes of cataracts in adults include:
- ultraviolet or radiation;
- age;
- injuries affecting the lens;
- infectious diseases;
- autoimmune pathologies;
- thyroid problems;
- ophthalmic concomitant diseases;
- eyeball surgery;
- long-term treatment with corticosteroids;
- the effect of toxic substances.
Disease development
Before deciding on surgical intervention, it is necessary to undergo an examination and find out at what stage of development the eye cataract is currently at. The operation may be delayed until other treatment methods have been tried. The disease can progress in different ways. Someone may have enough therapeutic treatment to stop the clouding of the lens, and someone will be operated on as soon as possible.
There are four stages of cataract development:
- Initial, when the lens becomes cloudy in far away areas. The patient does not experience inconvenience, does not notice the disease, there is a slight decrease in vision, sometimes doubles in the eyes. If therapy is started at this stage, then the transition to the second stage may last 10-20 years or not occur at all.
- Immature cataracts are characterized by significant visual impairment. The lens becomes inhomogeneous, and pressure inside the eye leads to glaucoma with subsequent atrophy of the optic nerve. At this stage, cataract surgery is considered the most effective.
- Mature cataracts are manifested by low vision, when a person already has poor vision and is difficult to distinguish colors. In this case, eye cataract surgery should be performed as soon as possible in order to restore vision.
- Overripe (Morganieva) cataract is characterized by complete disintegration of the lens, which may partially return the ability to see the outlines of objects for some moments. However, the destruction of the so-called lens can lead to the release of contents and the complete destruction of the entire eye.
Patient preparation
First, you need to conduct a diagnosis, which includes the following:
- Visometry is a manipulation that determines visual acuity according to the tables.
- Tonometry is a measurement of intraocular pressure.
- Ophthalmoscopy - the study of the optic nerve, retina and choroid.
- Binocularity - an assessment of the quality of simultaneous vision with both eyes.
- Biomicroscopy is the study of the lens, the degree of its change, the size of the nucleus and its density.
- Perimetry - the study of the boundaries of the field of view.
Also, the doctor can prescribe a number of special procedures, for example, refractometry, ophthalmometry or apply electrophysiological methods for determining pathology.
A few days before cataract surgery, it is necessary to obtain the results of laboratory tests of urine and blood. If urinalysis is quite general, then blood should be donated:
- for hepatitis B and C;
- on RW;
- on prothrombin according to Quick;
- on platelets;
- to sugar level.
The patient should be aware that the results of these studies are valid from ten days to one month. In addition, it is necessary to do electrocardiography no earlier than two weeks before cataract surgery. For placement in a hospital, fluorography should be on hand.
A visit to a therapist is also necessary, which will give an opinion on the general condition of the patient and the possibility of surgical intervention. It is advisable to visit such doctors as a dentist, gynecologist, urologist, otorhinolaryngologist to identify possible infections in the body that can lead to complications after cataract surgery.
What can not be done before surgery? Here the requirements are standard and apply to any operations:
- It is unacceptable to strain physically.
- Do not drink alcohol and drugs.
- From the evening of the day preceding the intervention, you should refuse food.
- Liquids should be consumed to a minimum.
- Acceptance of medicines for chronic diseases should be agreed with the surgeon and anesthetist.
Procedures on the day of surgery
Upon admission, the patient will be examined by an ophthalmologist. In some medical institutions, a patient is sampled for plasma separation. After surgical procedures, it is administered to the patient to accelerate the recovery of the body. Usually, the patient is given a sedative several hours before the intervention. Also, before entering the operating room, drops are added to him, expanding the pupil.
The patient is offered a sterile set of clothes, which he puts on himself. After changing clothes, he goes to the operating room, where he is placed on the table. As mentioned above, the entire procedure will last from 15 to 40 minutes. The time depends on the lens replacement method.
Types of Surgery
There are several methods for surgical treatment of cataracts. What operations today are the most popular and less traumatic, we learn further, having studied each type separately. The general list of types of operations includes:
- Extracapsular extraction.
- Intracapsular extraction.
- Ultrasonic phacoemulsification.
- Laser phacoemulsification.
The main opinion of doctors and patients, in short, states that the first method is the most affordable in terms of financial costs, and the latter is considered the most sparing, but expensive.
Extracapsular extraction
It is performed in patients with especially dense lens tissue and retinal angiopathy. This operation allows you to save the back of the lens capsule. The virtue of the method, experts call the remaining natural barrier between the front of the eye and the vitreous substitute. However, the disadvantage of this method is the high invasiveness of the cornea, since the incision is the largest. As a result of the operation, the artificial lens is replaced by the natural lens. Cataract surgery in this case is performed as follows:
- Processing the operating field.
- A solution for pain relief is instilled.
- Mydriatics for dilating the pupil and solutions for disinfection are introduced into the conjunctival sac.
- A corneal incision is performed, which is usually between 7 and 10 mm.
- Open and remove the front capsule.
- Remove the lens.
- Clear the cavity of the remains of the lens.
- Install the artificial lens in the capsule bag.
- Suture.
After this kind of intervention, inflammation of the remaining posterior part of the capsule or the development of film cataract is possible.
Intracapsular extraction
The method is based on the complete removal of the capsule with the lens inside, which saves the patient from cataracts. Reviews about this kind of operation are different. Both positive and negative opinions are posted on the web. Doctors do not really like this method. Despite the fact that complications in the form of film cataract are excluded with this method, there is a risk of falling out of the lens with a bag, which can lead to vascular damage, retinal detachment, and hemorrhage.
We outline the main stages of surgical intervention:
- The first three stages are identical to extracapsular extraction.
- A wide incision of the cornea is performed.
- Move the iris.
- The extreme part of the lens is exposed.
- Fix (freeze) the tip of the cryoextractor to the extracted part.
- Remove the lens.
- The artificial substitute is fixed in the anterior chamber or in the pupil opening.
- Sew the incision.
In modern ophthalmology, this metol is rarely used, usually in case of damage to the lens, and is not used at all until the patient’s 18th birthday.
Ultrasonic Phacoemulsification
This is the preferred option, providing excellent results and good reviews. Cataract surgery at this level is considered the gold standard. The first three stages are carried out in the same way as with other interventions. Then make a small incision, which does not exceed 3 mm. After they make a hole in the front capsule of the lens and a special fluid is injected through it. The next step is to crush the vitreous by ultrasound. Small fragments are removed through the phacoemulsifier, and the doctor removes the remaining tissue. After that, a new lens is installed in place of the lens, and the incision is pulled together using seamless technology.
This method has a lot of advantages. After surgery to remove cataracts using ultrasound, complications are observed only in 1% of cases, and they most often involve retinal detachment.
Laser phacoemulsification
This is the most advanced technique for cataract surgery. The lens is replaced here in the same way as in the previous version, but the recovery of the damaged body in a different way. First, the processing of the surgical field, anesthesia and the input of the necessary fluids are performed. Next, a cut and a hole are made, after which parts of the fiber-optic system are introduced into it. Using a laser beam, the natural lens is destroyed, the tissues of which are displayed in the form of an emulsion through special tubes. After polishing the back of the capsule, a new artificial vitreous body is installed instead of the old lens. The incision is also pulled together without using stitches.
This method cannot be used on overripe cataracts and with clouding of the cornea of the eye.
Duration of surgery
The time of surgery for cataracts depends on its type. Extracapsular and intracapsular extraction can last up to 40 minutes. Surgical procedures performed using a laser or ultrasound reduce the total duration by half. Such operations last 15-20 minutes.
Contraindications for cataract removal
You can not do an operation if the patient has revealed:
- Oncological problems of an ophthalmic nature.
- Common infectious diseases.
- Eye infections.
With caution, it is recommended to carry out the intervention and accurately follow the doctor's prescriptions in the postoperative period, if there are the following chronic pathologies:
- Diabetes.
- Renal and liver failure.
- Hypertension.
Possible complications
After cataract surgery, the reviews given by patients are accompanied by a description of unpleasant symptoms and problems that have arisen. Let's analyze each state separately:
- Corneal edema is the safest symptom that usually resolves itself within 3-4 days.
- Retinal detachment, triggered by surgical intervention, does not carry anything good in itself and, possibly, will lead to another operation.
- Secondary cataract, when deposits on the lens and clouding occur. You can get rid of the problem with a laser, without having to replace the vitreous body again.
- An increase in intraocular pressure appears when the lens is displaced or when the fluid partially remains after the operation. Therapy is carried out with special eye drops.
- Infection can occur during any operation, but in this case it is treated with a course of antibiotics.
How to behave after replacing the lens?
Any surgical intervention requires a subsequent rehabilitation period. What can not be done after cataract surgery, and what manipulations should be performed, we will consider further. The doctors' recommendations that they give to patients are as follows:
- You can not put pressure on the eye and rub it.
- It is necessary to use the antiseptic drops prescribed by the doctor.
- A gauze bandage should be worn for several nights to protect the damaged surface.
- It is better to sleep on the back or on the side that is opposite to the operated eye.
- Limit stress, avoid reading, watching television, working and relaxing using a computer.
- Do not allow tap water to get into your eyes, but you must rinse them daily with sterile water.
- From visiting the sauna, pool, sports and gym, from drinking alcohol should be abandoned for several weeks.
- You can not bend, lift weights.
- Temperature differences should be avoided.
- If you are comfortable, you can use dark glasses, because the artificial lens allows more light to pass through than you are used to.
- Do not drive a car until you are sure that there is no danger caused by getting used to a new vision of the world.
- Deterioration of vision, redness, or pain in the eye are signs that need to be consulted by a specialist as soon as possible.
- Also, doctors should be visited at regular intervals. It will indicate to you the frequency of examinations when you arrive at the clinic the day after surgery for routine monitoring.
How long is the rehabilitation period?
Of course, it depends on the method of the operation. Experts say a full recovery within six months. Significant factors that can affect the extension of the term are age, general well-being, stage of development of the disease, compliance with the postoperative regimen and the doctor's recommendations. It is believed that the fastest recovery occurs after the laser method of getting rid of cataracts.
Do the operation?
Cataract is a complex disease leading to unpleasant consequences. If left untreated, blindness is guaranteed in the future. However, the decision to undergo surgery is not easy for many. Experts say that it is necessary to undergo a comprehensive study. And if his results have alerted you, you need to contact another specialist. Perhaps you will be convinced of the correctness of the diagnosis and the need for surgery in the first minutes of the visit, or the doctor will suggest an alternative method of therapy.
In any case, going to the doctor is the first step towards treatment. Modern medical equipment allows you to identify the problem and deal with it in the early stages.
If all the doctors you consulted have been diagnosed with cataracts, you should immediately begin treatment or prepare for surgery. Listen to the opinion of the ophthalmologist and find out which way he offers a way out of this situation.
The patient should keep in mind that clouding of the lens is an irreversible process that requires the intervention of doctors.The consequences of the development of the disease are not only a loss of transparency of the vitreous body, but also an increase in size, which makes it difficult for the outflow of intraocular fluid. This leads to increased pressure and the development of glaucoma.
The opinion of doctors
Doctors tend to surgery, explaining their choice as follows. The process of clouding of the lens is impossible to reverse. Therefore, the only way is surgery. Domestic specialists already have vast experience in conducting radical treatment. The operation does not last long and is usually performed using local anesthesia, which reduces the load on the heart. Vision improvement occurs immediately after surgery. It should be noted that the result depends not only on the skilled hands of ophthalmologists and equipment, but also on the implantable lens.
Vitreous selection is important. This is usually done by a specialist, but he can take into account your wishes. Be sure to tell your doctor your current occupation. This will help the doctor make the right choice, and you will not be disappointed after installing the lens. Cataract surgery can significantly change vision and improve the clinical picture.