The secondary cataract occurs in the postoperative period and causes the deterioration of contrast sensitivity. Treatment of secondary cataracts at an early stage, only drugs can be carried out - it all depends on the patient's lens.
Causes of occurrence
Many are concerned about the appearance of secondary cataracts after, the reasons for which are the following factors:
Important! The presence of the cells-balls of Adamyuk-Elshunig, says that the postoperative period passed with complications. Fibers of the fabrics, which remained on the inner surface of the lens, are converted into dense nodes over time. The visual acuity deteriorates, due to the fact that the film appears on the central optical zone.
The process of occurrence of secondary cataracts
As practice has shown, clouding a lens capsule on the inside is a natural process accompanying the overall aging of the body. The intraocular lens, located inside the lens, is sometimes deformed and thinned.
With untimely appeal to the doctor and the absence of competent treatment, the patient may develop fibrosis of the front capsule. Early fibrosis leads to a manifestation of capsuofimosis, which is characterized by a sharp cloud of a crystal capsule.
Launched crystal fibrosis, to cure drugs, it is impossible - surgery should be applied. The removal of the capsule is completely complicated by the task of implantation. However, modern medicine stepped forward. Now a new lens is inserted along with an artificial capsule.
The operation gives the maximum percentage of the fact that the secondary cataract after the crystal replacement will no longer return.
Removing Capsules Lens:
- clouding the rear wall of the capsule (secondary cataract);
- reduction of the size of the capsule, its wrinkling, associated with the stench of the walls;
- luling the front wall of the capsule, due to the increasing of the skin epithelium.
The result of the operation directly depends on the state of the rear wall of the lens. In order for the treatment to be successful, the lens should be militant and have a certain degree of moisture. In preparation for surgical intervention, doctors can introduce a special solution into a lens. 
Symptoms and clinical picture of lens
Symptomatics is the same as for the primary cataract, but still secondary cataract is sometimes accompanied by unpleasant sensations.
Any change (seal or deformation), radically affects the visual perception of the world by a man.
First of all, the symptoms of the disease lens are considered:
- Light. This is due to the refraction of light rays from the uneven surface of the lens.
- Flare. The reflected light falls on the eye iris, after which it is reflected from the lens. This effect creates a feeling of glare or as if someone shines in the eye.
- Fog. The fog has the character to appear and disappear, and in difficult cases - the fog is in front of the eyes constantly and fully explains the sharp decline in view. A person can see partially or not to see at all.
- Balls or spherical clots. The migration of the epithelium creates a vacuole lens on the surface, which prevent light on the walls of the capsule.
Important! With illiterate treatment of lens, such a disease may appear as the epithelial cell metaplasia. Metaplasia develops into an inflammatory stage, if not taken medicines. Capsuphomophomy and capsulorexis provoke silicone implants, with disc-like optics or implants consisting of several parts: acrylic optics and polymer gape.
Cataract lens can be divided into 2 groups:
- Primary cataract. It is characterized by the absence of pain, preservation of acute vision, and does not have extensive velocity areas. As a rule, the primary cataract does not need medical intervention. At this stage, the doctor may see the presence / absence of changes and muddy areas on the lens surface. Such a type of disease, most often available in pensioners.
- Secondary cataracts mainly occur in patients who have undergone an operation on the lens. The presence of chronic lens diseases complicate the process of recovery and make it longer. Concomitant diseases for cataracts: inflammation (including chronic) vessels of the eye, inner mucous membrane, glaucoma.
Features of laser therapy and forecast of the operation
Capsulotomy is a painless laser surgery at which the capsule itself remains in place. At first, the doctor removes a smooth crystal through a small hole made by a laser, and then sets an intraocular lens. Do not be afraid that during the operation, the lens can be broken or burst - the walls have sufficient elasticity to withstand such loads.
Of course, surgical interventions are carried out now, but the percentage of successfully performed operations is significantly inferior to laser therapy.
The secondary cataract laser discision is carried out using the latest YAG technology that does not require the hospitalization of the patient.
Advantages in the treatment of crust cataracts:
Before surgery for 3 days, it is necessary to exclude:
- use eye drops and solutions;
- wearing lenses;
- alcohol consumption;
- long stay in the sun;
- antibiotics treatment.
In order to effectively get rid of secondary cataracts, the treatment with a laser must be made on an empty stomach and under local anesthesia. If you have high pressure, diabetes or other illness that requires constant adoption of drugs, it should be remembered that the last reception of the drug should be in 6 hours before the start of surgery.
Possible complications in the postoperative period
Like any operation, laser, also has its own characteristics. The result largely depends on the skills of the doctor, the quality of equipment and medical materials, as well as from the patient's physiology.
Complications or the appearance of secondary cataracts after the primary replacement of the lens are:
Contraindications to the treatment of lens
Before signing up the operation, you need to tell the doctor about all the diseases available, to pass blood from the finger and veins and other tests.
There are a number of diseases in which laser intervention is strictly contraindicated:
- High pressure. Before entering anesthetic patients, it is measured by blood pressure. If it is higher than the norm (120-130 / 80-90), then the surgical operation is prohibited.
- Epilepsy of any stage. The injected drug can provoke convulsions or severe headache, loss of consciousness.
- Heart diseases. The absence of a permanent rhythm (bradycardia) during the operation can introduce a person to the state of anaphylactic shock, and the arrhythmia will contribute to the loss of consciousness.
- Kidney diseases associated with blood filtering disorders. In order for the patient to easily transfer anesthesia, his body must quickly remove the drug. If this does not happen or happens for too long, then the person will receive a number of side effects.
- Recent head injuries. This also includes all types of operations on the brain.
- Tumor or cancer. Surgical operations are a bit, but still weaken the human body, and therefore there is a chance that the disease will begin to progress.
Treatment and surgery on lens, it is not advisable to carry out pregnant women.
What will happen if not treated secondary cataract
Since the lens has a very gentle epithelium, then first of all the entire blow will have to the inner shell.
The absence of timely treatment may result in the following consequences:
- partial or complete loss of vision;
- retina pathology caused by inflammation of the epithelium;
- diplopia caused by a deterioration in the elasticity of the capsule.
Secondary cataracts after replacing the lens will no longer return if you comply with the following recommendations:
- You should not attend the pool for a month or swim in the river.
- In the summer season, avoid a sharp hit of the sunlight on the iris eye and do not sunbathe in an open area.
- Periodically change the load on the eyes: your main task is not overwhelming the visual nerves.
- Women are recommended after surgery to abandon cosmetics. Wash your face with baby soap.
After the operation carried out, the patient passes a course that includes eye exercises, medication and regular visits to the doctor.
The main thing in the life of every person is a healthy look at the world!
Secondary cataract is one of the most common conditions after a successfully conducted surgery of the eye lens. Millions of people with violations of violation and blindness get the opportunity to clearly see the world around the world after removal of cataracts, because the implantation of artificial lens, no doubt, is one of the most successful inventions of modern ophthalmosurgery. However, the consequences of this intervention still exist. And one of them is a secondary cataract.
Despite its name, the cataracts described changes after replacing the lens called incorrectly. Being once remotely, cataract cannot arise in a person again. For the first time, the crystal replacement was performed in 1950 by the English Ophthalmologist Sir Harold Ridley. After that, the technique of operation was constantly improved, which made it possible to reduce the frequency of the occurrence of secondary cataracts after the crystal replacement. However, doctors cannot completely get rid of this complication.
Secondary cataract after the crystal replacement - what is it?
In the process of interference, the ophthalmic surgery removes a clouded crystal, replacing it with artificial. The anatomy of the eye is such that the human lens is located in a capsule - a capsule bag. During the operation, the surgeon exchanging the front wall of the capsule bag, removes the actual crystal itself itself, and inside the capsule implants the artificial lens. The rear wall of the capsule bag is the rear capsule - it remains untouched to provide in the first weeks and months after the operation, the stable position of the artificial lens in the operated eye. Changes from the remaining rear capsule, its fibrosis and turbidity after a while after replacing the lens and got the name "secondary cataract".
The secondary cataract after the crystal replacement is quite frequent complication of cataract surgery. The causes of the development of secondary cataracts predetermine the development of two forms of this disease:
- The rear capsule fibrosis is clouding the capsule and the development of secondary cataracts after replacing the lens caused by a fibrous metaplace of the lens epithelium cells, which leads to a seal and, subsequently, to the turbidity of the rear capsule, and is accompanied by a significant decrease in visual acuity after replacing the lens.
- Pearl dystrophy or, actually, "secondary cataract" is the most common morphological option. In this case, the secondary cataract after the crystal replacement is formed due to the slow growth of epithelial leak cells, which form crustal fibers, as it would happen in normal. However, these crystal fibers are anatomically and are functionally defective and received the name of Adamyuk-Elshnig's balls. When migrating from a spike zone to the central optical part of the cell-balls of elmshnig form a tight supervision of the rear capsule in the form of a film, significantly reducing postoperative vision. The above changes lead to a violation of the passage of the light beam through the rear capsule of the lens, which causes a significant decrease in visual acuity.
The secondary cataract after the crystal is replaced in 20% -35% of the operated patients within 6-18 months after the cataract operation.
The probability of the occurrence of secondary cataracts is greater in young patients. Often, such a complication takes place in the congenital cataracts of children operated on. At the same time, the elderly patients, as a rule, occurs fibrosis of the back capsule of the lens, while the young cataract itself is often detected.
The frequency of the occurrence of secondary cataracts after the operation also depends on the model of artificial lens and the material used in its manufacture. The use of silicone intraocular lenses with rounded edges of the optical part is associated with an increased frequency of secondary cataracts, rather than the use of acrylic artificial lens with square edge edge.
Symptoms of secondary cataracts
Removal of cataracts and implantation intraocular lenses lead to a noticeable improvement of vision. However, after some time after replacing the lens - from several months to several years, a progressive impairment of vision is registered. Since symptoms are similar to the manifestations of the primary disease, such a state was called the "secondary cataract". The main features appearing after the occurrence of secondary cataracts are sufficiently characteristic, and, as a rule, their development never happens unnoticed:
- Progressive reduction in visual acuity and fuzziness of the image after noticeable postoperative improvement.
- The growing feeling of "fog" or "haze" in the operated eye. In the overwhelming number of patients, the secondary cataracts after replacing the lens causes the feeling of the "cellophane package".
- Black or white points in sight, causing significant visual discomfort.
- Sometimes patients after the development of secondary cataracts may appear constant two in the eyes or image distortion.
- Adjust the resulting cloudiness and reduction of vision with glasses or contact lenses, as earlier with primary cataract, is not possible.
The appearance of such symptoms after the surgery transferred in the past, the crystal replacement operation should be pushing the idea of \u200b\u200bthe presence of secondary cataracts. To all patients in such a situation, it is recommended not to tighten with the appeal to the doctor, since the symptoms will only progress, gradually increasing visual discomfort and significantly reducing visual acuity.
Diagnostic algorithm
Before inviting the patient a secondary cataract disc composure, the doctor conducts an extended ophthalmological examination, studies the history of the disease for concomitant diseases and conducts a comprehensive ophthalmologic examination and inspection:
- Assessment of visual acuity.
- Biomicroscopy of the eye with the help of a slit lamp is to determine the length and type of turbidity of the rear capsule, as well as in order to exclude edema and inflammatory process in the front of the eyeball.
- Measurement of intraocular pressure.
- Survey of the Eye DNA for retinal detachment or problems in a macular region, which can reduce the positive effect of the implementation of the secondary cataract discus.
- If the presence of edema of Macula is suspected, which happens in 30% of patients who have undergone the operational correction of cataracts, it is possible to carry out fluorescent angiography or optical coherent tomography.
Such a diagnostic algorithm is performed for a reliable formulation of the diagnosis of the disease, as well as to identify a number of states in which the treatment of secondary cataracts is impossible. We are talking about the active inflammatory processes and the edema of Makula.
Discussion of secondary cataracts or capsulotomy is the excision of the modified rear capsule of the lens and is the main method of treating the secondary cataract of the eye.
Since the time of the first implantation of artificial lens, when conducting extracapsular cataract extraction, ophthalmosurgeons faced with the need for capsulotomy in a remote postoperative period. And before the "laser era", the removal of secondary cataracts was performed by a mechanical way. Despite the outpatient nature of the manipulation and minimal operational injury, as well as any operational intervention, the mechanical discision of secondary cataracts could be accompanied by a number of undesirable complications.
Since 2004, the standard Practice of the Ophthalmoshurgeon of the modern eye clinic implies laser capsulotomy, which differs not only by the painless and non-invasive nature of surgery, but also the minimum number of postoperative complications.
Today, the Gold Standard for the treatment of secondary cataracts after replacing the lens is the Laser Discussion of Secondary Cataracts - laser capsulotomy. The most common option for removing secondary cataracts is based on the use of a laser on an alumo-yttrium grenade with neodymium. His Latin abbreviation looks like ND: YAG, and the doctors call it yag - laser (Iag-laser).
The mechanism of action of the YAG - laser is the photodegradation of the clouded tissues of the rear capsule of the lens. Such a laser does not have temperature reactions and coagulation properties, which avoids various complications.
The secondary cataract laser discision consists in the formation using a Round hole YAG laser in the back capsule of the lens along the visual axis of the patient. This allows the beam of the light to be easily falling on the central zone of the retina, and all the symptoms of impaired vision are stopped.
The removal of the secondary cataract YAG - laser is shown if patients have symptoms of secondary cataracts, significantly worsening the quality of life and make it difficult to perform everyday tasks. Also, the laser discission of secondary cataracts must be carried out and if necessary to continuously monitor the state of the retina in the operated patients.
Contraindications for laser capsulotomy:
- clouding and scar correction of the cornea,
- edema cornea,
- inflammatory processes of the eyeball,
- cystic edema of the macular region,
- various retinal pathology and / or maculas, in particular, retinal breaks and vitreo-macular tractions.
Secondary cataract - treatment with a laser in Moscow
Laser discision secondary cataracts is carried out outpatient in the laser office of the ophthalmologist. Hospitalization in the hospital is not required for that intervention.
Removal of secondary cataracts is carried out under local anesthesia. 30-60 minutes before the operation, the patient bury anesthetizing and expanding the pupil drops. The patient must be comfortably located in the chair in front of the slit lamp. Special attention should be paid to the fixation of the head in the correct position.
During the procedure, the patient can hear "clicks" arising from the work of the YAG laser, as well as see flashes of light. It is not necessary to scare this. Sometimes, for better fixation of the eyelid and the eyeball during the removal of secondary cataracts, doctors use a special contact lens similar to the gonoscopic. Such a lens has magnifying properties, which allows you to better visualize the area of \u200b\u200bthe rear capsule of the lens.
The Yag-laser is performed rounded incision in the area of \u200b\u200bthe rear capsule. This intervention can be considered completed. At the end of the operation, antibacterial and anti-inflammatory drops are buried.
Despite the outpatient nature of the operation, the laser discision of secondary cataracts requires compliance with a certain postoperative mode.
Postoperative period
Like any ophthalmological operation, the YAG-laser discioma of secondary cataracts may have certain complications. The most frequent is an increase in intraocular pressure. Its monitoring is necessary after 30 and 60 minutes after removing the secondary cataracts. If there is a permissible level of intraocular pressure, then the patient is released home with recommendations for the use of local anti-inflammatory and antibacterial therapy. The maximum peak of increasing intraocular pressure is observed in the first three hours after the laser treatment of secondary cataracts, normalization occurs within 24 hours. Patients with glaucoma, as well as having a tendency to hypertension, as a rule, are additionally prescribed hypotensive drops and repeated inspection of an ophthalmologist the day after laser capsulotomy.
The second frequency is a potential complication - the development of anterior uveit. It is possible to prevent it with local use of antibacterial and anti-inflammatory funds. The relief of the inflammatory reaction is necessary during the week after laser treatment of secondary cataracts. Therefore, drops after secondary cataracts are prescribed for a period of 5-7 days. Other possible complications are retinal detachment, macula edema, damage or displacement of artificial lens, edema of cornea and hemorrhage in the iris after secondary cataracts are extremely rare, and, as a rule, are errors in the technique of conducting a laser discission of secondary cataracts.
With the successful implementation of the discission of secondary cataracts, regardless of the method of capsulotomy, the maximum visual acuity is returned within 1-2 days in 98% of patients.
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The presence of flies or floating points before eyes is permissible for several weeks after secondary cataracts. It is not necessary to scare - they arise because of being in the field of view of the particles of the destroyed rear capsule. Gradually, such manifestations will disappear.
The presence of flies in front of the eyes during the month and more or the appearance of flashes of light and stains before our eyes cannot be left and need to contact your doctor. Medical control also requires a gradual decline in visual acuity after severe positive dynamics.
In most cases, the secondary cataract discusion proceeds without complications and has good remote results. Do not fear such interference. Absolutely painless and non-removable removal of secondary cataracts will help return the visual sharpness and significantly improve the quality of life.
Cost of treatment of secondary cataracts
The price of the discusion of the secondary cataract varies depending on the operation method. With mechanical capsulotomy, the price is 6-8 thousand rubles. At the same time, the cost of a non-invasive method is more sparing towards tissues - a laser discission of secondary cataracts - is in the range of 8-11 thousand rubles. To this price of the treatment of secondary cataracts, it is also necessary to add the cost of a survey conducted before performing capsulotomy, the average price of which is 2-5 thousand rubles.
The secondary cataract is a separate disease, practically nothing to do with the primary manifestations of the eponymous disease. For various reasons, the epithelial tissue begins to grow on the lens, which is why the shoes are formed and the vision is very reduced.
The secondary cataract after replacing the lens is not repeated after the primary cataract, however, in such patients, the risks of development of the problem increases significantly and is about 30% of all clinical cases.
The main methods of getting rid of the disease are surgical intervention and laser correction of pathology. Operation - the most effective way to restore vision, but has some contraindications and side effects.
Causes of occurrence
There are many predisposing factors for the development of secondary cataracts. Their impact on the organs of vision is not fully studied, but the statistics confirms the stable pattern - patients from the risk group more often turn to the doctor with the symptoms of the pellets before their eyes.
The main reason for the occurrence of secondary cataracts after a previously conducted replacement of the eye lens is the incorrect actions of a specialist during surgery, as well as non-compliance with the patient of medical recommendations during the rehabilitation period.
What else affects the development of such a complication:
More accurate to predict the causes of pathology can not be any specialist. The disease is not fully studied, so the failure in the genetic code is considered one of the main causes of secondary cataract.
Risk factors
The main and most important risk factor for the occurrence of such pathology is the previously conducted operation in the eyes. Much depends on the type of previous surgical treatment, as well as the age of the patient and the presence of aggravating diseases in the history. A combination of several predisposing causes increases the risk of growing epithelial tissue on pupil.
In which clinical cases risk factor increases:
- patients suffering from systemic and metabolic disorders (for example, diabetes mellitus, thyroid pathology, human immunodeficiency virus);
- retirement age;
- myopia, hypermetropia (myopia and hyperopia);
- work in harmful production (contact with radiation, bright light, construction dust, as well as strong physical exertion, probability of eye damage);
- other aggressive chronic diseases of the organs of vision;
- congenital eye pathology.
The secondary cataract is most often evolving six months after the operation, but can manifest themselves even in a few years. Sometimes the launching mechanism becomes a inflammatory process, which is why the cells of the epithelium on the lens begin to grow uncontrollably. This occurs the immune response to external stimuli.
Various inflammatory eye pathology in the period of rehabilitation increases the risks of complications of 3-5 times.
Another reason for the occurrence of pathology, experts refer to the adaptation of the lens for the formulation of intraocular lenses during the first surgical intervention. The body is trying to take root with the foreign body, because of which the epithelial tissue is growing greatly. Often such a complication is a consequence of the incorrect actions of a specialist during surgery.
Symptoms and clinical picture of lens
It is almost impossible to ignore the development of secondary cataracts, since pathology is accompanied by rather pronounced symptoms. Such signs should be alert if a short time ago an operation was carried out before the eyes.
The symptoms of the disease is as follows:
If several similar symptoms are attended, and three or more than a month ago surgical intervention in the eyes, the development of secondary cataracts can be assumed. With the initial appearance of pathology on the bodies of vision, no physical changes will be formed visually. In the future, the color of the eye can become muddy.
Treatment
For the treatment of cataracts and eliminate the repeated epithelium, the operation will be required. However, it is initially necessary to diagnose pathology with the help of specialized equipment. To this end, the specialist uses isometric, eye biomicroscopy, ultrasonic research method and optical coherent tomography.
Also, if necessary, you will need to pass some laboratory tests. Based on all the results obtained, the ophthalmologist confirms the diagnosis, and then selects the type of surgical intervention.
Surgical intervention
The surgical operation is a mechanical disinchild of the formed connective tissue on the lens surface. It is carried out in the hospital, after which the patient is still under observation. The procedure is performed under local anesthesia, lasts about 20-30 minutes.
After the operation, it follows several days to walk in a special gauze bandage, handle eye antibacterial drops and perform regular dressings. Also for a while, physical exertion is prohibited.
Cons of surgical intervention
One of the main advantages of the standard operation is its price. It may be minimal or done at all for free, depending on the region of residence.
However, such an aggressive impact has a number of shortcomings:
- the duration of the rehabilitation period;
- the likelihood of complications;
- the need for dressings after the operation;
- impairment of vision with incorrectly made films.
Soreness, duration of preparation, the high risk of possible complications - all this is a reason to abandon surgical interference in favor of no less effective laser.
Each technique has its own contraindications, so it is better to select the type of surgical intervention together with an ophthalmologist.
Features of laser treatment
Laser treatment is a safer and efficient technique. In other words, the operation is called capsulotomy or discus. Intervention is carried out in outpatient conditions, after some time after the procedure, the patient can go home.
This technique has a minimum of complications, and subsequent rehabilitation does not require any additional manipulations.
Pluses of laser therapy:
- ambulatory treatment;
- the procedure does not take much time;
- no long-term preliminary diagnosis is required;
- minimum of contraindications;
- restrictions in the recovery period are also minimal.
The main minus such an operation is the cost. In various regions of Russia, it varies within 30-60 thousand rubles for correcting one eye.
The treatment of secondary cataracts is carried out under local anesthesia using special drops that additionally expand the pupil and open access to the rear wall.
During the procedure, using a specially intended laser, a small section is generated at the rear of the lens. In the future, this makes it possible to correctly penetrate the light through the retina, which is why the vision is restored.
Contraindications
Despite the fact that laser treatment has a minimum of contraindications and side effects, there are still bans on operation. Pre-ophthalmologist determines the overall health of the patient, as well as directly by the organs of vision.
Under what states it is forbidden to carry out the procedure:
Laser treatment is also not carried out before the occurrence of 6 months after the surgery to replace the crystal. There are also relative contraindications in which any interference in the body is not recommended.
Among them:
- HIV, as well as other viral and bacterial infections;
- problems with cardiovascular system;
- complicated diabetes;
- the presence of inflammatory processes in the eye area.
If there are similar states, the ophthalmologist will advise to be examined in profile specialists to confirm the safety of the future operation in front of the eyes.
Possible complications in the postoperative period
Even the simplest intervention in the body can sometimes lead to complications. Often it happens because of the incorrect actions of a specialist during the procedure, as well as due to the individual characteristics of the body, which is sometimes impossible to predict.
Possible complications:
The risk of possible complications can be minimized. To do this, it is necessary to carry out a full diagnosis of health status before the operation, as well as carry out all the recommendations of the doctor.
Especially need to follow the prescriptions of the doctor after surgical treatment, since most complications are observed in this case. The consequences after the laser are found much less often, and their absence directly depends only on the qualification of the doctor.
What will happen if not to treat secondary cataract
The most unpleasant complication of secondary cataract is partial or complete loss of vision. This is possible if the therapy was not used for a long time.
Also, patients with the disease note:
- the appearance of "flies" when looking at the subject;
- dizziness;
- headaches;
- inability to carry out any employment activities (read, write).
After some time, the eye begins to be covered with a transparent or white veil, which is why there are not only functional disorders, but also spars the aesthetics of the appearance, and the affected eye has a more blooming color of the pupil and iris.
Preventive measures
After the operation on the replacement of the lens and performing corrective lenses, it is necessary to carry out the prevention of secondary cataracts. This complication occurs in 15-30% of all clinical cases, therefore it is necessary to take measures to prevent the development of the disease.
What you need to do for prevention:
- to regularly attend an ophthalmologist for preventive inspections;
- refuse bad habits, such as alcohol use, smoking;
- pay attention even to minor signs of the occurrence of secondary cataracts;
- limit heavy exercise;
- timely take measures to combat infectious diseases, as well as maintain the body in chronic pathologies;
- do not pick up alone glasses or lenses for vision correction;
- responsibly approach the choice of an ophthalmologist and subsequently carry out all the recommendations of the specialist after a lens replacement operation;
- protect eyes from severe sunny or artificial light.
It is with the condition of attentive attitude to your health, as well as when trusting a doctor, you can prevent the occurrence of secondary cataracts or to identify it in a timely manner. Also for prevention, you can use special drops that are prescribed after surgery to prevent various complications.
Vision is one of the main ways for a person to know the world, as well as achieve any of its goals. That is why the eyes need to take care and when the symptom of a serious illness appears to immediately contact the specialists.
A certain percentage of patients faces postoperative complications. After the replacement of a magnificent lens was carried out on an artificial, first time there is a significant improvement in view, but over time the situation changes and a person may need to replace an artificial lens to a new one. The following symptoms arise:
- fuzziness, blur pictures;
- glare, diamond-shaped ranges around items;
- litwords, fog;
- worsening visibility in the dark;
- poor distinguishing of objects.
The deteriorating dynamics makes patients contact the doctor with the question, whether the replacement of the lens of the eye crust is possible during cataract.
Position of specialists of the "Center for Surgery Eye"
To give an unambiguous answer in absentia, without a person inspection, it is impossible. Several nuances should be taken into account.
These symptoms may be evidenced by clouding the rear lens chamber. It produces a fibrous film - secondary cataract. It arises if destructive processes continue in the body even after surgery.
In this case, repeated replacement of the lens of the eye under Kataract does not produce - there is no need for it. There is an alternative - a simple operation of purification of an intraocular lens (removal of fibrous film) with a laser. A secondary complication is usually evolving from 6 to 18 months.
Other prerequisites
There are other reasons for the reduction of visual acuity:
- Retinal disinsertion.
- Glaucoma.
- Diabetic retinal lesion.
- Tumors.
The earlier a person is examined, the easier it will take place the correction of symptoms.
When the replacement of artificial lens is shown to the new
Only in extreme cases - for example, if the ol displacement occurred into the cavity of the vitreous body. The patient may suspect it by:
- split picture;
- the emergence of the Sickle Moon;
- reduction of the ability to distinguish objects;
- rainbing.
But in this case, it is not necessary to remove the artificial lens and replace it with a new one. The lens can be laid to the iris or scler, also removed without the secondary installation.
Can Iol be changed to more modern
It is not recommended to do it. Iol is a prosthesis that passes into adjacent fabrics, the body is adapted for a long time. Intervene in these processes for "updated options", which constantly appear on the market, do not.
The service life of intraocular products is lifetime. It is better to immediately choose lenses with protection from the rear capsule crust. They cost more, but inspiring from such phenomena.
Secondary Cataract - Symptoms and treatment
What is secondary cataract? The causes of the occurrence, diagnosis and methods of treatment will be analyzed in the article by Dr. Orlova Olga Mikhailovna, an ophthalmologist with an experience of 7 years.
Publication date August 12, 2019Updated October 4, 2019
Definition of the disease. Causes of the disease
Secondary Cataract - This is the clouding of the rear capsule of the eye lens. Lounge may appear after the removal of cataracts and replacing the native lens to artificial, also known as artificial or intraocular lens (IOL).
This is one of the most common pathologies arising from the removal of cataracts. Before we start discussing the causes of the emergence and methods of treatment of secondary cataracts, it is important to note that in most cases this pathology not evolving due to negligence or unprofessionalism surgeon. As a rule, this is an individual feature of the body, the result of cell reactions and metabolic processes in the lens capsule.
The average life of secondary cataracts from two months to four years after surgical treatment. Many patients mistakenly consider a secondary cataract type of clouding of a native lens. In fact, this is the clouding of its back capsule, which occurs after the replacement of the native lens to artificial.
The main cause of the development of secondary cataracts is the growth of epithelium cells on the back capsule of the lens after surgical treatment.
Also on the formation and speed of development of secondary cataracts affect the concomitant factors:
- age - the older the person becomes, the more changes occur in the metabolic processes of the body, including at the cellular level;
- the presence of concomitant diseases in the body, such as diabetes mellitus, rheumatism and other diseases, bound primarily with violation of metabolic processes;
- eyeball injuries;
- inflammatory processes arising from the eye after replacing the lens, for example, iridocyclite and uveitis.
Sometimes the risk of risk of secondary cataracts and the rate of its progression can serve as the technique of cataract removal. For example, for extracapsular cataract extractionwhen the affected lens is getting through a small incision (10-12 mm) on the cornea, the risk of secondary cataracts is higher than when facoemulsifuciation (section of only 2-3 mm). However, now the extraction method is practically not used in connection with the emergence of new, more modern technologies.
There is also an assumption that the development of secondary cataract affects the impact of ultraviolet rays and various drugs. However, this information is not confirmed.
So the likelihood and speed of development of secondary cataracts is individual and depends on many factors.
When you find similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!
Symptoms of secondary cataracts
The main complaint of patients is a gradual decrease in visual acuity after the crystal replacement. Vision can deteriorate both in the distance and near, it is possible to violate the focus of the view. Contrast sensitivity and / or color perception (image brightness) may decrease.
Some patients have complaints about disorders of the dark adaptation, the appearance of glare and halois, especially in the dark time when looking at a bright light source (lantern, light headlights).
Increases fatigue when reading and conventional visual loads. There is a bias and a feeling of a wrench or fog before the operated eye.
Pathogenesis of secondary cataracts
To understand how the secondary cataract is formed and develops, it is necessary to figure out the structure of the eye, and more precisely lens.
Crystal - this is a transparent, two-way biological lens, one of the main components of which protein is. That is, this is a protein structure. Unlike other structures of the eye in it, very little water (about 50-60%). With age, the amount of water decreases, lens cells are purified and compacted. Normally, the biological lens of an adult is a yellowish color, and when the cataract occurs, it acquires a more intense yellow or red shade. Crystal in the eye is in a special capsule bag (capsule bag, capsule). A part of the capsule that covers the crystal in front is called the "front capsule", the capsule bag covering the lens from the back is the "rear capsule".
From the inside the front capsule of the lens is covered with epithelium cells, and the back of the capsule bag does not have such cells, so it is thinner almost twice. The epithelium of the front capsule throughout his life is actively multiplied and participates in the metabolic processes of the lens, selectively passing nutrients to it through the front capsule.
When the native crystal is muttered and formed by Cataract, the question of surgical treatment arises.
There are several types of operations to remove cataracts. To date, the most efficient and fast way to treat clouding - Facoemulsification with a replacement for a slurry lens on intraocular lens. The technique of operation is quite simple and does not require long-term rehabilitation. Initially, the surgeon makes microscopes on a cornea of \u200b\u200b1 mm and 2-3 mm. Next, a round hole is formed in the front capsule and with ultrasound a turbid lens is removed through this hole. The rear capsule of the lens remains the whole. After the crustal masses are removed, in a capsule bag through the same hole implanted artificial lens (IOL).
In terms of its structure, an intraocular lens is much thinner than biological, so in the capsule bag the first time it is in a free position. On the time from one week to month, the capsule bag is tightly enveloped artificial lens.
Sometimes single epithelial cells can remain on the front capsule of the lens. Depending on the exchange processes and individual characteristics of the organism, these cells can grow and switch to the rear capsule of the lens. When a large number of these cells accumulate on it, the capsule of the turbulent and visual acuity gradually decreases. Such cloudy rear capsule is called secondary cataract. That is, pathology is the result of the growth of epithelial cells on the rear capsule of the lens.
Classification and stage of development of secondary cataracts
There are several classifications of secondary cataracts. In this section, we will consider the most common.
Complications of secondary cataracts
Considering that the main symptoms of secondary cataracts are associated with the deterioration of visual functions after replacing the lens, the main complication is to reduce the quality of the patient's life. Without treatment, symptoms will progress, gradually increasing visual discomfort.
Secondary cataract can lead to disability and disability. But before that, as a rule, it does not reach, as patients turn to the doctor much earlier, at the stage of impairment of vision.
Diagnosis of secondary cataracts
Usually, a standard ophthalmic survey is required to identify secondary cataracts - biomicroscopy. (Check visual acuity and inspection in a slit lamp with an extended pupil).
In some cases, the density of clouds on the rear capsule (the thickness of the rear capsule) is determined using the instrument Pentacam(used for computer topography of cornea and a comprehensive study of the front segment of the eyeball). This type of diagnosis is most often carried out with the aim of clinical studies or to determine the feasibility of removing the capsule, as well as to determine the laser power during the operation.
Differential diagnosis of the disease is not carried out, since the clinical and laboratory signs of the disease are obvious.
If, in the presence of cloudy the capsule, the doctor sees that the degree of turbidity does not correspond to the degree of reduction of visual acuity, then further reassessing is carried out. A specialist should identify another disease that causes impairment of vision, and determine the further tactics of the patient's treatment.
Treatment of secondary cataracts
The main task of treating secondary cataracts is to form a circular hole in the slurry rear capsule of the lens in order to improve visual functions.
There are two main ways to make such a hole:
- Surgical treatment (invasive method penetrating operation).
- Laser treatment (non-invasive, imperressive operation).
In the first case, the surgeon in the operating conditions makes cuts, penetrates the eyeball and mechanically removes a slurred capsule, forming a round hole in it. This is a fairly traumatic method, therefore it is extremely rare, usually in the presence of absolute contraindications to laser treatment.
Currently, in the treatment of patients with secondary cataracts, they are mainly used laser photodegrade (LFD) . The LFD is a laser discission of secondary cataracts (otherwise it is called YAG-Laser Discussion Capsules Crustal or laser capsulotomia), that is, the dissection of the slurry rear capsule of the lens with the laser beam.
The exact and dosage effect of the laser beam has low trauma on the structures of the eye and allows you to achieve high visual functions immediately after the operation.
This type of operation does not require hospitalization. The procedure is painless, is done without anesthesia and lasts no more than 5-10 minutes. Only in some cases may require instillation of painkillers.
Methodology for the operation
30 minutes before the procedure began, the patient burst into the eye of the Midryatic (drops that expand the pupil). Depending on the type of velocity of the rear capsule and other factors, the surgeon determines the optimal tactics of laser treatment and the laser radiation power. The doctor focuses the laser beam on the rear capsule, when it is exposed to the rear capsule dissets in several places and a round hole is formed.
Indication to the YAG laser discission:
- secondary cataract (turbidity of the back capsule of the lens).
Possible contraindications:
- low predicted result after the procedure (as a rule, it is associated with the concomitant diseases on this eye);
- inflammatory processes of the eye in the acute period;
- muddy eyes, which make it difficult to surgrade the rear capsule review and can affect the quality of the operation.
Postoperative period
Rehabilitation period After removing secondary cataracts is not required. The patient may immediately after the operation lead the familiar lifestyle. In some cases, the doctor prescribes eye anti-inflammatory and / or hypotensive drops within a few days after surgery and / or restriction of physical exertion and active actions for a certain time.
Any therapy must be appointed by the attending physician. It is necessary to understand that every case is individual, and to correctly determine the tactics of treatment, it is important to know the overall picture of concomitant diseases.
Complications during laser treatment and postoperative period
The appearance of laser equipment in ophthalmological practice until recently was perceived only optimistic. However, with the accumulation of clinical experience, information about the risk of development of various complications began to appear.
The most important advantage of laser surgery is the formation of a stable optical opening in the back capsule of the lens. The exact dosage effect of the laser beam provides high postoperative results. However, despite the simplicity of technique for the operation, the possibility of the development of these complications requires a thorough examination of patients and taking into account all possible risk factors. This approach allows you to carry out the procedure safely and get a good postoperative result.
Forecast. Prevention
Secondary cataract does not occur again. The cause of the disease is the cloud of a lens capsule, which during the operation dishes a laser and removed. In its place, an empty hole is formed ("window"), and cells that caused a decline in vision, there is no place to grow anymore. Some surgeons, the issue of prevention of secondary cataracts is solved simultaneously with the removal of cataracts. This is especially true for patients with the threat of a macular edema or retinal tramp and in young children. This technique avoids the development of secondary cataracts and, as a result, laser intervention.
However, today it has been proved that the removal of the rear capsule of the lens is simultaneously with the removal of cataracts for the prevention of secondary cataracts is not advisable, as it can lead to a number of complications.
Above, we talked about the fact that one of the factors of the development of secondary cataracts are inflammatory processes in the eye after surgical treatment. Consequently, anti-inflammatory therapy in the early postoperative period reduces the likelihood of clouds on the back capsule of the lens.
Photodynamic therapy (photochemical effects on newly formed vessels) can be carried out as preventive measures) before the surgical treatment of cataracts. However, it has many contraindications and not always the effectiveness of such therapy is justified.
An important value is the material from which an artificial lens is made. To date, the preference is given to Iol from Acrylic. In addition to many advantages, such lenses are laser power. That is, if it is necessary to remove the secondary cataract, the likelihood that the laser beam will damage the lens optics and will affect the quality of view after the operation, there is practically absent.
It must be remembered that in order to prevent prevention, it is recommended to pass an ophthalmologist 1-2 times a year and immediately access the doctor if a sharp impairment of vision occurs.
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