Cataract modern methods of treatment. Causes of eye cataracts Methods of restoring vision after surgery

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(lat. Cataracta, from ancient Greek “waterfall”, since with cataracts vision becomes blurred, and a person sees everything as if through falling water or through foggy glass) is an ophthalmological disease associated with partial or complete clouding of the lens of the eye with progressive deterioration of vision.

The lens of the human eye is a “natural lens” that transmits and refracts light rays. It is located inside the eyeball between the iris and the vitreous body.

In youth, the human lens is transparent, elastic - it can change its shape, almost instantly “focusing”, due to which the eye sees equally well both near and far. With cataracts, partial or complete clouding of the lens occurs, its transparency is lost and only a small part of the light rays enters the eye, so vision is reduced and a person sees unclearly and blurred.

Over the years, the disease progresses: the area of ​​clouding increases and vision decreases. If not treated promptly, cataracts can lead to blindness.

There are congenital cataracts, traumatic cataracts, complicated cataracts, radiation cataracts, and cataracts caused by general diseases of the body. But the most common age-related (senile) cataract occurs, which develops in people after 50 years of age. For the most part, cataracts are a natural result of aging. Physically, clouding of the lens is caused by denaturation of the protein that makes up this organ.

Factors contributing to the development of cataracts:

• genetic predisposition;
• any eye injuries;
• various eye diseases (glaucoma, high myopia);
• endocrine disorders (metabolic disorders, diabetes mellitus, vitamin deficiency);
• radiation, microwave and ultraviolet irradiation;
• long-term use of a number of medications;
• increased radiation;
• unfavorable environmental conditions;
• toxic poisoning (naphthalene, thallium, mercury, ergot);
• smoking.

Symptoms of cataracts

The most common symptom of cataracts is decreased visual acuity. The degree of vision impairment depends on in which part of the lens the cataract develops and how dense it is (the degree of its maturity).

If cataracts begin to develop on the periphery of the lens, the patient may not experience any changes in vision. Such cataracts are discovered by chance during a routine medical examination. The closer to the center the clouding of the lens is, the more serious the vision problems become. With the development of opacities in the central part of the lens (its core), myopia may appear or intensify, which is manifested by improved near vision, but worsened distance vision. This explains why people with cataracts have to change their glasses very often.

Many elderly patients in this situation note the fact that the ability to read and write, lost in the fifth decade of life, without plus glasses, inexplicably returns for some time (nuclear cataract). In this case, objects are seen unclearly, with blurred contours. The image may appear double. The pupil, which usually appears black, may take on a grayish or yellowish tint. With a swelling cataract, the pupil becomes white.

People with cataracts may complain of increased or decreased sensitivity to light. So, some say that the world around has become somehow dim. On the other hand, intolerance to bright light, better vision in cloudy weather or at dusk is typical for opacities in the central zone of the lens. Most often, such complaints are observed with posterior capsular cataracts.

The development of cataracts is usually painless; in rare cases, swelling of the lens may occur with an increase in intraocular pressure and the development of a painful attack.

In children, congenital cataracts can manifest as strabismus, the presence of a white pupil, and decreased vision, which is detected by the lack of reaction to silent toys.

According to the observations of ophthalmic surgeons:

• In 12% of patients, cataract maturation occurs rapidly. From the development of the disease to extensive clouding of the lens, requiring immediate surgical intervention, it takes 4–6 years.
• 15% of patients have slowly progressive cataracts that develop over 10–15 years.
• In 70% of patients, cataract progression occurs within 6–10 years. Mandatory surgical intervention is required.
• All of the symptoms listed are indications to consult a doctor.

Diagnosis of cataracts

When conducting diagnostics, the doctor must determine visual acuity, visual field, measure intraocular pressure, and perform ultrasound and electrophysiological studies of the retina and optic nerve.

A doctor can determine the degree of maturity of cataracts and lens opacities using a slit lamp. After the examination, treatment is prescribed - medication or surgery.

This is a rather insidious disease and only a qualified specialist can accurately diagnose it.

At an advanced stage of cataract, the swollen lens begins to occupy most of the anterior chamber of the eye, thus disrupting the outflow of intraocular fluid. As a result, serious complications of cataracts can occur - secondary glaucoma. This is very dangerous and can lead to complete loss of vision!

Cataract treatment

The current level of development of eye microsurgery makes it possible to remove initial cataracts without a long wait for its maturation (as was the case in the past). But you should not immediately resort to surgery. In the initial stages, contact lenses and properly selected glasses can improve vision.

If there is no glaucoma, then for cataracts medications are prescribed that keep the pupil dilated. Wearing sunglasses in bright light and using lamps that provide indirect light rather than direct bright light will not cause much constriction of the pupil and will help vision.

The operation can be performed at any age and usually does not require general anesthesia or a long hospital stay. Your lens is simply removed and an artificial one is implanted in its place, which is made of plastic or silicone and is called an artificial intraocular lens. Without it, patients must wear a contact lens. If they cannot wear it, they must use glasses with very thick lenses, which affect the quality of vision.

Sometimes, weeks or even years after the artificial lens is implanted, cloudiness develops behind it (secondary cataract). Usually this clouding can be eliminated with laser treatment.

In very rare cases, after cataract removal, a person may develop an infection or bleeding from the blood vessels in the eye, leading to loss of vision. Therefore, older people should take steps in advance to get help at home in the first days after surgery. To prevent infection, reduce inflammation and speed up healing, it is recommended to use eye drops or ointment for several weeks after leaving the hospital. During this time, it is recommended to wear glasses or a protective bandage to protect your eyes from damage.

Be sure to visit the doctor the day after surgery and then, as a rule, every week or two for a month and a half.

Treatment of the initial stages of age-related cataracts is based on the use of various medications, mainly in the form of eye drops: Quinax, Catachrome, Vitaiodurol, Vitafacol, Vicein and a number of others.

All medications should be prescribed only by a qualified specialist; self-medication is unacceptable!

The use of these drugs does not lead to the resorption of already formed opacities, but at best only slows down their progression. The only effective treatment for cataracts is surgery.

The first replacement of the lens with an artificial analogue was made during the Second World War by the English surgeon Harold Ridley. He noticed that pilots who received eye injuries when plastic fragments got into their eyes (the plastic was part of the aircraft cabin) did not develop any adverse reactions. So he came up with the idea of ​​​​making an artificial lens, which he carried out on November 8, 1949, by implanting an artificial lens made of polymethyl methacrylate (PMMA).

Important! Treatment is carried out only under the supervision of a doctor. Self-diagnosis and self-medication are unacceptable!

– pathology of the light-refracting structure of the eye – the lens, characterized by its clouding and loss of natural transparency. Cataracts are manifested by blurred vision, deterioration of night vision, weakened color perception, sensitivity to bright light, and diplopia. Ophthalmological examination for cataracts includes visometry, perimetry, ophthalmoscopy, biomicroscopy, tonometry, refractometry, ophthalmometry, ultrasound scanning of the eye, electrophysiological studies. To slow the progression of cataracts, conservative therapy is carried out; Cataract removal is performed by microsurgical intervention with the replacement of the lens with an intraocular lens.

General information

Cataract (from the Greek katarrhaktes - waterfall) is a clouding or change in color of part or all of the lens, leading to a decrease in its light transmittance and a decrease in visual acuity. According to WHO, half of the cases of blindness worldwide are caused by cataracts. In the age group of 50-60 years, cataracts are detected in 15% of the population, in 70-80 years - in 26%-46%, over 80 years - in almost everyone. Among congenital eye diseases, cataracts also occupy a leading position. The high prevalence and social consequences of the disease make cataract one of the most pressing problems of modern ophthalmology.

The lens is part of the dioptric (light-conducting and light-refracting) apparatus of the eye, located posterior to the iris, opposite the pupil. Structurally, the lens is formed by a capsule (bag), capsular epithelium and lens substance. The surfaces of the lens (anterior and posterior) are spherical in shape with different radii of curvature. The diameter of the lens is 9-10 mm. The lens is an avascular epithelial formation; nutrients enter it by diffusion from the surrounding intraocular fluid.

In terms of its optical properties, the lens is a biological biconvex transparent lens, the function of which is to refract the rays entering it and focus them on the retina of the eye. The refractive power of the lens is heterogeneous in thickness and depends on the state of accommodation (at rest - 19.11 diopters; in a state of tension - 33.06 diopters).

Any change in the shape, size, or position of the lens leads to significant impairment of its functions. Among the anomalies and pathologies of the lens are aphakia (absence of the lens), microphakia (reduction in size), coloboma (absence of part of the lens and its deformation), lenticonus (protrusion of the surface in the form of a cone), cataract. Cataract formation can occur in any of the layers of the lens.

Causes of cataracts

The etiology and mechanisms of cataractogenesis - the development of cataracts - are explained from the perspective of several theories, but none of them gives a comprehensive answer to the question of the causes of the disease.

In ophthalmology, the most widespread theory is free radical oxidation, which explains the mechanism of cataract formation from the point of view of the formation of free radicals in the body - unstable organic molecules with an unpaired electron that easily enter into chemical reactions and cause severe oxidative stress. It is believed that lipid peroxidation - the interaction of free radicals with lipids, especially unsaturated fatty acids, leads to the destruction of cell membranes, which causes the development of senile and diabetic cataracts, glaucoma, microcirculation disorders in brain tissue, and hepatitis. The formation of free radicals in the body is primarily promoted by smoking and ultraviolet radiation.

An important role in the mechanism of cataract development is played by an age-related decrease in antioxidant protection and a deficiency of natural antioxidants (vitamins A, E, glutathione, etc.). In addition, with age, the physicochemical properties of the protein fibers of the lens, which make up over 50% of its structure, change. Disruption of lens metabolism and the development of opacities may be associated with changes in the composition of the intraocular fluid in recurrent inflammatory diseases of the eye (iridocyclitis, chorioretinitis), as well as dysfunction of the ciliary body and iris (Fuchs syndrome), terminal glaucoma, pigmentary degeneration and retinal detachment.

In addition to age-related involution, deep general exhaustion after severe infectious diseases (typhoid, malaria, smallpox, etc.), fasting, anemia, excessive insolation, exposure to radiation, toxic poisoning (mercury, thallium, naphthalene, ergot) predispose to the development of cataracts. Risk factors for the development of cataracts are endocrinopathies (diabetes mellitus, tetany, muscular dystrophy, adiposogenital syndrome), Down's disease, skin diseases (scleroderma, eczema, neurodermatitis, Jacobi poikiloderma). Complicated cataracts can occur with mechanical and contusion injuries to the eye, eye burns, previous eye surgeries, unfavorable heredity for cataracts in the family, high myopia, uveitis.

Congenital cataracts in most cases are caused by toxic effects on the embryo during the formation of the lens. Among the causes of congenital cataracts are infections suffered during pregnancy (influenza, rubella, herpes, measles, toxoplasmosis), hypoparathyroidism, taking corticosteroids, etc. Congenital cataracts can occur with hereditary syndromes and be combined with malformations of other organs.

Cataract classification

In ophthalmology, cataracts are divided into two large groups: congenital and acquired. Congenital cataracts, as a rule, are limited in area and stationary (do not progress); with acquired cataracts, changes in the lens progress.

Among acquired cataracts, depending on the etiology, there are senile (senile, age - about 70%), complicated (in case of eye diseases - about 20%), traumatic (in case of eye injuries), radiation (in case of damage to the lens by X-ray, radiation, infrared radiation ), toxic (due to chemical and drug intoxication), cataracts associated with general diseases.

Based on the location of the cloudiness in the lens, there are:

• anterior polar cataract – located under the capsule in the area of ​​the anterior pole of the lens; the cloudiness looks like a round spot of whitish and grayish color;
• posterior polar cataract - located under the capsule of the posterior pole of the lens; similar in color and shape to anterior polar cataract;
• fusiform cataract – located along the anteroposterior axis of the lens; has the shape of a spindle, in appearance it resembles a thin gray ribbon;
• nuclear cataract – located in the center of the lens;
• layered (zonular) cataract - located around the nucleus of the lens, with cloudy and transparent layers alternating;
• cortical (cortical) cataract – located along the outer edge of the lens shell; has the appearance of whitish wedge-shaped inclusions;
• posterior subcapsular - located under the capsule behind the lens;
• complete (total) cataract - always bilateral, characterized by clouding of the entire substance and capsule of the lens.

Overmature cataracts can be complicated by phacogenic (phacolytic) glaucoma, associated with clogging of the natural outflow tracts of eye fluid with macrophages and protein molecules. In some cases, the lens capsule may rupture and protein detritus may enter the eye cavity, which entails the development of phacolytic iridocyclitis.

Cataract maturation can be rapidly progressive, slowly progressive, or moderately progressive. In the first option, 4-6 years pass from the initial stage to extensive clouding of the lens. Rapidly progressive cataract develops in approximately 12% of cases. Slow maturation of cataracts occurs over 10-15 years and occurs in 15% of patients. Moderate progression of cataracts in 70% of cases occurs over a period of 6-10 years.

Symptoms of cataracts

The severity of clinical manifestations depends on the stage of cataract. Visual acuity with initial cataracts may not suffer. Early signs of the disease may include double vision (diplopia), flashing “spots” before the eyes, blurred vision (“like in a fog”), and a yellowish tint to visible objects. Patients with cataracts report difficulty writing, reading, and working with small details.

The cataract clinic is characterized by increased sensitivity of the eyes to light, deterioration of night vision, weakened color vision, the need to use bright lighting when reading, and the appearance of a “halo” when looking at any light sources. Vision with cataracts changes towards myopia, so patients with severe farsightedness sometimes suddenly discover that they can see perfectly well near without glasses. The visible image blurs before the eyes, but it is not possible to correct it with glasses or contact lenses, despite changing the diopter level.

In the stage of immature and especially mature cataracts, visual acuity sharply decreases, objective vision is lost, and only light perception is preserved. As the cataract matures, the color of the pupil becomes milky white instead of black.

Diagnosis of cataracts

Cataracts are identified by an ophthalmologist based on a number of standard and additional examinations.

Routine ophthalmological examination for suspected cataracts includes visometry (testing visual acuity), perimetry (determining visual fields), color testing, tonometry (measuring intraocular pressure), biomicroscopy (examination of the eyeball using a slit lamp), ophthalmoscopy (examination of the fundus). Taken together, a standard ophthalmological examination allows us to identify such signs of cataracts as decreased visual acuity, impaired color vision; examine the structure of the lens, assess the localization and magnitude of opacification, detect dislocation of the lens, etc. If it is impossible to examine the fundus of the eye, with severe opacification of the lens, they resort to the study of entopic phenomena (mechanophosphene and the phenomenon of autoophthalmoscopy), which allows one to judge the state of the neuroreceptor apparatus of the retina.

Special examination methods for cataracts include refractometry, ophthalmometry, ultrasound scanning of the eye in A- and B-mode, ultrasound biomicroscopy, etc. Additional methods allow the ophthalmologist to calculate the strength of the intraocular lens (artificial lens) and determine the optimal operating technique.

To assess the functional state of the retina, optic nerve and central parts of the visual analyzer in case of cataract, electrophysiological studies are carried out: electrooculography (EOG), electroretinography (ERG), registration of visual evoked potentials (VEP).

Cataract treatment

In the initial stages of senile cataracts, conservative therapy is used, including instillation of eye drops (azapentacene, pyrenoxine, combination drugs with cytochrome C, taurine, etc.). Such measures do not lead to the resorption of lens opacities, but only slow down the progression of cataracts.

The meaning of the so-called replacement therapy is the administration of substances, the deficiency of which leads to the development of cataracts. Therefore, the composition of eye drops includes amino acids, vitamins (riboflavin, nicotinic acid, ascorbic acid), antioxidants, potassium iodide, ATP and other substances. The drug azapentacene has a different mechanism of action - due to the activation of proteolytic enzymes, it to some extent promotes the resorption of the opaque protein structures of the lens.

Conservative treatment of cataracts is ineffective, so the only method of eliminating the pathology and restoring vision is microsurgery - removing the altered lens and replacing it with an intraocular lens. The capabilities of modern eye microsurgery eliminate the need to wait for the cataract to fully mature before removing it.

Medical indications for surgical treatment include: swelling cataract, overmature cataract, subluxation or dislocation of the lens, detection of secondary glaucoma, concomitant pathology of the fundus requiring treatment (diabetic retinopathy, retinal detachment, etc.). Additional indications for surgical treatment of cataracts are determined by professional and everyday needs to improve the quality of vision. For bilateral cataracts, the eye with lower visual acuity is operated on first.

In modern cataract surgery, several methods are used to remove a clouded lens: extracapsular and intracapsular cataract extraction, ultrasound and laser phacoemulsification.

The most serious prognosis for visual function is associated with congenital cataracts, since in this case, as a rule, there are changes in the neuroreceptor apparatus of the eye. Surgical treatment of acquired cataracts, in most cases, leads to the achievement of acceptable visual acuity, and often to the restoration of the patient’s ability to work.

Prevention of congenital cataracts requires the prevention of viral diseases during pregnancy and the elimination of radiation exposure. To prevent the development of acquired cataracts, especially at a young age, antioxidant protection of the body, earlier treatment of concomitant general and ophthalmological pathologies, prevention of eye injuries, and annual medical examinations by an ophthalmologist are necessary.

Section description

Cataract is a congenital or acquired disease, which is characterized by opacification of the lens substance, its capsule or subcapsular epithelium. Pathology leads to a progressive decrease in visual acuity and even loss. Let's talk about the causes and symptoms of the disease, methods of diagnosing it, as well as how to treat cataracts.

Lens clouding most often develops in people over 45-50 years of age. The pathology is one of the most common causes of blindness throughout the world. According to statistics from the World Health Organization, about 80-90% of all cases of cataracts are detected in people over 70 years of age. However, the disease is often diagnosed in young men and women, teenagers and even newborns. Naturally, due to the widespread prevalence of the disease, the question “Can cataracts be cured?” is so relevant?

What is cataract

Cataract is an acquired (less commonly congenital) disease that is characterized by clouding of the lens. The lens is the optical medium of the eye and plays a major role in refraction and accommodation. When its substance becomes clouded, light rays cannot fall unhindered on the retina, which leads to a pronounced decrease in visual acuity.

Age-related cataracts of the eye without treatment have a slowly progressive course and sooner or later lead to blindness. As a rule, the disease affects first one and then the other eye. Unfortunately, conservative methods of treating cataracts can only stop the development of pathology, but do not cure it.

Development mechanism

The cause of clouding of the lens is the destructive processes occurring in it. Not long ago, scientists discovered that free radicals, active substances formed under the influence of ultraviolet radiation, play a major role in the development of cataracts. They lead to irreversible destruction of lens proteins.

Initially, the patient develops an incomplete lens defect, which over time develops into a mature, and then into an overripe cataract. The swelling form of the disease often leads to severe deterioration of vision and an increase in intraocular pressure. The patient may develop phacogenic.

Unfortunately, in most cases, conservative methods of treating cataracts cannot help the patient. Cloudiness can only be removed with the help of.

Causes

The cause of congenital lens opacification may be aggravated heredity or the harmful effects of teratogenic factors (causing malformations) on the fetus during pregnancy. Sometimes the pathology is combined with severe developmental defects. In such cases we are talking about various syndromic diseases: Rothmund-Thomson, Werner, Down syndrome. Congenital cataracts account for only 3% of all cataracts, but are the cause of birth defects in more than 60% of cases.

In more than 90% of cases, the cause of primary acquired cataracts is natural age-related changes in the visual organ. In 4% of cases, the etiological factor is traumatic damage to the eyeball (penetrating wounds, contusions), in 3% - exposure to ultraviolet or radiation radiation (radiation cataract). Clouding of the lens is possible due to prolonged use of corticosteroids or due to poisoning with certain substances: mercury, thallium, naphthalene, trinitrotoluene.

The following factors contribute to the development of age-related cataracts::

• long periods of watching TV or working at the computer;
• low physical activity, obesity;
• consumption of large amounts of fats and carbohydrates, lack of vitamins in the diet, frequent starvation diets;
• prolonged exposure to the sun without sunglasses;
• polluted habitat, work in unfavorable production conditions.

Causes of secondary cataracts:

• Endocrine disorders (diabetes mellitus, hypo- and hyperthyroidism). Diabetic cataract can be true or senile. The first is quite rare - only 2-6% of cases. Such cloudiness develops very quickly and can resolve spontaneously if blood glucose levels are timely normalized.
• Incomplete extraction of lens masses during surgery. Extracapsular cataract extraction is especially dangerous in this regard. Nowadays, this operation has been replaced by phacoemulsification. However, even after removing the lens using the FEC method, a posterior capsule remains, which can still become cloudy.
• Congenital defects of eye development, neoplasms of the orbit and eyeball, glaucoma, chronic iridocyclitis, chorioretinitis and some other diseases of the visual organ.
• Autoimmune diseases (scleroderma, systemic lupus erythematosus, various vasculitis), metabolic disorders (galactosemia, oculocerebrorenal syndrome, galactokinase deficiency), hypertension, myxedema.

Types of congenital cataracts

Depending on the location, there are different types of cataracts. It should be noted that small, inconspicuous opacities in the periphery and posterior capsule are sometimes detected in the healthy eyes of a newborn. This phenomenon is a variant of the norm; it does not progress and does not prevent the child from seeing normally in the future.

Anterior polar

It is localized directly under the lens capsule at the anterior pole. It looks like a round white or grayish spot. The defect is formed due to disruption of the normal embryonic development of the lens epithelium. A cataract that protrudes into the anterior chamber and has the appearance of a conical elevation is called pyramidal. It is located in the very center, which is why it significantly reduces visual acuity.

Posterior polar

It is a rudiment of the embryonic vitreous artery. Outwardly it resembles the anterior polar one, but is located at the posterior pole of the lens. Often fuses with the posterior lens capsule.

Fusiform

It looks like a thin grayish ribbon stretching from the anterior to posterior capsule of the lens. Like polar cataracts, fusiform cataracts are rare and usually do not progress. From childhood, a child learns to look through opacities, while having fairly high visual acuity. As a rule, in this case, treatment is not required.

Double sided

Cataracts in both eyes most often indicate congenital malformations. It can be zonular, complete or membranous, less often – polar. The defect is often combined with other anomalies in the structure of the visual organ in a child.

Central

It looks like a rounded spherical formation with clear boundaries. It is white in color and localized in the center of the lens. Typically the diameter of such a cataract does not exceed 2 mm.

Zonular (layered)

Accounts for about 40% of all congenital forms of the disease. It is characterized by alternating transparent and opaque layers in the lens substance. The pathology can be either congenital or develop secondarily at an early age. Layered opacities significantly affect visual acuity.

Full (total)

The most severe form, rare. It is characterized by the transformation of the lens substance into a cloudy soft mass. In the case of complete resorption of the lens, only a clouded, wrinkled capsule remains (membranous form of the disease). While incomplete cataracts only lead to decreased visual acuity, total cataracts are a common cause of blindness in newborns.

Atypical forms

Atypical forms of the disease include ring-shaped cataract, suture cataract, coral cataract, lance-shaped cataract, and flower-type cataract. They are rare and usually have a relatively favorable course.

Types of acquired cataracts

The classification of acquired cataracts is based on the reasons for their development. The lens may become cloudy due to injury, intoxication, radiation, metabolic or endocrine disorders.

The following main types of cataracts are distinguished:

• traumatic;
• radial;
• toxic;
• age (aka senile or senile);
• complicated;
• exchange.

Separately, phacosclerosis should be highlighted - age-related thickening of the lens nucleus. The pathology is not a cataract (with phacosclerosis there are no opacities), but it can cause its development.

Nuclear

It occurs infrequently, in only 8-10% of cases. Nuclear (yellowish or brown) cataracts lead to compaction of the lens nucleus, which causes it to refract rays too much. The patient gradually develops lenticular, which can reach 8-9 or even 12 diopters. A person begins to wear negative glasses for cataracts. As a rule, he thinks that he is nearsighted. After a few years, the patient develops a mature corticonuclear cataract, the consequences of which are quite unfavorable.

Cortical

Anterior and posterior cortical cataracts are approximately 10 times more common than nuclear cataracts. Initially, vacuoles and water gaps appear under the lens capsule, and later opacities form. At first, the pathological process can be localized in the periphery, then it spreads closer to the evator, significantly affecting visual acuity.

Posterior capsular

The opacification is located under the posterior lens capsule. Typically, posterior capsular cataracts develop quickly and require immediate treatment. In this case, the patient requires cataract extraction and intraocular lens implantation.

Mixed forms

There are also mixed forms of cataracts. They are characterized by the presence of several opacities of different localization. Most often, nuclear-cortical forms of pathology are detected in patients.

Cataract stages

Any clouding of the lens goes through several successive stages of development. Initially, a slight clouding appears, which gradually increases in size and leads to a steady decrease in visual acuity. There are four stages of cataracts.

Initial

At this stage, the patient begins to notice diplopia (double vision) and flickering spots before the eyes. Ophthalmoscopy reveals minor, barely noticeable opacities that have almost no effect on visual acuity.

Immature

At this stage, the attending physician detects areas of turbidity of varying intensity, alternating with transparent zones. The patient complains of a pronounced decrease in visual acuity. If secondary glaucoma develops, a person requires cataract extraction along with antihypertensive therapy. The operation is also performed in cases where clouding of the lens reduces the ability to work and interferes with normal life activities.

Mature

It manifests itself as complete clouding of the lens and slight compaction of its substance. The pupil looks gray or milky white, and looks like a thorn inside the eye. In this case, the patient needs immediate cataract extraction.

Overripe

If not treated promptly, mature cataracts may become overripe. The lens substance is completely destroyed, and its capsule falls down. The pupil looks milky white. Overmature cataracts often lead to phacolytic glaucoma and therefore require immediate removal.

Symptoms

The severity of the clinical picture of the disease depends on the location and size of the cataract, the stage of the pathological process, the presence of complications or concomitant lesions of the visual organ.

The most characteristic symptoms of cataracts:

• double vision when looking at various objects;
• the appearance of flies or colored spots before the eyes;
• the appearance of luminous halos around objects;
• Difficulties when working with small parts.

Later, the person notices a progressive decrease in visual acuity. The larger the size of the opacities, the worse he sees. It should be noted that glasses do not help with cataracts, so wearing them is useless. Only surgery can restore normal vision. You should not hope that some miracle pill will cure the disease.

Diagnostics

Before treating cataracts, an ophthalmologist must confirm the diagnosis. As a rule, to do this, it is enough for him to check visual acuity, measure IOP, and conduct an examination in a slit lamp, focal and transmitted light. After this, the specialist selects the most suitable cataract treatment methods for the patient.

Treatment

Is it possible to cure cataracts without resorting to surgery? Unfortunately, this is practically impossible. Drug treatment of eye cataracts is effective only in the initial stages. It can slow down the progression of the disease, but is not able to remove opacities that have already formed.

Conservative

Conservative treatment of pathology should include proper nutrition (the patient should receive vitamins, antioxidants, minerals), special exercises for the eyes, and the use of medicinal drops (Quinax, Taufon, Oftan, Katachrom). You can take any medicine for cataracts only after consulting a specialist.

Treatment of the underlying disease that caused the development of cataracts is of great importance; for example, diabetes mellitus requires regular monitoring of blood sugar levels. To protect the eyes from ultraviolet radiation outdoors, patients should wear special sunglasses. Gymnastics for the eyes should be performed regularly, several times a day and include rotational movements of the eyes, focusing alternately on close and distant objects.

In the initial stages, cataract treatment is sometimes carried out at home with honey, onion or carrot juice, and various compresses. However, in later stages they have no effect. They, like the “Glaznik” device, which is popular on the Internet, cannot replace surgery.

Surgical

Today, surgical treatment of cataracts is the gold standard in the treatment of this disease. The operation allows you to quickly remove opacities, return a person to normal vision and avoid the development of undesirable consequences.

Operation options

There are various ways to treat cataracts surgically, but nowadays doctors prefer phacoemulsification. This is a low-traumatic operation that lasts no more than half an hour and requires hospitalization for only 1-2 days. FEC allows you to remove opacities and restore vision with minimal risk to health.

Phacoemulsification

Ultrasound phacoemulsification removes destroyed lens masses through small, self-sealing incisions in the cornea. After this, the patient is implanted with an intraocular lens of the required strength (calculation is made on an individual basis). FEC with IOL implantation is performed under local anesthesia.

Extracapsular extraction

The essence of the intervention is to remove the lens without the capsule in which it is located. Unfortunately, the cornea is severely injured during the operation. Therefore, in our time, such cataract extraction is performed extremely rarely.

Intracapsular extraction

The essence of the operation is to remove the lens along with the capsule through a large incision in the cornea. This intervention is very traumatic, which is why it is not used in our time. Today, ophthalmologists choose more modern methods of treating cataracts.

Contraindications to surgery

The operation should not be performed on persons with decompensated diabetes mellitus, increased intracranial or intraocular pressure, acute inflammatory diseases of the visual organ, and certain dystrophic lesions of the cornea. Intervention can be carried out only after treatment of the concomitant pathology.

Complications after surgery

After phacoemulsification, patients may develop secondary cataracts, increase intraocular pressure, and swell the cornea. It is also possible that the intraocular lens may shift or occur.

Rehabilitation period

Recovery after cataract removal using phacoemulsification lasts several weeks. During this period, the patient must avoid lifting heavy objects, bending over, and sleeping on his side. When walking outside, a monocular patch should be applied to the operated eye. If necessary, after 2-3 months the person will be able to choose reading glasses.

Forecast

With congenital cataracts combined with other developmental defects, the prognosis may be unfavorable. Age-related clouding of the lens does not pose a serious threat to the health and life of the patient. With timely surgical treatment of cataracts, almost complete restoration of vision is possible.

Prevention

To date, there is no specific prevention of acquired cataracts. You can reduce the likelihood of developing the disease by eliminating risk factors. To prevent the development of congenital cataracts in a newborn, a pregnant woman should avoid exposure to teratogenic factors during pregnancy.

A cataract is any clouding of the lens substance or its capsule. The disease can be congenital or acquired. In 90% of cases, it occurs in people over 45 years of age and is called age-related. Timely treatment of cataracts in older people can avoid premature loss of vision.

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Cataract is accompanied by complete or partial irreversible clouding of the lens - the optical lens of the eye. The result of the disease is blurred vision and blindness.

The reasons for the development of cataracts are varied. Some are impossible to influence.. But there are others, related, for example, to lifestyle. By excluding them, the development of the disease can be prevented or slowed down.

Causes of lens clouding

There are many reasons for the development of cataracts. Cloudiness of the lens can begin after 40 years of age and in the first stages is hidden. But age is not the only reason. There are other external and internal factors that lead to the disease.

The development of cataracts is influenced by:

• Genetic predisposition(if the parents have the disease, the likelihood of lens clouding is higher);
• Age(after 60 years, the risk of cataracts increases threefold);
• Floor(according to statistics, the disease is diagnosed more often in women).

External provoking factors can also be ultraviolet, electromagnetic, radioactive irradiation, poisoning with toxins or the use of potent drugs.

The development of lens opacities contributes to:

You can read about the symptoms and treatment of cataracts, as well as about secondary cataracts. There are, including.

Diseases leading to cataracts

The main internal cause of the disease is deterioration in the nutrition of eye tissue, which occurs as a result of certain diseases or metabolic disorders.

The likelihood of developing cataracts increases if you have:

Less commonly, congenital cataracts are observed in children born to healthy parents. The reason may be incompatibility of the Rh factor of the mother and child.

Some causes of the disease cannot be controlled. But others can be influenced: quit smoking and alcohol, do not abuse the use of medications, protect your eyes from ultraviolet radiation, take vitamin complexes with antioxidants and promptly treat concomitant diseases.

Cataract is a pathology in which there is clouding of the lens or its capsule. This pathology leads to a decrease in visual acuity due to a decrease in the transparency of the lens. The disease usually progresses slowly in adulthood. However, certain types of cataracts can develop rapidly and lead to vision loss in a short time.

Cataracts have been known since ancient times, since the time of the Great Ancient Greek physician Hippocrates. Cataract means “waterfall” in Greek. The ancient Greeks explained this by saying that when a disease appears, a person begins to see surrounding objects, as if through a falling stream of water, which prevents light rays from penetrating into the eye. But it was very difficult for doctors of that time to differentiate cataracts from other eye diseases, for example, from glaucoma, and there was no talk of correct treatment.

Some tried to treat cataracts with compresses made from antimony, milk, honey, vinegar, and even blood and animal entrails. Others use diet, massage, medicinal baths, castor oil and various herbs. None of these treatment methods resulted in significant improvement in vision. Over time, cataracts have become a serious problem, leading to a sharp deterioration in vision. Therefore, many thousands of years ago it began to be treated with surgical intervention, as evidenced by descriptions in treatises of ancient Greece, Rome and Egypt. But, unfortunately, even such methods did not lead to improvement in vision, since the principle of this operation was only to remove the clouded lens, which allowed patients to distinguish between the light entering the eyeball and the shadows.

Cataracts are currently considered one of the most common ophthalmological diseases occurring in people of old age. Thus, approximately 17 million people aged 60 years and older suffer from cataracts. According to the World Health Organization, per 1000 people aged 70 to 80 years, cataracts occur in 460 women and 260 men, and after 80 years of age, it affects almost everyone. There are currently more than 40 million blind people in the world, half of them have lost their sight due to cataracts. In developed countries, cataracts occur in 15% of people over 50 years of age, and in developing countries it reaches 40%.

Anatomy and physiology of the lens

The lens is a biconvex lens located directly behind the pupil. It is one of the most important light-conducting parts in the light-refracting system of the eye.

The lens consists of a capsule, which is filled with the normally transparent lens substance. The capsule is thin, malleable to tear. Lens masses have a layered structure and with age they tend to become increasingly dense and change color closer to yellow.

The lens receives all the substances necessary for metabolic processes from the so-called aqueous humor of the posterior chamber of the eye.

Inside the eyeball, it occupies the space between the iris and the vitreous humor, dividing the eye into anterior and posterior chambers. At a young age, the lens of the human eye is transparent and highly elastic, which allows it to easily change its shape. Like a camera, a healthy lens instantly “focuses,” allowing the human eye to see objects both far and near with perfect clarity. A healthy lens consists of 60 - 65% water, 35 - 40% proteins, 2% fats and various enzymes, and no more than 1% minerals.

In the human eye, the lens performs very important functions: light transmission, light refraction, is the dividing barrier of the eye into the anterior and posterior chambers, as well as a protective barrier (prevents the penetration of microbes into the vitreous body from the anterior chamber of the eye).

Causes of cataracts

Today, there are numerous known causes that contribute to the occurrence of cataracts. Depending on the root cause that caused the disease, all cataracts are divided into two large groups: congenital and acquired.

Risk factors for developing cataracts

1. Unbalanced diet
2. Lack of timely and adequate treatment of chronic diseases (arterial hypertension, diabetes mellitus, hepatitis, cholecystitis, stomach ulcers)
3. Previous injuries or inflammatory diseases of the eyes
4. Presence of cataracts in first-degree relatives
5. Long-term use of certain medications

Mechanism of cataract development

The normal functioning of the lens is maintained as long as the percentage balance of the substances that make up the structure of the lens is maintained. The cataractogenic process is characterized by numerous biochemical factors: a change in the amount of water included in the lens, loss of potassium, increased calcium content, decreased amount of oxygen and ascorbic acid, as well as glutathione and hexose. The transparency of the optical lens of the eye ensures the water solubility of the proteins included in its structure. With age, processes of chemical oxidation of membrane substances begin to predominate in the lens of the eye, which in turn leads to self-destruction of proteins. Consequently, proteins gradually turn from water-soluble to water-insoluble.

This chain of pathological processes leads to a loss of transparency of the lens, that is, to the occurrence of clouding. Opacification of the lens is a response from the lens substance to the influence of various unfavorable factors or modification of the components that make up the intraocular fluid, which is the medium surrounding the lens.

Symptoms of cataracts

The clinical picture of cataract varies depending on the location, shape, and stage of lens opacification. All patients with cataracts experience a gradual progressive decrease in vision. Most of them complain of the presence of a veil or fog before the eyes, the presence of black dots they feel in the field of vision, which move simultaneously with eye movements and remain fixed when the patient’s eye does not move.

Patients may also experience double vision, halos around objects in bright light, optical distortions, photophobia, dizziness, discomfort, visual disturbances that worsen at night, when driving, writing, reading, sewing, or when working with small parts . Over time, as the cataract matures, vision deteriorates, the ability to read is lost, and patients cease to recognize the faces of others and objects. In the future, only the ability to distinguish between light and shadow remains. The combination of these symptoms leads to the development of professional and social maladaptation of a person. If not treated promptly, cataracts most often lead to complete blindness.

Stages of cataract maturation

Primary cataract- characterized by the appearance of clouding along the periphery of the lens, without damaging the optical zone.

Immature cataract- it is characterized by the spread of lens opacification to the center of the optical zone. Visual acuity at this stage is significantly reduced.

Mature cataract- clouding of the entire area of ​​the lens. Progressive deterioration of vision, loss of objective vision, patients are able to recognize only light and shadow.

Overmature cataract- further development of the process, which is accompanied by complete destruction of the lens fibers and dissolution of the cortex. As a result, the lens becomes milky white and uniform in consistency. Overmature cataracts are quite rare. This is the most dangerous stage, which is characterized by the development of severe complications, for example, rupture of the capsule with the release of its contents into the eye cavity, which also entails adverse consequences.

Diagnosis of cataracts

Detecting a cataract in a patient’s eye is not particularly difficult; difficulties arise when the ophthalmologist is faced with the task of determining the stage, location, etiology of the clouding and, most importantly, establishing the required volume and tactics of surgical intervention. The difficult diagnosis of cataracts is explained by the fact that severe opacities in the lens make it very difficult, and sometimes completely impossible, to study the condition located directly behind the lens, the vitreous body and the retina.

All methods of examining a patient with cataracts can be divided into four large groups:

1. Standard (routine) methods required for each patient

• Visometry- determination of visual acuity
• Determination of binocular vision - assessment of three-dimensional, stereoscopic vision with both eyes simultaneously
• Perimetry- visual field examination
• Tonometry- measurement of intraocular pressure
• Biomicroscopy- a method of microscopic examination of eye tissue, allowing a detailed study of the anterior and posterior parts of the eyeball, regardless of room lighting. Biomicroscopy is the most important stage of examining a patient with cataracts, with the help of which the ophthalmic surgeon selects the most effective method of cataract removal. To perform biomicroscopy, a special device called a slit lamp is used. The study is carried out under conditions of medicinal mydriasis (dilation of the pupil with the help of medicinal drugs), the following indicators are assessed: the size and density of the nucleus, the stage of dystrophic changes in the capsule, the position of the lens, the presence of pronounced or hidden subluxation of the lens caused by dystrophic changes, destruction of the fibers of the ligament supporting the lens
• Ophthalmoscopy- a method for studying the retina, optic nerve, choroid in rays of light that are reflected from the fundus of the eye. Sometimes due to severe clouding of the lens, this research method is difficult to perform. At the same time, ophthalmoscopy is very informative when examining the eyes of patients with diabetes mellitus, uveitis, myopia, and retinitis pigmentosa.
• Gonioscopy- study of the angle of the anterior chamber of the eye. This research method is of fundamental importance in determining the tactics of surgical treatment of patients with lens pathology in combination with glaucoma

1. Additional methods are also mandatory for each patient

• Refractometry- determination of the refraction of the eye (the refractive power of the optical system of the eye). The method is necessary to determine the degree of farsightedness, myopia and astigmatism.
• Ophthalmometry- is an examination of the eye using a special device - an ophthalmometer. Using this device, an ophthalmologist can measure the radii of curvature of surfaces, both the cornea and the lens itself
• Determination of anterior - posterior size of the eyeball
• Skiascopy- a method for determining the refraction of the eye, which consists of observing the movement of shadows in the area of ​​the pupil, while a beam of light directed at the eye is reflected from the mirror
• Electrophysiological study of the eye- used to determine the lability and sensitivity threshold of the optic nerve

Carrying out all research methods included in this group is necessary to calculate the necessary parameters of the eye, allowing you to accurately calculate the optical power of the artificial lens that will be implanted during the operation (intraocular lens). All received data is processed using a computer, which makes it possible to instantly correct farsightedness and myopia.

1. Additional methods used as prescribed by the doctor

• Densitometry
• Ultrasound biomicroscopy
• Endothelial biomicroscopy

1. Laboratory research methods.

Prescribed to patients before hospitalization for surgery or directly in the hospital. Mandatory for all patients are: general blood and urine analysis, glycemia, coagulogram, blood test for HIV, hepatitis B and C, syphilis. A biochemical blood test is performed as prescribed by a doctor if the patient has concomitant diseases. In the case of congenital cataracts, to clarify its etiology, it is necessary to test the blood serum and lens substance of the mother and child to determine markers of the hepatitis B virus in them.

Cataract treatment

Drug treatment

Conservative treatment is advisable only in the initial stage of cataract development, which involves preventing the rapid progression of lens opacification. Patients are prescribed instillation of drugs that have a positive effect on the metabolism occurring in the structures of the eye. Such preparations contain ascorbic acid, glutamine, cysteine, as well as a complex of vitamins and microelements, for example, Quinax, Oftan Katahrom, Taufon. The results of such treatment do not always meet the patient's expectations. In severe cases, lens opacities in some forms of initial cataracts may stop developing or resolve if timely and rational treatment of the primary disease that caused the development of cataracts is carried out.

We must not forget that cataracts are a progressive and irreversible process. Drug treatment methods can only stop the development of the process for some time, but will never be able to return the lens to its original transparency.

It is very important to know that if the clouding of the lens continues to worsen, it is necessary to undergo cataract surgery.

Cataract surgery

A direct indication for surgery is a decrease in visual acuity, which causes the patient’s disability to work and discomfort in everyday life. When determining indications for cataract removal, the stage of its maturity does not matter. Cataract surgery is considered completely futile only in cases of complete blindness. This is possible when there are other pathologies in the eye with cataracts that lead to blindness.

Preparing for surgery

Before surgery, each patient needs to undergo a thorough examination of both eyes using the methods indicated earlier in the section “diagnosis of cataracts,” as well as a complete assessment of the general condition of the whole body. This is necessary for correctly predicting the results of the operation, regarding the prevention of all kinds of complications, both from the operated eye and the body itself as a whole, as well as to determine the functional ability of the eye after surgery.

If during the examination inflammatory processes are detected in the eye, or in organs and tissues located in the vicinity of the eye, then it is mandatory to sanitize the foci of inflammation plus anti-inflammatory therapy before surgery. Directly on the operating table, preparing the patient involves instilling disinfectant drops into the operated eye, as well as drops that dilate the pupil. Pain relief depends on the type of surgery to be performed; it can be local or general (intravenous anesthetics).

Selection of intraocular lens

Selecting an intraocular lens is a rather complex and time-consuming process, and most importantly the most important factor in a successful operation, since the quality of the patient’s vision after surgery depends on the correctly selected lens. Individual lens selection is carried out by a specialist using specialized equipment (methods are listed in the “cataract diagnosis” section). The choice also depends on the patient’s desire to see well either near or far without glasses. Careful selection of an intraocular lens is so important because all lenses are different, so it is necessary to make the only correct choice for your eye.

Types of intraocular lenses

• Monofocal intraocular lens is the most commonly used type of artificial lens. Provides the highest quality of distance vision, regardless of the degree of illumination of the area or room. But at the same time, near vision (writing, reading, sewing) needs minor correction with glasses.
• Accommodating monofocal intraocular lens - has the property of easily changing its position in the eye, which helps focus the image on the retina, regardless of whether the patient is looking near or far. The accommodation of such a lens is similar to the natural accommodation of a healthy lens. After surgery, the patient can easily do without glasses.
• Multifocal intraocular lens - due to the manufacturing features, they have ultra-precise optical characteristics, imitating the functioning of a healthy lens of the eye, which allows the patient after surgery to see equally well without glasses at any distance.
• Toric intraocular lenses - due to their cylindrical shape, are able to change the refractive power in certain areas, which is very important in the correction of corneal astigmatism, which often complicates cataracts.
• Aspheric intraocular lens - has all the properties of a healthy lens, except for high visual acuity, implantation of this type of lens provides high sharpness and contrast sensitivity of vision.

Types of cataract surgeries

Surgical treatment of cataracts involves removing the clouded lens and replacing it with an artificial intraocular lens. There are several options for cataract removal surgery:

• Intracapsular cataract extraction- the lens is removed along with the capsule, carried out through a large incision using a special device - a cryoextractor. This technique is quite traumatic for the eye, so it is practically not used at present. Typically, the indication for such an operation is traumatic cataracts, when it is not possible to maintain the integrity of the lens capsule, or dislocation of the lens when the threads (chordas) that suspend it are damaged.
• Extracapsular cataract extraction- the lens is removed, but its posterior capsule is preserved, which gives the method advantages over the first. The barrier between the anterior and posterior chambers of the eye is maintained. But, nevertheless, this method is also very traumatic due to the large incision and requires sutures on the postoperative wound. It is widely used at present, but is being intensively replaced by a modern low-traumatic method - phacoemulsification.
• Phacoemulsification- removal of the lens using ultrasound. Its advantages are that the operation is performed through a micro-incision from 2.2 to 5.5 mm, depending on the selected intraocular lens. The operation is performed under local anesthesia, this allows the surgeon to be in contact with the patient throughout the operation. Does not require postoperative sutures. The duration does not take more than 15 minutes, it is absolutely painless and safe, the risk of postoperative complications is minimal. The patient is quickly rehabilitated, full functionality is restored after 10 days.
• Laser cataract surgery- is based on the use of laser radiation to crush the nucleus of the lens, which has a maximum degree of hardness in a short period of time, and is absolutely safe, practically without damaging the posterior epithelium of the cornea.

After operation

After the operation is completed, a sterile bandage is applied to the operated eye. Within a few hours after the operation, the patient sees quite well in the operated eye, and within a week his visual functions are completely improved.

If the patient does not experience any complications during the operation or in the early postoperative period, he is discharged home the next day. You should beware of excessive eye strain, do not lift heavy objects, avoid sudden movements, maintain eye hygiene, avoid sudden changes in temperature, and abstain from alcohol for at least 3-4 weeks after surgery.

Immediately after returning home, the patient returns to his previous lifestyle. It is allowed to read, write, watch TV, etc. On an individual basis, the doctor prescribes eye drops to shorten the recovery period, and also informs the patient about the need for preventive examinations.

Prevention of cataracts

To prevent cataracts, it is recommended to replenish certain substances in the body, such as antioxidants. These include: glutathione, lutein, vitamin E. A balanced diet, abstinence from smoking and alcohol, and physical activity can prevent the development of cataracts. Regular examination by an ophthalmologist for people over 50 years of age.