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Eye diseases. Clinic and treatment of cataracts (the most important)

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53. Clinic and treatment of cataract

clinical picture. The clinical picture of cataract in the primary form is manifested by complaints of decreased visual acuity. Sometimes the first symptoms of cataract are distortion of objects, monocular polyopia (multiple vision of objects).

In the clinical course of senile cataract, there are initial, immature, mature and overripe stages. In the initial stage, patients may not have complaints, others note a decrease in visual acuity, the appearance of "flying flies", and sometimes polyopia. In a biochemical study at this stage, the appearance of intracapsular blisters, stratification of the lens fibers are determined. After 23 years, the stage of immature cataract begins. At this stage, the phenomena of hydration of the lens increase, and patients complain of a sharp decrease in vision. The stage of immature cataract lasts for years. Gradually, the lens begins to lose water, and the turbidity acquires an intense gray hue, becomes uniform. There is a stage of a mature cataract. At this stage, the figure of a lens star, intense opacification in the region of the lens sutures are visible. Patients complain about the lack of objective vision. With an overripe cataract, the cortical substance is converted into a liquefied milky mass, which undergoes resorption, the volume of the lens decreases.

With a nuclear cataract, central vision is disturbed early, far vision suffers more. Temporary nearsightedness may occur. In side light, the lens in these cases has a light green tint.

Complications of cataracts are phacolytic glaucoma, phacogenous iridocyclitis. Phacolytic glaucoma develops in immature cataracts due to the absorption of a decaying substance during swelling of the lens, an increase in its volume and as a result of a violation of the outflow of intraocular fluid. When cataract masses fall into the anterior chamber of the eye and their resorption is delayed, iridocyclitis may occur, associated with the development of hypersensitivity to the lens protein.

Treatment. Conservative cataract therapy is used for initial lens opacification to prevent its progression. Medicines used to treat cataracts contain a means for correcting metabolic processes, normalizing electrolyte metabolism, redox processes and reducing lens edema (oftankatachrome, soncatalin, vitaiodurol, quinax).

Surgery (cataract removal) remains the main treatment for lens opacities. Indications for surgical treatment are determined individually. This depends on the state of visual functions, the nature and intensity of lens opacification. Removal can be internal or extracapsular. In intracapsular removal, the lens is removed within the capsule. During extracapsular removal, after opening the anterior capsule of the lens, the nucleus is squeezed out and the lens masses are sucked out. A method has been developed to remove cataracts through tunnel incisions, which are sutured.

Author: Shilnikov L.V.

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