Eye diseases. Senile cataracts and principles of cataract treatment (the most important)

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Eye diseases. Senile cataracts and principles of cataract treatment (the most important)

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56. Senile cataract and principles of cataract treatment

Senile cataracts are characterized by a slow progressive decline in vision. With initial cataracts (cataracta incipiens), visual acuity is usually high. With side lighting, no changes in the lens may be detected. In transmitted light with a dilated pupil against the background of a pink reflex, you can see opacities on the periphery along the equator of the lens in the form of spokes or streaks or in the center if the cataract is nuclear.

If a patient has an immature (swelling) cataract (cataracta nondum matura s. intumescens), he complains of a significant decrease in vision. When illuminated from the side, a gray cloudy lens is visible in the pupil area. The lens may swell, causing the anterior chamber to become shallow. Due to the existing transparent areas in the lens, the shadow of the iris is visible on it in lateral lighting, as well as a reflex from the fundus in transmitted light. Swelling of the lens can cause increased intraocular pressure.

Patients with mature cataracts (cataracta matura) are practically blind. Visual acuity is equal to light perception or hand movement near the face; there is no shadow from the iris, there is no reflex from the fundus.

If the cataract is overripe (cataracta hypermatura), then cholesterol deposits are observed in it in the form of white plaques on the anterior capsule of the lens; the nucleus may descend downward, as the cortical substance liquefies. White plaques and a descended nucleus are visible when examined using a combined method and in the light of a slit lamp.

Congenital cataracts that have almost no effect on visual acuity (for example, polar cataracts, suture cataracts) cannot be treated. Zonular, diffuse, membranous, nuclear and other cataracts are removed when visual acuity decreases to 0,2, and also if vision does not improve with pupil dilation.

Senile cataracts are treated depending on the stage of the process and the state of vision function. In the initial stage, the administration of vitamin drops (cysteine, vitaminodurol, etc.) is indicated; for mature cataracts, intracapsular extraction is indicated.

If visual acuity is very low, the patient is practically blind, and the cataract is not quite mature, intracapsular extraction is also performed. Treatment of sequential cataracts is carried out depending on the etiology of the process and the degree of vision loss. For example, in diabetes, lens opacities may disappear under the influence of insulin therapy.

Before prescribing a patient for surgery, it is necessary to have the following additional data: a physician’s opinion to exclude somatic contraindications to surgery, chest X-ray results, positive reports from an otolaryngologist and dentist, conjunctival culture, reaction to toxoplasmosis, Wasserman reaction, blood tests (general, coagulability and bleeding time), urine analysis.

On the eve of the operation, it is necessary to cut your eyelashes and shave your eyebrows. On the morning of the operation, a cleansing enema is given, the patient does not eat. For children the operation is performed under general anesthesia, for adults under local anesthesia. The surgical field is treated with alcohol, lubricated with iodine, and covered with sterile napkins.

Author: Shilnikov L.V.

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