Mature and mature stages of cataract development. Overripe cataract complication Speed ​​of cataract maturation

Cataract is a clouding of the lens that covers it partially or completely. It can be congenital or acquired.

Acquired cataracts can be age-related, complicated (associated with eye diseases), caused by general diseases, toxic (the effect of certain drugs) and traumatic, resulting from the action of physical, chemical or thermal and radiation factors.

With age (usually after 50 years), the fibers of the lens become denser and it may become cloudy. Also, eye diseases such as recurrent iridocyclitis, chorioretinitis, glaucoma, retinal degeneration, and high myopia lead to the development of cataracts. In all these conditions, degenerative changes occur in the lens.

Quite a lot of common diseases lead to the development of cataracts. For example, diabetes mellitus, exhaustion due to starvation, infectious diseases (malaria, typhoid). Hormonal drugs have a toxic effect on the lens.

Traumatic cataracts can occur with blunt and penetrating injuries to the eye. Very often a so-called Vossius ring appears (an imprint of the pigment ring of the iris, which resolves with adequate treatment). With the development of true cataracts, vision permanently decreases.

Because The lens is capable of absorbing invisible infrared rays; radiation cataracts may develop in workers in hot shops and when the orbit is irradiated without the use of protective equipment (glasses, masks).

Congenital cataracts are associated with impaired differentiation of the lens during embryogenesis and are not amenable to conservative treatment.

Congenital cataract

Symptoms of cataracts

Depending on the location, cataracts are distinguished:

- polar (anterior and posterior) - located at the anterior or posterior pole

- fusiform - located along the anterior-posterior axis in the center of the lens

- layered - around the core

- cortical (under the oval-shaped capsule)

- nuclear - occupy the entire core

- complete - clouding of the entire lens

According to the degrees of development, the stages of cataract are distinguished: initial, immature, mature and overripe.

At the initial stage, changes begin in the periphery, vision loss is absent or insignificant. Amenable to conservative treatment.

Primary cataract

When immature, the degree of opacities increases and vision decreases. It is possible to develop swelling cataracts, leading to complications (phacogenic glaucoma).

Immature cataract

Mature is characterized by thickening of the clouded lens masses and a persistent decrease in visual acuity. Surgical treatment is required.

Mature cataract

Overmature cataracts (milk cataracts, Morganian cataracts) are rare. In this case, the cortical substance disintegrates, the dense core separates from the capsule and “settles” at its bottom. It can be complicated by glaucoma (since inflammation occurs) and iridocyclitis when the capsule ruptures and the lens masses exit into the anterior and posterior chambers of the eye. Treatment is only surgical.

Overmature cataract

Symptoms that may indicate the development of cataracts and consult a doctor:

- decreased visual acuity down to light perception. If the clouding occupies the central part, then the patient sees better in the twilight, when the pupil dilates and the unaffected area of ​​the lens increases;

- The lens may become gray in color.

If the symptoms described above appear, you should consult a doctor to clarify the diagnosis.

Diagnosis of cataracts

Examination methods:

— determination of visual acuity (from normal to light perception and blindness). With a normal retina, light perception with the correct projection. Otherwise, surgical treatment will not restore vision, but can save the eye as an organ.

— perimetry to determine the condition of the retina and diagnose possible complications;

— determination of intraocular pressure to exclude glaucoma. If necessary, tonography;

— research in transmitted light. With cataracts, against the background of a pink fundus reflex, shadows from a cloudy lens are detected;

— biomicroscopy allows you to determine the location and degree of opacities;

— examination of the fundus to exclude concomitant pathology.

Based on these studies, the doctor can make a diagnosis, but additional methods and consultations are needed to determine the causes:

— general clinical tests, including blood sugar;

— consultations with a therapist, ENT, dentist to exclude concomitant pathologies and identify contraindications for surgical treatment (active inflammatory processes, severe decompensated diseases).

Cataract treatment

Treatment must be started in a timely manner; it can be conservative and surgical.

Conservative treatment methods include the prescription of drops that help improve the metabolism of the lens to slow the progression of opacities. These include Taufon, Quinax, Oftan-katachrome. Place 1-2 drops into the conjunctival sac 3 times a day continuously. Interruptions in treatment contribute to the progression of the disease.

Surgical methods for treating cataracts are most often used. With the development of medicine, you don’t even need to go to the hospital. Some operations are performed without incisions, on an outpatient basis, and the patient goes home the same day.

Methods of surgical treatment of cataracts:

— intracapsular cataract extraction is a historical method that is not currently used due to high morbidity and the development of complications. In this case, the lens is completely removed along with the capsule;

— extracapsular cataract extraction — removal of clouded masses while preserving the capsule and replacing it with an intraocular lens (IOL), which performs all the functions of the lens. IOLs are available in rigid and flexible types. Nowadays the latter are almost always used.

One of the most common treatment methods is phacoemulsification of cataracts with IOL implantation. A micro-incision is used, the lens masses are removed using ultrasound, and an IOL is implanted. The whole procedure takes about 10 minutes. Local anesthesia reduces the risk of complications. The patient is prescribed drops and goes home under the supervision of an ophthalmologist at his place of residence.

Postoperative treatment:

- antibacterial drops (Floxal, Tobrex, Oftaquix) first every hour, then 4 times a day for 10 days,

- anti-inflammatory drops (Indocollir, Diclof) 2 times a day for 2 weeks,

- hormonal drops (Oftan-dexamethasone, Maxidex) every 12 hours for 2 weeks,

- for dry eyes, tear substitutes are prescribed (Artificial tears, Systane, Oxial) - drop as needed.

After the operation, heavy lifting, being in dusty rooms and outdoors in windy weather, hypothermia, and taking baths are contraindicated.

There are traditional methods of treatment, for example, dropping diluted honey into the eyes, taking infusions of calendula, sage, etc., but their effectiveness has not been proven, and some substances can be harmful.

Complications of cataracts

If untimely or untreated treatment may result in complications:

Cataracts - causes, types, symptoms and signs, diagnosis of clouding of the eye lens, complications

Cataract represents eye disease. in which clouding occurs in one of the structural units of the human eye, namely the lens. Normally, the lens of the eye is completely transparent, due to which light rays pass through it freely and are focused on the retina, from where the image of the “picture” of the surrounding world is transmitted to the brain along the optic nerve. Thus, the transparency of the lens is one of the necessary conditions for good vision, since, otherwise, light rays will not even reach the retina of the eye, as a result of which a person will not be able to see in principle.

Cataracts are a disease in which the lens becomes cloudy and loses its transparency, resulting in poor vision. With long-term cataracts, the clouding of the lens can be so significant that the person becomes completely blind. The main manifestation of cataracts is the appearance of a feeling of “fog” before the eyes, through which objects are seen as if through haze, a layer of water or fogged glass. In addition, with cataracts, vision deteriorates at night, the ability to recognize colors is impaired, double vision and increased sensitivity to bright light appear.

Unfortunately, the only treatment method that allows you to completely get rid of cataracts is surgery, during which the clouded lens is removed and a special clear lens is inserted into the eye instead. But such an operation is not always necessary. So, if a person sees normally, then conservative treatment is recommended to stop the progression of cataracts and maintain vision at the current level, which will be an adequate replacement for surgery.

Brief description of the disease

Cataracts have been known since ancient times, since a description of this disease is found in ancient Greek medical treatises. Greek healers gave the name to the disease from the word katarrhaktes, which means “waterfall.” This figurative name was due to the fact that a person suffering from this disease sees the world around him as if through the thickness of water.

Currently, according to the World Health Organization, cataracts are the most common eye disease in the world. However, the frequency of its occurrence varies among people of different age groups. Thus, in people under 40 years of age, cataracts develop extremely rarely, and in this age group, predominantly cases of congenital disease that developed in the child in the womb before his birth are recorded. Among people 40–60 years old, cataracts occur in 15%, in the group of 70–80 year olds, the disease is recorded in 25–50%, and among those who have crossed the 80-year mark, cataracts are detected in everyone to one degree or another. Thus, cataract is an urgent and common medical problem, as a result of which the disease and methods of its treatment are being intensively studied, due to which significant progress has been made in recent years in the success of therapy.

With cataracts, one of the structures of the eye is affected - the lens, which becomes cloudy. To understand the essence of the disease, it is necessary to know the position and functions of the lens in the human visual analyzer system.

So, the lens is a biconvex, elliptical, absolutely transparent structure located behind the iris of the eye (see Figure 1) with a maximum diameter of 9 - 10 mm.

Picture 1– Structure of the eye.

Since the lens is completely transparent, even with a careful look into the pupil or iris of the eye it is not visible. The structure of the lens is a gel-like mass enclosed in a dense capsule of connective tissue that holds the required shape of the organ. The gel-like content is transparent, allowing light rays to pass through it freely. The shape of the lens is similar to an ellipse, which extends from one corner of the eye to the other, and the curved surfaces adjacent to the pupil are optical lenses capable of refracting light rays. The lens does not contain blood vessels that would disrupt its complete transparency, as a result of which its cells are nourished by the diffusion of oxygen and various necessary substances from the intraocular fluid.

In terms of its functional purpose, the lens plays a very important role. Firstly, it is through the transparent lens that light rays pass into the eye and are focused on the retina, from where the image for analysis and recognition is transmitted to the structures of the brain along the optic nerve. Secondly, the lens not only transmits light waves into the eye, but also changes the curvature of its surfaces so that the rays are focused precisely on the retina. If the lens did not change its curvature, adjusting to different lighting intensities and the distance of the objects in question, then the light rays passing through it would not focus accurately on the retina, as a result of which a person would see blurry rather than clear images. That is, with the constant curvature of the lens, a person’s vision would be poor, he would see like someone suffering from myopia or farsightedness and not wearing glasses.

Thus, we can say that the main function of the lens is to ensure that the image of the surrounding world is focused directly on the retina. And for such focusing, the lens must constantly change its curvature, adapting to the visibility conditions of the environment. If an object is close to the eye, the lens increases its curvature, thereby increasing optical power. If the object is far from the eye, then the lens, on the contrary, stretches and becomes almost flat, rather than convex on both sides, due to which the optical power decreases.

In fact, the lens of the eye is similar to an ordinary optical lens, which refracts light rays with a certain force. However, unlike a lens, the lens is capable of changing its curvature and refracting rays with different powers necessary at a given moment in time so that the image is focused strictly on the retina of the eye, and not closer or behind it.

Accordingly, any change in the shape, size, location, degree of transparency and density of the lens leads to visual impairment of greater or lesser severity.

And cataract is clouding of the lens, that is, loss of transparency due to the formation of varying amounts of dense and opaque structures in its gel-like subcapsular contents. As a result of cataracts, the lens stops transmitting a sufficient amount of light rays, and the person stops seeing a clear picture of the world around him. Due to the cloudiness of the lens, vision becomes “foggy,” and the outlines of objects become unclear and blurry.

The causes of cataracts have not yet been reliably established, but, nevertheless, scientists have identified a number of predisposing factors against the background of which a person develops cataracts. These factors contribute to the development of cataracts, so they are conventionally classified as the causes of this disease.

At the biochemical level, cataracts are caused by the breakdown of proteins that make up the gel-like contents of the lens. These denatured proteins are deposited in flakes and cloud the lens, leading to cataracts. But the reasons for the denaturation of lens proteins are very diverse - these can be age-related changes in the body, injuries. chronic inflammatory eye diseases. radiation, metabolic diseases, etc.

The most common predisposing factors for cataracts are the following conditions or diseases:

Hereditary predisposition;

Age-related changes in the body;

Endocrine diseases (diabetes mellitus, hypothyroidism, hyperthyroidism, muscular dystrophy, etc.);

Exhaustion due to starvation. malnutrition or severe illnesses (for example, typhoid malaria, etc.);

Anemia;

Excessive eye exposure to ultraviolet radiation;

Radiation exposure;

Poisoning with poisons (mercury, thallium, ergot, naphthalene);

Down's disease;

Skin diseases (scleroderma, eczema, neurodermatitis, Jacobi poikiloderma, etc.);

Injuries, burns. eye surgeries;

High myopia (more than 4 diopters, etc.);

Severe eye diseases (uveitis, iridocyclitis, retinal detachment, etc.);

Infections suffered during pregnancy (influenza, rubella, herpes, measles, toxoplasmosis, etc.) - in this case, the newborn may have congenital cataracts;

Taking glucocorticosteroid drugs (Prednisolone, Dexamethasone, etc.).

Depending on the age at which cataracts appear, the disease may be congenital or acquired. Congenital cataracts occur during fetal development. As a result, the baby is born with a visual defect. Such congenital cataracts do not progress over time and are limited in area.

Acquired cataracts appear throughout life due to the influence of various causative factors. The most common acquired cataracts are senile cataracts, caused by age-related changes in the body. Other types of acquired cataracts (traumatic, toxic due to poisoning, caused by systemic diseases, etc.) are much less common in senile cases. Unlike congenital ones, any acquired cataracts progress over time, increasing in size, increasingly impairing vision, which can ultimately lead to complete blindness.

Cataracts are divided into several types. depending on the nature and location of lens opacities. Determining the type of cataract is important to determine the optimal treatment strategy.

Cataracts of any type and location pass sequentially from the moment of appearance 4 stages of maturity– initial, immature, mature and overripe. At the initial stage, the lens becomes hydrated, and cracks appear in the gel-like mass filling it, which disrupt the transparency of the entire structure. However, since the slits are located on the periphery, and not in the area of ​​the pupil, this does not interfere with the person’s vision, so he does not notice the development of the disease. Further, at the stage of immature cataract, the number of foci of opacification increases, and they appear in the center of the lens opposite the pupil. In this case, the normal passage of light through the lens is already disrupted, as a result of which the person’s visual acuity decreases and a feeling of seeing surrounding objects appears as if through foggy glass.

When opacities fill the entire lens, the cataract becomes mature. At this stage, the person sees very poorly. The pupil with mature cataracts acquires a characteristic white tint. Next comes the stage of overripe cataract, at which the lens substance disintegrates and its capsule shrinks. At this stage the person becomes completely blind.

Rate of cataract progression. that is, its passage through all four stages of development may be different. Thus, in one person, cataracts can progress very slowly, due to which vision remains satisfactory for many years. In other people, on the contrary, cataracts can progress very quickly and lead to complete blindness literally within 2 to 3 years.

Symptoms of cataracts may vary depending on the stage of the disease. In the first stage, the person does not suffer from visual impairment. but notices frequently recurring episodes of double vision, flickering “spots” before the eyes, a yellowish coloration of all surrounding objects, as well as some blurriness of the visible picture. People often describe blurred vision as “seeing as if in a fog.” Due to the symptoms that appear, it becomes difficult to read, write, and do any work with small parts.

At the stage of immature and mature cataracts, visual acuity sharply decreases towards myopia, objects begin to blur before the eyes, there is no color discrimination, a person sees only blurred contours and outlines. A person no longer sees any small details (people’s faces, letters, etc.). By the end of the stage of mature cataract, a person ceases to see anything at all, and he only has light perception.

In addition, at any stage of development, cataracts are characterized by increased sensitivity to light, poor vision in the dark, and the appearance of a halo around lighting fixtures when looking at them.

For diagnosing cataracts An ophthalmologist checks visual acuity (visometry), determines visual fields (perimetry), the ability to distinguish colors, and measures intraocular pressure. examines the fundus of the eye (ophthalmoscopy), and also performs a detailed study of the lens using a slit lamp (biomicroscopy). In addition, sometimes additional refractometry and ultrasound scanning of the eye can be performed, which are necessary to calculate the optical power of the lens and determine the surgical procedure for replacing the lens. Based on the examination results, the diagnosis of cataract is confirmed or refuted. With cataracts, there is usually a deterioration in visual acuity, impaired color discrimination and, most importantly, visible opacities on the lens when examined with a slit lamp.

Cataract treatment can be operative or conservative. If the disease is detected in the initial stages, when vision is practically not affected, then conservative therapy is carried out aimed at slowing the progression of cataracts. In addition, conservative therapy is recommended in all cases where cataracts do not interfere with a person’s ability to carry out any normal activities. Currently, various eye drops are used as conservative treatment for the disease. containing vitamins. antioxidants. amino acids and nutrients (for example, Oftan-Katachrome, Quinax, Vitafacol, Vitaiodurol, Taufon. Taurine, etc.). However, it must be remembered that eye drops cannot lead to the disappearance of existing opacities in the lens, but can only prevent the appearance of new foci of opacity. Accordingly, eye drops are used to maintain vision at the current level and prevent the progression of cataracts. In many cases, such conservative therapy turns out to be very effective and allows a person to live for a long period of time without resorting to surgery.

Surgical treatment of cataracts involves removing opacities and then installing a special lens into the eye, which, in essence, is like a lens prosthesis. This artificial lens performs the functions of a lens, allowing a person to completely and permanently get rid of cataracts and restore vision. Accordingly, the only complete and radical treatment for cataracts is surgery.

Currently, ophthalmologists, knowing that surgery is the treatment method with the most noticeable positive result, recommend removal of opacities and installation of lenses in almost all cases of cataracts. This position of actively promoting the surgical treatment of cataracts is due to the convenience of the doctor, who simply needs to perform a relatively simple operation, after which the patient can be considered cured. But conservative therapy requires effort from both the doctor and the patient, since it is necessary to constantly apply eye drops in courses, undergo examinations and monitor vision. And yet, despite the advantages of surgery, in many cases with cataracts, conservative therapy is preferable to stop the progression of the disease.

Causes of cataracts

The causes of congenital and acquired cataracts are different, since the formation of the former occurs when the fetus is exposed to various unfavorable factors during pregnancy, and the latter are formed during a person’s life due to various pathological processes in the body.

The causes of congenital cataracts are divided into two large groups: genetic abnormalities and exposure to adverse factors during pregnancy that can disrupt the formation of the fetal lens.

Genetic abnormalities, the manifestations of which include congenital cataracts, include the following diseases or conditions:

Pathologies of carbohydrate metabolism (diabetes mellitus, galactosemia);

Pathologies of calcium metabolism;

Pathologies of connective tissue or bones (chondrodystrophy, Marfan syndrome, Weil-Marchesani syndrome, Apert syndrome, Conradi syndrome);

Skin pathologies (Rothmund syndrome, Block-Sulzberger syndrome, Schaefer syndrome);

Chromosomal abnormalities (Down syndrome, Shershevsky-Turner syndrome, Marinescu-Sjögren syndrome, Axenfeld syndrome).

Factors whose impact on a woman during pregnancy can provoke disruption of the formation of the lens and congenital cataracts in the child include the following:

• Rubella, toxoplasmosis or cytomegalovirus infection. transferred in the first 12 - 14 weeks of pregnancy;
• The effect of ionizing (radioactive) radiation on the body of a pregnant woman at any period of gestation;
• Rh incompatibility between fetus and mother;
• Fetal hypoxia;
• Lack of vitamins A, E, folic (B 9) and pantothenic (B 5) acids, as well as protein;
• Chronic intoxication of a pregnant woman's body with various substances (for example, smoking, drinking alcohol, drugs, taking contraceptives or abortifacients).

As for acquired cataracts, the spectrum of its causative factors comes down to conditions or diseases in which metabolism is disrupted to one degree or another, a deficiency of antioxidants occurs, and processes of damage to cellular structures prevail over their repair (restoration). Unfortunately, at present, the exact causes of acquired cataracts have not been established, however, scientists were able to identify a number of factors that were conventionally called predisposing, since if they are present, the likelihood of lens clouding is very high. Traditionally, it is predisposing factors at the everyday level that are considered causes, although this is not entirely correct from the point of view of science. However, we will also indicate predisposing factors as causes, since it is precisely under these conditions that cataracts develop.

So, the causes of acquired cataracts can be the following diseases or conditions:

• Hereditary predisposition (if parents or grandparents had cataracts, then the risk of its occurrence in a person in old age is very high);
• Female gender (women develop cataracts several times more often than men);
• Age-related changes in the body (slowdown of metabolism, accumulating pathological changes in cells, deterioration of immunity and chronic diseases together lead to the formation of opacities in the lens);
• Alcohol, drug use and smoking;
• Endocrine diseases (diabetes mellitus, hypothyroidism, hyperthyroidism, muscular dystrophy, obesity, etc.);
• Chronic autoimmune or inflammatory diseases that worsen the condition of blood vessels (for example, rheumatoid arthritis, etc.);
• Exhaustion due to starvation, malnutrition or severe illnesses (for example, typhoid, malaria, etc.);
• Hypertonic disease;
• Anemia;
• Excessive eye exposure to ultraviolet radiation (exposure to the sun without protective glasses);
• Exposure to strong thermal radiation on the eyes (for example, working in a hot shop, frequent visits to hot baths, saunas);
• Exposure to radiation, ionizing radiation or electromagnetic waves on the eyes or the body as a whole;
• Poisoning with poisons (mercury, thallium, ergot, naphthalene, dinitrophenol);
• Down's disease;
• Skin diseases (scleroderma, eczema, neurodermatitis, Jacobi poikiloderma, etc.);
• Injuries, burns, eye surgeries;
• High myopia (3 degrees);
• Severe eye diseases (uveitis, iridocyclitis, chorioretinitis, Fuchs syndrome, pigmentary degeneration, retinal detachment, glaucoma, etc.);
• Infections suffered during pregnancy (influenza, rubella, herpes, measles, toxoplasmosis, etc.) - in this case, the newborn may have congenital cataracts;
• Taking glucocorticosteroid drugs (Prednisolone, Dexamethasone, etc.), tetracycline for a long time or in high dosages. amiodarone, tricyclic antidepressants;
• Living or working in unfavorable environmental conditions.

Types of cataracts

Let's look at the different types of cataracts and their characterological features.

First of all, cataracts are divided into congenital and acquired. Accordingly, congenital cataracts are formed in the fetus during intrauterine development, as a result of which the baby is born with eye pathology. Acquired cataracts develop during a person’s life under the influence of predisposing factors. Congenital cataracts do not progress, that is, the number of opacities and their intensity do not increase over time. And any acquired cataracts progress - over time, the number of opacities and the degree of their intensity in the lens increase.

Acquired cataracts are divided into the following types depending on the nature of the causative factor that caused them:

Age-related (senile, senile) cataracts. developing due to age-related changes in the body;

Traumatic cataracts. developing as a result of injury or contusion of the eyeball;

Radiation cataracts. developing due to exposure of the eyes to ionizing, radiation, x-rays, infrared radiation or electromagnetic waves;

Toxic cataracts. developing with long-term use of medications, smoking. alcohol abuse or poisoning;

Complicated cataracts. developing against the background of other eye diseases (uveitis, iridocyclitis, glaucoma, etc.);

Cataracts against the background of severe chronic pathologies(for example, diabetes, thyroid diseases, metabolic disorders, dermatitis, etc.);

Secondary cataracts. developing after one operation to remove a cataract and install an artificial intraocular lens (lens).

Both acquired and congenital cataracts are classified into the following different types depending on the location and shape of the opacities in the lens:

1. Layered peripheral cataract(picture 1 in picture 2). The opacities are located under the lens shell, with transparent and opaque areas alternating.

2.Zonular cataract(picture 2 in picture 2). The opacities are located around the center of the lens, with alternating transparent and opaque areas.

3. Anterior and posterior polar cataracts(picture 3 in picture 2). Cloudiness in the form of a round white or grayish spot is located directly under the capsule in the region of the posterior or anterior pole of the lens in the center of the pupil. Polar cataracts are almost always bilateral.

4. Fusiform cataract(Picture 4 in Figure 2). The opacification in the form of a thin gray ribbon has the shape of a spindle, and occupies the entire width of the lens along its anteroposterior dimension.

5. Posterior subcapsular cataract(picture 5 in figure 2). The opacities are whitish wedge-shaped lesions located along the outer edge of the posterior part of the lens shell.

6. Nuclear cataract(picture 6 in figure 2). Cloudiness in the form of a spot approximately 2 mm in diameter, located in the center of the lens.

7. Cortical (cortical) cataract(picture 7 in figure 2). Opacities are whitish wedge-shaped lesions located along the outer edge of the lens shell.

8. Complete cataract(picture 8 in figure 2). The entire substance of the lens and capsule is cloudy. As a rule, such cataracts are bilateral, that is, both eyes are affected.

Figure 2– Types of cataracts depending on the location and form of opacities.

Congenital cataracts can be represented by any of the above types, and acquired ones are only nuclear, cortical and complete. The shape of cataract opacities can be very diverse - stellate, disc-shaped, cup-shaped, rosette, etc.

Age-related cataracts, in turn, go through the following stages of development, which are also their types:

Initial cataract. An excess of fluid appears in the lens, as a result of which water gaps form between the fibers, which are foci of opacities. Cloudiness usually appears in the peripheral part of the lens, and rarely in the center. Foci of opacities when looking inside the pupil in transmitted light look like spokes in a wheel. At this stage, vision is not significantly affected.

Immature cataract. Cloudiness from the peripheral spreads to the optical zone of the lens, as a result of which a person’s vision sharply deteriorates. The fibers swell, causing the lens to increase in size.

Mature cataract. The entire lens is cloudy, and a person sees practically nothing, but can only distinguish whether it is light or dark indoors or outdoors.

Overripe cataract. The fibers disintegrate and the lens substance liquefies, accompanied by an inflammatory process, which leads to increased intraocular pressure and complete blindness. If the substance of the lens has completely liquefied before this structure is removed, then its core sinks down, and such a cataract is called a blink cataract. Sometimes the substance of the lens liquefies, but the shell remains dense, and in this case it shrinks. The operation to remove the lens at this stage is performed only for the purpose of preserving the eye, since vision during the transition of cataracts to overripe, as a rule, is lost irretrievably due to damage to the structures of the ocular analyzer by toxic decaying lens structures. An overmature cataract appears as a large (dilated) milky-white pupil with numerous white spots. In rare cases, an overripe cataract appears as a black pupil due to excessive sclerosis of the lens nucleus.

Cataracts are diagnosed based on an examination by an ophthalmologist and data from instrumental examinations. The examination consists of examining the iris and pupil of the eye, during which the doctor sees foci of white-gray opacities located in various parts of the lens. Moreover, if the light is directed into the patient’s eyes, the opacities are visible in the form of gray or gray-white flakes. If the eye is viewed in transmitted light, then the opacities are visible in the form of black stripes or spots on a red background. It is the presence of such opacities that makes the ophthalmologist suspect cataracts.

Visometry– determination of visual acuity.

Perimetry– determination of visual fields.

Ophthalmoscopy– examination of the fundus.

Tonometry– measurement of intraocular pressure.

Biomicroscopy– examination of the eye using a slit lamp (this method is decisive for confirming cataracts, since during such an examination the doctor can accurately see the number and shape of opacities in the lens).

Color testing(aimed at finding out how well a person distinguishes colors - very important for identifying cataracts, since with this disease the ability to distinguish colors sharply deteriorates).

Refractometry and ophthalmometry are produced to determine the linear parameters of the eye - the length of the eyeball, the thickness of the lens and cornea, the radius of curvature of the cornea, the degree of astigmatism, etc. The measured parameters allow the doctor to calculate the characteristics of an artificial lens that will optimally suit a person and can be inserted into the eye during surgery.

Ultrasound scanning of the eye– carried out to exclude other eye diseases, such as retinal detachment. hemorrhages, destruction of the vitreous body.

OCT examination(optical coherence tomograph) – allows you to determine all the parameters of the eye, identify the type of cataract and the optimal option for surgical treatment; In addition, OCT examinations can be used for dynamic monitoring of the condition of the eye and vision both after surgery and at the stage of preparation for it or during conservative treatment.

If the clouding of the lens is very strong, as a result of which it is impossible to examine the fundus of the eye, then a study of mechanophosphene and the phenomenon of autoophthalmoscopy is carried out, which make it possible to determine the condition of the retina.

In addition, in some cases, in addition to assessing the condition of the retina, optic nerve and visual cortex of the cerebral hemispheres, functional diagnostics are performed using electrooculography (EOG), electroretinography (ERG) and recording of visual evoked potentials (VEP).

Clinical picture of cataract

The symptoms of cataracts can be different, depending on what stage the pathological process goes through - initial, immature, mature or overripe. Moreover, acquired cataracts are characterized by a gradual passage through all stages of development with the alternate appearance of symptoms inherent in a certain stage. And congenital cataracts are characterized by a lack of progression, as a result of which the symptoms remain constant for a long period of time, and the clinical manifestations generally correspond to the stages of initial, immature or overripe acquired cataracts. For example, if the congenital cataract was initially small, the opacities were located in the peripheral zone of the lens, then this corresponds to the initial stage of acquired cataract. Naturally, the symptoms of this type of pathology will also correspond to the initial stage of acquired cataract. If a congenital cataract is located in the visual area of ​​the lens, then this corresponds to an immature cataract with corresponding symptoms. And congenital cataract, which completely covers the child’s lens, corresponds to the stage of mature acquired cataract with corresponding clinical manifestations.

We will consider the clinical manifestations of each stage of acquired cataracts and the distinctive features of the symptoms of congenital cataracts separately to avoid confusion.

Symptoms of acquired cataracts. At the initial stage of cataracts, a person experiences the following clinical symptoms:

Diplopia (double vision) in an eye affected by cataracts. To identify this symptom, you need to close your eyes one by one and note whether there is double vision in any of them. As the cataract progresses and enters the immature stage, double vision disappears.

Blurry of the visible picture of the surrounding world (see Figure 3). When looking at both close and distant objects, a person sees them as if blurry, as if looking through fog, a layer of water or foggy glass. Glasses and contact lenses do not correct this blurred vision defect.

A feeling of running or flashing “flies”, spots, stripes and balls before the eyes.

Glare, flashes and flashes of light before the eyes in a dark room.

Deterioration of vision in darkness, semi-darkness, twilight, etc.

Photosensitivity, in which any light sources seem too bright, hurt the eyes, etc.

When looking at a light source, a halo appears around it.

Difficulty in distinguishing small details, such as people's facial features, letters, etc. As a result, it becomes difficult for a person to write, read, and also perform any type of activity related to the need to clearly distinguish small details (for example, sewing, embroidery, etc.).

Loss of the ability to distinguish colors, because, firstly, they become very pale, and secondly, they acquire a yellowish tint. It is especially difficult for a person to distinguish between blue and violet colors.

The need to frequently replace glasses or lenses, because Visual acuity decreases very quickly.

A temporary improvement in vision, especially if the person was farsighted before developing cataracts. In this case, he notices that he is suddenly able to see well up close without glasses. But this improvement is short-lived, it quickly passes, after which a sharp deterioration in visual acuity occurs.

Whitish or grayish spots around the perimeter of the pupil.

Figure 3– Vision of surrounding objects with cataracts. On the left is the picture that a person suffering from cataracts sees, and on the right are objects as seen by a normal eye.

When cataracts transition from the initial to the immature stage, a person’s myopia sharply increases. In addition, he sees very poorly any objects located in the distance (at a distance of 3 meters or further from the eye). The haze and blurriness of the visible image of the surrounding world, photosensitivity, difficulty in distinguishing small details and the inability to distinguish colors increase, but double vision, flickering of “floaters”, spots, flashes, as well as a halo around the light source disappear. Photosensitivity becomes so strong that a person sees better in cloudy weather or at dusk than in daylight or good artificial lighting. At the same time, large foci of milky-white cataract spots are clearly visible in the depths of the pupil (see Figure 4). Throughout the entire stage of immature cataracts, vision deteriorates, a person sees worse and worse, the ability to distinguish more and more details is lost and only the vision of blurred outlines of surrounding objects remains.

Figure 4– Pupil with immature cataract.

When cataracts pass into the mature stage, a person loses objective vision, and he only has light perception. That is, a person does not even see the outlines of surrounding objects; his eye is able to distinguish only light or dark at the current moment in time indoors or outdoors. The pupil in the center becomes whitish-gray, and black-purple areas are visible along its edges.

When cataracts pass into the overripe stage, a person becomes completely blind and even loses light perception. At this stage, treatment is absolutely useless, since vision will not be restored. Surgery for overripe cataracts is performed only to save the eye, because disintegrating lens masses are toxic to all other eye tissues, which can lead to glaucoma or other serious complications. Overmature cataracts are also called blinking or mammary cataracts because the pupil is completely milky white. Sometimes with overripe cataracts, the pupil turns black due to excessive sclerosis of the lens nucleus.

Symptoms of congenital cataracts. With congenital cataracts, the child is still too young to say that he sees poorly, so their symptoms are indirect, identified by a doctor or parents. So, the symptoms of congenital cataracts in children are as follows:

The child does not look exactly at people's faces;

The child does not react to the appearance of people's faces, as well as large or colorful objects in his field of vision;

The child cannot find small objects, although they are in his field of vision;

In bright sunlight or artificial light, the child looks sideways, sideways or closes his eyes;

Strabismus;

Nystagmus (repeated wandering movements of the eyes);

In photographs of the child, he does not have a red eye.

As a rule, parents can independently notice the signs of congenital cataracts only if they are present in both eyes. If a cataract affects only one eye, then it is very difficult to notice, since the child will look with one eye, which until a certain age will be able to compensate for the absence of the second. Therefore, infants should undergo regular preventive examinations with an ophthalmologist, who will be able to notice signs of cataracts by simply carefully examining the baby’s pupils.

Lens with cataract

With cataracts, gradual destruction of the lens occurs, manifested by the formation of opacities in it and occurring in several stages. At the first, initial stage the lens becomes hydrated, that is, an excess amount of liquid appears in it. This liquid exfoliates the fibers of the lens, forming gaps filled with water between them. These gaps are the primary foci of opacities.

Further, at the second, immature stage Due to the delamination of the fibers, a sufficient amount of nutrients does not penetrate into them, as a result of which the proteins of the structural components of the lens disintegrate. The disintegrated proteins cannot be removed anywhere, since the lens is covered with a capsule, as a result of which they are deposited in previously formed cracks between the fibers. Such deposits of disintegrated proteins are lens opacities. At this stage, the lens increases in size and can provoke an attack of glaucoma due to a violation of the outflow of intraocular fluid.

In the third stage of mature cataract All the proteins of the lens gradually disintegrate, and it turns out to be completely occupied by turbid masses.

At the fourth stage of overripe cataract The cortex of the lens disintegrates, as a result of which its dense core separates from the capsule and falls to the posterior wall. The entire lens shrinks. The process of disintegration of the cortex is accompanied by inflammation, which can result in rupture of the lens shell and the release of necrotic masses into the chambers of the eye. And since the masses of disintegrating cortical substance are toxic, complications in the form of iridocyclitis, glaucoma, etc. may develop. It is recommended to urgently remove the lens at the fourth stage of cataract in order to avoid possible complications and at least save the eye, even if it is completely blind.

Vision with cataracts

Vision with cataracts is very specific and characteristic. Firstly, a person sees surrounding objects as if in a fog; it seems to him that there is haze, fogged glass or a layer of water in front of his eyes, preventing him from clearly seeing all the details. All outlines of objects are blurry, with unclear contours and without small details. Due to such blurriness, a person does not distinguish small details of objects (letters, faces, etc.), as a result of which it is difficult for him to read, write, sew and perform other activities related to the need to see small objects.

A person sees objects located far away (3 meters or further from the eye) poorly, and objects that are close cannot be seen due to blurred images. Blurred vision cannot be corrected by glasses or contacts.

In addition, when looking at light sources, a person sees a halo around them, so it is difficult for him to drive a car in the dark or walk along a street illuminated by lanterns, since the glare from the llamas leads him astray. In addition to the specific vision of light sources, with cataracts photophobia appears, when to a person any normal lighting (sun or artificial) seems too bright and irritating to the eyes. Because of photophobia, paradoxically, a person sees better on cloudy days or at dusk, rather than in sunny, clear weather.

With cataracts, it is very difficult for a person to distinguish colors because they become pale, especially blue, indigo and violet. In addition, all colors acquire a certain yellowish tint. The colored world becomes as if pale and fuzzy.

Also, with cataracts, a person is bothered by double vision, constantly flashing lights and flashes of light before the eyes in the dark.

If a person was farsighted before the onset of cataracts, they may find that they are suddenly able to see well up close and even read without glasses. This short-term improvement in vision is due to the fact that cataracts change visual acuity towards myopia. But as the disease progresses, myopia will increase, and the acquired ability to read without glasses will disappear.

Cataract - what is it? Symptoms and signs. Operation to install an artificial lens - video

Complications

Cataracts left untreated can lead to the following complications.

Cataracts are treated without surgery only at the initial stage of the disease. There are various means that stop the clouding of the lens and improve metabolism in the tissues of the eye. However, your doctor should choose them for you. Are baths with iodine and calcium, cysteine ​​suitable for you, will you have to prescribe vitamin drops - "Catalin", "Katachrome", "Quinax", "Taufon" or is it better to take Mirtilene Forte or Adruzen Zinco capsules orally - all these are questions that can Only a specialist can decide. He must also monitor whether the use of these drugs helps, whether the clouding of the lens stops, or whether the patient still cannot do without surgery. Typically, the lens of the eye loses its transparency within 2-5 years. When vision deteriorates so much that the eye can no longer distinguish anything around, but only distinguishes light from darkness, the cataract is considered to be “ripe.” That is, changes in the lens are already irreversible. For mature cataracts, there is only one way out - surgery.

Doctors examine in detail the condition of the fundus, lens and cornea to determine the severity of the disease. This allows us to predict visual acuity after lens removal. But the most important thing is that ultrasound is used to determine the size of the lens with high accuracy. Based on the shape and size of the “damaged” lens, doctors select a lens made of a special polymer material. It will take on the role of the lens after surgery and should fit the eye as closely as possible. It happens that the use of such lenses is contraindicated due to the patient’s health condition. For example, he suffers from a chronic eye disease. Or it turns out that his artificial lens is rejected. Then they select glasses that can to some extent compensate for the lack of a lens. In most cases, even patients with cataracts, aggravated by glaucoma, or those suffering from diabetes tolerate implantation of an artificial lens well. This operation is performed under a microscope to minimize trauma to the affected eye. However, sometimes complications do occur, such as corneal edema.

Therefore, recently, ultrasound, rather than surgical treatment, is increasingly used to remove cataracts. This method allows you to practically avoid eye injury. Through a miniature incision, ultrasound quickly and painlessly destroys the inside of the lens, which is then sucked out with a very thin needle. And one more important advantage of this method: it allows you to remove not the entire lens from the eye, but only its cloudy contents. This operation is easily tolerated. No one is surprised that after just a few days, patients begin to work. In young people, cataracts often begin to develop during pregnancy. The “blame” here is heredity or eye diseases suffered by the expectant mother. Sometimes this also affects the condition of the baby’s eyes. But even if this happens, there is no need to despair. Treatment is easier for young people. The fact is that at a young age the lens does not have a dense core.

This allows the cloudy contents of the lens to be removed through a very small hole in the lens capsule. The contents exit into the anterior chamber of the eye and gradually dissolve. Sometimes a tiny puncture is made in the capsule using a laser, which acts as drainage. Such operations are less traumatic and usually occur without complications. If the cataract progressed rapidly or was overripe, then glaucoma may develop in parallel. Therefore, it is necessary to monitor the condition of the eyes in order to reduce intraocular pressure in time, if necessary. Otherwise, the nutrition of the optic nerve will deteriorate, and this may result in blindness. To prevent this from happening, you need to take vitamins A, C, B vitamins, as well as medications that improve blood supply to eye tissue. Laser treatment helps with the rapid development of glaucoma. Sometimes an artificial lens implanted in the eye is rejected.

Inflammation of the membranes of the eye begins. If you do not pay attention to this and do not take anti-inflammatory drugs, it will become persistent. And to prevent infection, for example, conjunctivitis, the doctor will prescribe special antibiotics for the eyes, which must be taken strictly according to his recommendation. In addition, complications sometimes arise when the posterior wall of the lens capsule remains unharmed during cataract surgery. In some patients it may become cloudy over time. Secondary cataract develops. In such cases, intervention will be needed again, this time with a laser. A small “window” is made with a laser in the cloudy wall, which allows light to freely reach the fundus of the eye.

Cataract. 70 years ago.

D.A. Sivtsev, “Textbook of eye diseases”, Biomedgiz, Moscow-Leningrad, 1937

YES. Sivtsev - Soviet ophthalmologist. 1875-1940. His name is widely known from the Sivtsev-Golovin vision testing tables. This book is a manual for secondary medical school, but it is very interesting to read from a historical perspective.

I would like to give a chapter about the lens, cataracts and its surgical treatment.

So, let's go.

Lens.

Anatomy.

The lens is located immediately behind the iris in the recess of the vitreous body. It is a colorless, transparent, avascular biconvex body (biconvex lentil, convex), both convex surfaces of which merge into one another at a rounded edge. The lens is covered with a structureless bag. The lens itself consists of a soft, water-rich cortex and a dense core lying in the center. From the edge of the lens to the ciliary processes there is a special ligament (ligament of Zinn), consisting of the finest fibers; With the help of this ligament, the lens is connected to the ciliary (accommodative) muscle.

When removed from the eye, the lens immediately takes on a more convex shape. When the eye is at rest, it has a flatter shape due to the fact that its ligament is stretched. When the ciliary muscle contracts, the ligament relaxes and the lens becomes more spherical.

The growth of the lens, like nails and hair, continues throughout life and occurs from the surface: young fibers envelop it and press on older, deeper fibers. The core of the lens thus consists of the oldest, dried fibers, which have turned into a solid mass. The nucleus becomes noticeable already in young men, with age it gradually increases and in old age it already occupies most of the lens. As the nucleus grows, the lens becomes more and more dense and therefore loses the ability to take on a more convex shape when the ciliary muscle contracts.

Diseases of the lens.

A cataract is a clouding of the lens, no matter what causes it.

Patients complain of loss of vision. The degree of visual impairment depends, firstly, on the position of the clouding: if the clouded part of the lens is located at the equator (on the edge) of the lens, i.e. in a place covered by the iris, it little or does not interfere with vision; if it is in the area of ​​the pupil, it greatly upsets vision; secondly, it depends on the density of the turbidity. When the lens is completely clouded, vision drops to light perception.

Saturated and extensive opacities of the lens are easily recognized in normal light: the pupil appears gray, gray-white, pearlescent. For a more accurate and subtle study, you need to use side lighting and transmitted light.

The forms of cataracts are extremely diverse. Cataracts can be divided into congenital and acquired, complete and incomplete, stationary and progressive.

Reasons: 1) heredity; 2) age (senile cataract), 3) general diseases: seizures, diabetes; 4) injuries; 5) eye diseases (complicated cataracts) - extensive corneal ulcers, iridocyclitis, high myopia, glaucoma. Senile cataract (cataracta senilis) refers to acquired progressive cataracts; appears after 50 years of life and rarely earlier. There are four stages of its development: 1) beginning cataract - there are separate opacities in the lens, between which there are still transparent parts; 2) swelling cataract - over the course of years, rarely months, opacities gradually spread to the entire lens; the lens becomes richer in water and swells; this makes the anterior chamber smaller; after the clouding has spread to the entire lens, it begins to give off water; 3) mature cataract - the entire lens is cloudy, grayish-white with a yellow tint; it assumed its normal volume, and the depth of the anterior chamber therefore became normal; 4) overripe cataract - decay - liquefaction and wrinkling of the clouded lens, its color is uniformly milky; his bag is thickened and cloudy; Often the bag ruptures, and then the cataract can dislocate.

The maturity of the cataract is important for its operation (cataract extraction). When extracting immature cataracts, the still unclouded parts are not removed from the eye, because they are transparent and cannot be seen during the operation; over time they begin to become cloudy; Thus, successive or secondary cataracts are obtained. When extracting overripe cataracts, complications easily occur: dislocation of the lens into the vitreous body and prolapse of the vitreous body. Therefore, cataract extraction is done in the stage of mature cataract. However, now they also perform extraction of immature cataracts in a special way.

Treatment. No drug therapy is effective against cataracts. With atropine, it is possible to achieve that with partial central cataracts, vision will improve by dilating the pupil. This is what “folk” remedies against cataracts are based on. But as cataracts progress, atropine no longer improves vision. Cure is achieved only by surgery. There are two cataract surgeries.

Cataract discision (discisio cataractae) aims to open the lens bag and cause swelling and then gradual resorption of the lens. In the lower outer segment, the cornea is pierced with a discision needle; the needle advances to the pupil, sticks into the lens and with several lever-like movements the bursa and surface layers of the lens are dissected; the needle is quickly removed.

Instrumentation: 1) eyelid dilator, 2) fixation tweezers, discision needle. After the operation, a bandage is applied to one eye. No special care required.

Discision, in essence, is similar to traumatic damage to the lens bag, only the injury is not caused accidentally and not to a transparent lens, but to a clouded lens. After the operation, aqueous chamber moisture penetrates through the wound into the substance of the lens, and the lens begins to swell; the swollen masses fall into the chamber in the form of gray lumps and shreds, then they gradually dissolve. Sometimes swelling occurs very rapidly, disproportionate to resorption; then a complication may occur in the form of iritis or glaucoma. The best way is to remove rapidly swelling masses by extracting them. Sometimes, on the contrary, swelling occurs very slowly or stops completely. In this case, you need to repeat the discipline.

Discision is a very simple operation, suitable for soft cataracts, i.e. those who do not yet have a large and hard core, that is, children and young men; the soft lens after dissection is capable of complete resorption; Discision is further suitable for secondary cataracts.

Cataract extraction (extractio cataractae) aims to completely and immediately remove the lens. It consists of 4 acts: 1) an incision of the cornea along its edge (along the limbus) or slightly away from it; the incision is made of such a size that the hard core of the lens can pass through it; 2) iridectomy to make it easier for the lens nucleus to come out; iridectomy, however, is optional: 3) opening of the lens bag; 4) removing the lens using light pressure on the edge of the cornea opposite the incision.

Instrumentation: 1) eyelid dilator, 2) fixation tweezers, 3) linear knife for cutting the cornea (Graefe knife), 4) everything for iridectomy, i.e. iris tweezers, scissors; 5) capsulotome or capsular tweezers for opening the lens bag, 6) spatula, 7) tweezers for removing blood clots, 8) Weber loop.

After the operation, toileting of the eyes follows. The remaining lens particles and blood in the chamber are removed through the corneal wound with a spatula or by friction through the lower eyelid; the iris, if it is pinched in the wound, is moved back into place with a spatula.

As a complication, vitreous prolapse sometimes occurs during surgery. It occurs when the lens ligament bursts. This can happen if the ligament is atrophic, as, for example, with overripe senile cataracts. In case of vitreous prolapse, the lens can no longer be removed in the usual way, because pressure on the eye will cause even more prolapse, and the lens will not come out. In such cases, a Weber loop is used, which is inserted into the wound behind the lens, so to speak, scoops it up and removes it.

Immediately after the operation, a bandage is applied to both eyes. Rest (immobile) position of the patient on his back until the next day. The corneal wound usually sticks together (closes) after just one day. On the 2-3rd day, bandage one eye. The patient is allowed to turn to the healthy side; the next day, the 3rd day, the patient can sit in bed; on the 4-5th day the patient sits with his legs down from the bed and begins to walk; on the 5-6th day, the bandage can be replaced with smoky canned food or a gauze curtain. Atropine is administered daily until the redness disappears and a dense scar of the corneal wound forms, i.e. within 2 weeks.

Results of cataract surgery. After removal of the lens, the eye becomes aphakic (lensless). It looks like this: the surgical scar is almost invisible; the chamber is deeper than normal; the iris trembles; the pupil is black; if an iridectomy was performed, then it has the appearance of a keyhole.

The result of the operation sometimes deteriorates due to the retention of cataract remnants in the eye, especially if the operation is not fully mature cataract. If the hole in the lens bag was small and closed, then these remnants no longer resolve and remain in the form of a white membrane - consistent, or secondary, cataract; depending on its density and density, vision decreases, and then secondary cataract requires additional surgery - discission or extraction.

Due to the absence of a lens, the refractive power of the eye decreases, resulting in a high degree of farsightedness, on average 10-12 diopters. Farsightedness can be corrected with appropriate glasses. The aphakic eye is unable to accommodate. Therefore, after cataract surgery, the patient needs two pairs of glasses: glasses for distance and glasses for classes, the latter being three diopters stronger than the former.

Thinking out loud.

The classification is interesting (in other respects also correct). Immature, incompletely mature and almost mature cataracts are hidden under the heading “intumescent cataract”.

But in general.

Everything was somewhat simpler (though more dangerous). No operating microscopes (hence, apparently, the frequent secondary cataracts, which, I believe, were not all associated with the “abandonment” of cortical masses. Microscopes in ophthalmology appeared at the turn of the 70s - 80s of the last century). No slit lamp (diagnosis based on examination in lateral illumination and transmitted light). No antibiotics (although penicillin was discovered by Flemming in 1928, mass production was a long way off, it began only in 1942). Hence, the postoperative period proceeded without any antibacterial support. But what a cruel thing - lying on a bed for four days.

What else did you find interesting? A clear phrase that " No drug therapy is effective against cataracts." At all times :) But who knows, most likely this will change someday.

It is also probably worth noting that there is a not entirely correct idea of ​​high myopia as a cause of the development of cataracts. According to modern data (*), true myopia is not a cause of cataracts. Here cause and effect are rather confused. Phakosclerosis as a cause of increased development or increased degree of myopia. But in the absence of ultrasound, how can you determine whether high myopia is phacogenic?

It’s scary to even read about cataract dissection:) It’s too close in essence to “reducing the lens into the vitreous.” Of course, no fear for the endothelium (I can imagine the swelling of their corneas.). Probably in 70 years, today's phacoemulsification will look like an equally barbaric manipulation. Well, the only thing that made me a little wary about cataract extraction was the presence of iridectomy. And I was pleased with the use of self-sealing corneal incisions.

I plan to publish another part of the book - about glaucoma and its conservative and surgical treatment at that time.

I hope you enjoyed reading this mothball-smelling material :)

Cataract, causes of its occurrence, stages and methods of treatment

Normal vision

Vision with cataracts

Cataract is an eye disease, the main symptom of which is clouding of the main substance or capsule of the lens (decreased transparency), accompanied by a decrease in visual acuity. The lens is one of the most important components of the optical system of the eye, the main function of which is to conduct light and focus the image of objects on the retina. Cataract is one of the most common eye diseases.

Cataracts are divided into congenital and acquired

Congenital cataract- may be a consequence of intrauterine development disorders, for example, infection in the mother (rubella, etc.), as well as a genetic predisposition.

Acquired cataract- most often the natural process of aging of the body, but it can also arise as a result of metabolic disorders of the body, it can be caused by toxic, radiation or radiation effects on the lens of the eye, trauma or as a result of diseases of the internal membranes of the eye. Cataracts often occur in people after 40-50 years of age, and they are called age-related. Age-related cataracts vary in stages - initial, immature, mature and overmature. The initial stage of cataract is characterized by a slight decrease in vision and the presence of streak-like opacities in the lens (detected by examination with an ophthalmoscope), extending from its periphery to the center.

Stages of cataract development and symptoms:

The initial stage of cataract is characterized by clouding of the lens of the eye along the periphery - outside the optical zone and is accompanied by a slight decrease in vision.

Immature cataract is the spread of lens opacities into the central optical zone. Cloudiness of the lens at this stage of cataract leads to a noticeable decrease in vision. The patient may see spots and streaks before the eyes, things and objects look blurry

Mature cataract - the entire lens of the eye is affected by opacities, which is characterized by a decrease in visual acuity to the level of light perception.

Overripe cataract - further development of the disease is accompanied by the disintegration of the fibers of the lens, the substance of the lens affected by the cataract liquefies, it becomes milky white.

Rate of cataract maturation

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. which develop over 10–15 years.

In 70% of patients, cataract progression occurs within 6–10 years. Mandatory surgical intervention is required.

Conservative treatment of cataracts

Conservative treatment is carried out in the initial stages of age-related cataracts and is based on the use of various medications, mainly in the form of eye drops such as: Quinax, Catachrom, Vitaiodurol, Vitafacol, Vicein and a number of others.

It should be noted that the use of conservative treatment does not lead to the resorption of already formed opacities, and at best only slightly (perhaps) slows down their development.

Conservative treatment is a way to postpone surgery, but not to restore vision.

Surgical treatment of cataracts - phacoemulsification

The only effective treatment for cataracts is surgery to replace the lens with an artificial intraocular lens.

Seeing the world in all its colors is a huge gift. Unfortunately, when faced with serious ophthalmological pathologies, some people lose this ability. There are many reasons for the development of eye diseases: infections, heredity, unhealthy lifestyle, injury, etc. The reason for the development of overripe cataracts, leading to blindness, is mainly one - untimely contact with a specialist. Treatment of overripe cataracts is not carried out with the help of medications, so a person with this diagnosis should be prepared for surgical intervention.

Symptoms of cataracts in older people

Deterioration of vision in old age is a common phenomenon, so not everyone can pay attention to alarming symptoms in time. The course of cataracts is gradual, and without timely treatment it leads to blindness, which is where the insidiousness of the pathology manifests itself.

Depending on the degree of maturity, the disease can be of the following types:

Glaucoma is a disease that cannot be cured, so if any unpleasant symptoms occur, you should not postpone a visit to an ophthalmologist.

A number of main symptoms that should not be ignored:

• when one eye is closed, the second sees blurredly, and objects appear double;
• glasses do not help improve vision;
• there is increased photosensitivity, glare periodically appears in front of the eyes (mainly in the dark);
• color perception is distorted;
• myopia develops.

Elderly people with cataracts go to the doctor and complain that their glasses are no longer as effective as before and ask to replace them with new ones. Some people notice that they can see much better without glasses than with glasses and mistakenly assume that their vision has improved. Unfortunately, this is not the case, and this is more of a bad sign than a good one.

Causes of overripe cataracts

The most important thing that a person diagnosed with cataracts should understand is that delay threatens blindness. Cataracts can be treated, but therapy for the overripe form is more difficult and longer.

The main reasons for the development of this pathology:

• changes associated with the patient's age;
• the presence of concomitant pathologies (endocrine and gastrointestinal diseases);
• heredity;
• received various types of injuries;
• wrong lifestyle;
• uncontrolled use of certain medications.

The process of cataract maturation

The part of the eye responsible for vision is the lens. Thanks to it, a person can focus his gaze on individual objects (see clearly, read). Age-related changes usually cause the lens to become denser and cloudy. Also, in old age, it loses its elasticity and turns yellow.

With overripe cataracts, the fibers of the lens disintegrate and it changes color (becomes milky white). How quickly this process will develop depends on one of three options for the progression of the disease:

• rapid progression (from 4 to 6 years);
• standard course (observed in most patients and ranges from 6 to 10 years);
• slow course (from 10 to 15 years).

In any case, periodic visits to an ophthalmologist (not only in adulthood and old age) will help to identify the pathology in a timely manner and prevent it from developing into an overripe form. It is impossible to determine the disease yourself in the early stages, since the disease makes itself felt already in the later stages.

Treatment of age-related cataracts

It is very important to understand that the presence of this pathology in any form (even immature) is a signal that one should be prepared for surgical intervention. The sooner the operation is performed, the easier and more successful it will be. Also, do not forget about possible complications. When treating overripe cataracts, there are many times more of them, and the parallel development of glaucoma threatens complete and irreversible loss of vision. The selection of treatment tactics is carried out by an ophthalmologist individually.

Medication

Medication is used only to slow the progression of the disease. First of all, drops have proven their effectiveness. But, despite their positive effect on the organ, the use of such funds should be long-term and systematic.

The patient should also take into account the following features of cataract therapy with drugs:

• it is important to monitor the expiration dates of purchased medications;
• You must always remember the rules of personal hygiene when performing procedures (instillation);
• It should be remembered that an interval (at least 15 minutes) must be maintained between the use of various drugs (drops).

At different stages (in different forms) different drugs are used. To prevent the disease and after surgery, the following groups of medications are prescribed:

Also useful for cataracts (after surgery) will be preparations containing vitamins and microelements important for the body and eyes. Overmature cataracts cannot be treated with medication.

Surgical

The opinion that cataracts can be treated surgically only after they have “ripened” is no longer relevant. The capabilities of modern medicine today make it possible to perform surgery at any stage without fear of serious complications and consequences.

For overripe cataracts, surgery is mandatory, but there are a number of contraindications for which surgery is not performed:

• the presence of infectious pathology in an acute form or during an exacerbation period;
• oncology or inflammation in the area of ​​the organ (eye);
• presence of mental disorders (inappropriate behavior);
• recently suffered serious illnesses (severe weakness of the body).

The main methods of surgical intervention for overmature cataracts are ultrasound or laser phacoemulsification, as well as intracapsular or extracapsular extraction.

The advantages of ultrasound phacoemulsification of cataracts (a popular method) are:

• absence of pain during the operation;
• short duration;
• the use of local anesthesia rather than stronger methods of pain relief;
• absence of “traces” from the operation;
• low risk of postoperative complications;
• the ability to undergo therapy on an outpatient basis.

Extracapsular cataract extraction is used less frequently, as it has a greater number of postoperative complications. Intracapsular cataract extraction is performed only when the above methods are not possible.

The advantages of these two methods are the low cost of the procedure and the possibility of treatment in the presence of other ophthalmological pathologies. Disadvantages - long-term rehabilitation, possible complications in the form of inflammatory processes, astigmatism and myopia. The older the patient is, the higher the risk of developing the above complications.

Features of the operation for elderly patients

Patients with overmature cataracts often undergo extracapsular extraction. The essence of the operation is the complete removal of the affected organ (lens) and implantation of a rigid lens (sewn to the iris or attached to the lens capsule). There is a risk of wound dehiscence during the rehabilitation period.

Despite the fact that the likelihood of unpleasant complications occurring is high, it is still necessary to convince an elderly person to undergo surgery. This can be done using the following arguments:

• Cataracts sooner or later lead to blindness, and blindness leads to a feeling of helplessness;
• there are no miraculous potions, and traditional medicine will never be able to cope with the disease, so it is important to understand that it is impossible to cure cataracts without surgery;
• you should not hesitate and doubt, since delay will not improve the situation in any way (the doctor needs to examine the patient, select treatment tactics, and this takes time);
• the operation in this case is quick and painless;
• improved lenses will allow you to see even without glasses, and in old age this is a special plus (of course, if there are no other ophthalmological pathologies).

Elderly people are often afraid to undergo surgery for various reasons, but in this case all possible risks are justified. You just have to trust your loved ones and your doctor.

Possible complications

The most dangerous complication in advanced stages of the disease is the development of glaucoma. If restoration of vision with overripe cataracts is possible, although partially, then with glaucoma vision is lost irrevocably. Anyone who has been diagnosed with cataract should remember this.

Very often people do not appreciate what they have. The opportunity to see your loved ones and the beauty of the world around you is an incomparable pleasure. Therefore, in order not to feel the truth of “folk” wisdom and not cry over what was lost (including irretrievably), you should contact specialists in a timely manner, lead a correct lifestyle and take care of your health in general.

Age-related cataracts appear in more than half of people over the age of 60. This is due to a decrease in nutrients, proteins and amino acids in the body and its depletion. This leads to clouding of the lens and deterioration of vision, in some cases even to complete blindness. Early stages, such as incipient and immature cataracts, can be managed without surgery. Let's look at how this disease develops in older people.

Cataracts develop quite slowly in older people. First, clouding of the transparent body begins, and then vision gradually deteriorates.

Cataracts can develop from the capsule or nucleus of the lens. Depending on this, cortical, subcapsular and nuclear forms are distinguished.

1. Unlike the subcapsular form, the nuclear form develops much faster. It matures not from the cortex, but from the nucleus of the lens, due to which vision rapidly declines.
2. Cortical differs in that initially changes occur in the substance of the lens itself. In this case, the image is blurred. There are initial, immature, mature and overripe stages of disease development.
3. The subcapsular type is dangerous due to its complications and difficulty in diagnosis. With this type, the anterior capsule becomes cloudy, and the disease spreads to the center of the lens. The cortex remains unaffected.

Most often, the age-related form of cataract is bilateral, but deterioration of vision and clouding of the lens can be observed not simultaneously, but alternately.

It is very important to identify the disease in time and take measures to preserve vision. After all, the more severe the stage and degree of damage to the lens, the greater the likelihood of complications.

Stages of the disease

Senile cataracts are divided into several types depending on the stage of its development. Let's look at each stage separately.

• The initial stage is characterized by the appearance of foci of clouding of the lens, while its central part remains transparent. The person does not experience any deterioration in vision. Very often, the initial cataract results in only a slight blurriness of the image. At this stage, the lens becomes hydrated, causing it to increase in volume. Some patients who suffered from myopia before cataracts may experience improved vision, but this is all temporary. Patients at the initial stage constantly want to rub their eyes, spots appear before the eyes, double vision, as well as a painful perception of bright light.
• Immature cataracts are characterized by significant visual impairment. Areas of cloudiness merge into one large spot and cover the pupil. Sometimes intraocular pressure increases. But still, at the swelling stage, the front surface remains transparent.

• Mature cataracts are characterized by severe complications. The lens becomes completely cloudy and loses water. Vision drops to minimal values, a person sees practically nothing, only bright light.
• But the most severe is overripe cataract. At this stage, complete degeneration of the lens is noted; it liquefies and becomes cloudy white. The core goes down. Overmature cataracts are dangerous because the decay products of the lens can enter the eye cavity, leading to infection, inflammation and decay. Glaucoma develops very often.

How quickly does one stage progress to the next?

Disease progression

Senile cataracts have their own developmental characteristics and a certain period from appearance to maturation.

If it takes an average of 6 years from primary to extensive lens opacification, then such senile cataracts are considered rapidly progressive and require immediate surgical intervention. They are observed in 12% of all patients.

Basically, about 10 years pass from the moment the disease is detected to surgical intervention. The timing depends on the speed of transition of cataracts from one to another stage.

Important! The rate of development of senile (age-related) cataracts depends on the individual characteristics of the patient.

Incipient cataracts do not always progress to the next stage. Most older people over 75 years of age are diagnosed with senile cataracts at an early stage. Immature cataracts are observed in only 30% of such cases.

But it is worth noting that if the disease has moved to an immature stage, then it very quickly becomes mature. This period can last from one to three years.

Patients with a mature form of the disease should soon expect an overripe stage. This can happen within a year. You should not delay treatment, especially with mature cataracts, because at the next stage it is almost impossible to restore vision.