Laser dissection of secondary cataracts. Secondary cataract. Treatment and prices Laser discission of secondary cataracts postoperative period
Cataracts of the eye are not a death sentence; they can be successfully treated with a simple operation to replace the lens. Surgical treatment of cataracts is a great success in ophthalmology, which has enabled patients to see the world around them again.
But, unfortunately, no one is immune from complications that may arise after it. One of the most serious consequences of pseudophakia (replacing the lens with an artificial lens) is secondary cataract, but with the development of modern medicine, this is not at all fatal.
Treatment of secondary cataracts after lens replacement
After lens replacement surgery, some patients are at risk of developing a late complication called secondary cataract. The disease is characterized by the same symptoms as the primary form, that is, a person’s vision slowly but surely deteriorates, objects lose clarity, their outline becomes double and blurry. The “water haze” before the eyes returns to the patient again. This happens due to clouding, now, not of the lens itself, since an artificial lens is in its place, but of its posterior capsule.
There are several ways treatment of secondary cataracts, developing after lens replacement. Until recently, elimination of postoperative relapse could only be accomplished through surgical intervention. But this method gradually became obsolete due to a number of negative consequences that could arise during the operation:
Due to these reasons, ophthalmologists refused to perform surgical interventions. With the advent of the ophthalmic laser, treatment has reached a new, progressive level.
Traditional medicine also offers several recipes. Of course, it is unlikely that they will help get rid of the disease, but it is possible to slow down the development process:
Before treatment with folk remedies, make sure that you are not allergic to any of the ingredients, and be sure to consult your doctor.
At the initial stage of secondary cataract, successful therapeutic treatment is possible with the help of hormonal and herbal preparations.
Laser dissection of recurrent cataracts has been successfully used for the last 30 years. The method was developed by an ophthalmologist - a woman who has been involved in physics for a long time. The procedure has proven to be a safe and effective way to get rid of recurrent eye disease. It does not require general anesthesia.
Intraocular incisions made with a laser are hundreds of times less traumatic than incisions made with surgical instruments. And the risk of damage to the cornea or intraocular lens is minimized. Distinctive features of the laser discision method are outpatient treatment, rapid rehabilitation and low trauma. Indications for the procedure are as follows:
- Serious impairment of visibility, especially in the dark and in bright light;
- Significant opacification of the posterior capsule, which interferes with normal life.
The operation is contraindicated for swelling of the iris and inflammation of the eye.
The treatment procedure is extremely simple:
- A drug is applied to the cornea to prevent increased eye pressure.
- Patients are instilled with a drug that dilates the pupils, after which most of them note a slight improvement in vision.
- In the back of the lens, using laser pulses, a hole is made, through which the clouded part is removed. The local action of laser beams allows you to leave healthy capsule tissue unharmed.
- Immediately after the procedure, it is necessary to use anti-inflammatory drops and stabilize the metabolism in the lens.
The operation is performed using local anesthetic, without bandages, stitches and hospitalization of the patient. Two hours after the procedure, the patient is sent for outpatient observation. Most people who have undergone laser surgery notice an improvement in their vision immediately after the operation.
Unfortunately, during laser treatment, there is a small percentage of complications:
A number of other complications of laser discision, such as retinal detachment and increased intraocular pressure, have minimal chances of developing.
Causes of secondary cataracts
Until now, doctors cannot name the exact cause of secondary cataract. But the main factor in the development of relapse is the epithelial cells of the removed lens remaining after the primary operation on the posterior wall of the capsule. Subsequently, they begin to multiply, which leads to repeated clouding and deterioration of vision.
In addition to this reason, there are several more, to a greater or lesser extent, that contribute to the recurrence of cataract development:
The use of antibacterial drops is a good prevention of secondary cataracts.
What you need to know about secondary cataracts?
The disease begins after surgical treatment of the lens. The first symptoms are blurred vision. The development is caused by epithelial cells of the primary cataract that remain on the posterior membrane of the lens after surgery.
It is treated with laser method without anesthesia and incisions. The procedure takes a few minutes. It consists of removing remaining cells and preventing their proliferation. The intervention does not require a rehabilitation period.
If your vision has deteriorated after surgery, a comprehensive eye examination is recommended.
Laser dissection of secondary cataracts is an effective and low-traumatic treatment method. Recurrent cataract occurs as a complication after surgical removal of a clouded lens. This pathology requires immediate treatment as it can lead to complete loss of vision. Laser dissection is recognized as the most optimal method for removing the posterior capsule of the lens, so today we would like to take a closer look at the features of this procedure.
Indications and contraindications
During such a medical procedure, a special ophthalmic apparatus is used. It affects the lens capsule and the anterior part of the eye. During this operation, the patient does not feel pain and doctors do not use general anesthesia, which has a negative impact on health. However, not all people are subject to discipline.
Indications based on which an ophthalmologist recommends laser surgery include:
- cataract resulting from severe trauma;
- open-angle or closed-angle glaucoma;
- repeated cataracts that occurred after removal of the lens;
- cyst on the iris;
- any type of pupillary membranes;
- secondary glaucoma, which is accompanied by pupil displacement;
- ribbon-like strands in the vitreous body of the eye.
It should also be noted that there are a number of contraindications, which can be absolute or relative. In the first case, doctors categorically refuse to perform laser discision, and in the second, it is used subject to a number of conditions. To begin with, we list the absolute contraindications, in which the operation will only worsen the patient’s situation:
- Uncompensated glaucoma. In the presence of such a concomitant disease, an increase in intraocular pressure and a pathological change in the optic nerve occurs.
- Severe neovascularization of the pupillary membrane (congenital disease).
- Cloudiness detected on the cornea of the eye, even if it is at an early stage.
- Compaction of the pupillary membrane that exceeds 1 mm.
- An infectious or inflammatory disease in the front of the eye.
With relative contraindications, the risk of complications increases, but surgical intervention is still performed.
This includes contact of the posterior capsule of the eye with the installed lens and slight neovascularization of the membrane. Doctors do not recommend surgery when less than 6 months have passed since the removal of the cloudiness, but they perform it if absolutely necessary.
Features of the procedure
Secondary cataracts are accompanied by deterioration of visual acuity, a white veil before the eyes, and double appearance of objects. Laser dissection is the most popular treatment for recurrent cataracts because it can quickly improve visual acuity. Doctors have been developing this method since the 80s. Since then, this method has been constantly improved and improved, which allows for greater safety for patients.
During the operation, local anesthesia is used so that the person does not experience pain or discomfort. After the painkiller has begun to act, the patient is instilled with a medication that dilates the pupils. Typically, this is venylephrine, tropicamide or cyclopentolate. Thanks to these drops, the surgeon can examine the posterior capsule in detail. In addition, a medication is used that regulates intraocular pressure, since it may increase during surgery.
The entire procedure takes no more than an hour and does not require hospitalization. During surgery, soft clicks may be heard; they arise as a result of the operation of the laser. Sometimes doctors use a special contact lens that has magnifying properties to fix the eyelid.
First, the microsurgeon performs a dissection of the eye capsule. After this, the laser begins to act on the clouded area. The surgeon’s actions must be as precise as possible so that the device does not touch the intraocular lens. During surgical treatment, the cloudy part in the projection of the axis of the ocular apparatus is removed.
Laser dissection allows you to restore vision in 90% of cases. Doctors usually leave the patient in the hospital for several hours after surgery to monitor his health. If no pathological changes are detected during this time, then the person goes home. The patient may notice an improvement in visual acuity in the first days after removal of the opacities.
Experts prescribe steroid drops in the postoperative period to avoid negative consequences. You will need to come back for a follow-up appointment one week after surgery. The price of such an operation varies from $100 to $160.
Period after surgery
Despite the fact that high safety and accuracy are ensured, this procedure has its contraindications. Most often, doctors are faced with high intraocular pressure. It is measured 30 and 60 minutes after removal of the secondary cataract. If indicators are found to be within normal limits, the patient is prescribed antibiotics or anti-inflammatory drugs and sent home.
Intraocular pressure may increase in the first 3 hours after surgery; it stabilizes within 24 hours. If blood pressure is high, the ophthalmologist prescribes antihypertensive drops and asks the person to see him the next day.
In the first few days after laser discision, vision is completely restored. During this period, floating circles may appear before your eyes; do not be afraid of them, as they will pass in the near future.
If spots or outbreaks continue to occur for a month, you should seek help from a doctor.
In addition, you should consult a specialist if your visual acuity decreases.
Before deciding on laser discision, the patient needs to analyze the indications and all the risks of surgery. An ophthalmologist will help you make the right decision after a complete diagnosis of the eye system.
The lens capsule is elastic. During cataract surgery, an artificial lens is placed in the eye to replace the real one. In this case, the posterior capsule serves as a support for the new one. It happens that the capsule begins to become cloudy, which causes a phenomenon such as secondary cataracts after replacing the lens. Treatment, the reviews of which are the most positive, is carried out in accordance with medical indications. The latest methods and high-quality equipment are used.
Causes of the phenomenon
Where does secondary cataract appear after lens replacement? Reviews from doctors about this complication indicate that the exact reasons for its occurrence have not been disclosed.
The development of a secondary complication is explained by the proliferation of epithelium localized on the surface of the posterior capsule. There is a violation of its transparency, which causes a decrease in vision. This process cannot in any way be associated with a surgeon’s mistake during the operation. Secondary cataracts after lens replacement, the causes of which lie in the body’s reaction at the cellular level, are a fairly common phenomenon. Lens epithelial cells turn into fibers that are functionally defective, irregular in shape, and opaque. When they move to the central part of the optical zone, clouding occurs. Visual impairment may be caused by fibrosis of the capsule.
Risk factors
Ophthalmologists have identified a number of factors that explain why secondary cataracts appear after lens replacement. These include the following:
- Patient's age. In childhood, cataracts occur more often after surgery. This is due to the fact that tissues in a young body have a high level of regeneration capacity, which causes the migration of epithelial cells and their division in the posterior capsule.
- IOL shape. The square-shaped intraocular lens allows the patient to significantly reduce the risk of damage.
- IOL material. Doctors have found that after the introduction of acrylic-based IOLs, secondary lens opacification occurs less frequently. Silicone structures provoke the development of complications more often.
- The presence of diabetes mellitus, as well as some general or ophthalmological diseases.
Preventive measures
To prevent the appearance of secondary cataracts, doctors use special methods:
- The lens capsules are polished to ensure maximum cell removal.
- A selection of specially designed designs is made.
- Medicines are used against cataracts. They are instilled into the eyes strictly for their intended purpose.
Signs of secondary cataracts
In the early stages, secondary cataracts may not manifest themselves at all after lens replacement. The duration of the initial stage of disease development can range from 2 to 10 years. Then obvious symptoms begin to appear, and there is also a loss of objective vision. Depending on the area in which the lens deformation occurred, the clinical picture of the disease can vary significantly.
If a secondary complication manifests itself on the periphery of the lens, then it may not cause visual impairment. As a rule, pathology is detected during a routine examination by an ophthalmologist.
How does such a pathological process as secondary cataract manifest itself after lens replacement? Treatment (symptoms and appropriate examinations must confirm the diagnosis) is prescribed for a persistent drop in visual acuity, even if it was completely restored during surgery. Other manifestations include the presence of a veil, the appearance of glare from sunlight or artificial light sources.
In addition to the symptoms described above, monocular doubling of objects may occur. The closer to the center of the lens the cloudiness is located, the worse the patient's vision. Secondary cataracts can develop in one eye or in both eyes. Distortion of color perception appears and myopia develops. External signs are usually not observed.
Treatment
Secondary cataracts after lens replacement, which are successfully treated in modern ophthalmology clinics, are removed by capsulotomy. This manipulation helps free the central zone of the optics from clouding, allows light rays to enter the eye, and significantly improves the quality of vision.
Capsulotomy is performed both mechanically (instruments are used) and laser methods. The latter method has great advantages, since it does not require the insertion of a surgical instrument into the eye cavity.
Surgical intervention
How is secondary cataract of the lens eliminated? Treatment involves surgery. This surgical intervention involves dissection or excision of the clouded film using a surgical knife. Manipulation is indicated in cases where secondary cataracts after changing the lens have caused major complications, and there is a possibility that the patient will go blind.
During the operation, cross-shaped incisions are made. The first is done in the projection of the visual axis. As a rule, the hole has a diameter of 3 mm. It may have a higher value if examination of the fundus of the eye is needed or photocoagulation is required.
Disadvantages of surgery
The surgical method is used for both adult patients and children. However, a fairly simple operation has a number of significant disadvantages, which include:
- infection entering the eye;
- getting injured;
- corneal edema;
- the formation of a hernia as a consequence of a violation of the integrity of the membrane.
Features of laser treatment
What innovative methods are used to eliminate such a problem as secondary cataract of the lens? Treatment is carried out using laser beams. This method is highly reliable. It requires precise focusing and low energy consumption. As a rule, the energy of the laser beam is 1 mJ/pulse, but if necessary, the value can be increased.
Laser intervention is called discision. It has a high level of efficiency. With this treatment, a hole is made in the back wall of the capsule by burning. Through it, the clouded capsule is removed. For this method we use a YAG laser. In modern medicine, this method is preferred.
Reviews from patients indicate that such an intervention does not require a hospital stay, the operation is very quick and does not cause pain or discomfort. Manipulations are carried out using local anesthesia.
How is secondary cataract eliminated after lens replacement? Treatment of complications with laser involves the following steps:
- Pupil dilation with medications. Eye drops are applied to the cornea to dilate the pupils. For example, tropicamide 1.0%, phenylephrine 2.5%, or cyclopentolate 1-2% are used.
- To prevent a sharp increase in pressure inside the eye after surgery, apraclonidine 0.5% is used.
- Firing several laser shots using a special device mounted on a slit lamp causes a transparent window to appear in the cloudy capsule.
How does a person feel after laser removal of such a phenomenon as secondary cataract after lens replacement? Reviews from patients indicate that after the operation they went home within a few hours. No stitches or bandages are required for this intervention. Patients are prescribed hormonal eye drops. Their use in the period after surgery will be the last step on the path to vision restoration.
After a week, the person who has undergone surgery will have a routine examination by an ophthalmologist to make sure everything is going correctly.
Another examination is indicated a month later. It is not considered planned, but passing it is desirable. This way you can identify possible complications and eliminate them in a timely manner. It should be noted that the overwhelming number of complications occur within a week. Later they occur extremely rarely.
For the most part, secondary cataracts are eliminated with a single laser surgery. Secondary intervention is performed extremely rarely. The likelihood of complications from this type of treatment is very small and is about 2%.
In what cases is discretion prescribed?
Discision of secondary cataract is used if:
- a damaged posterior stack of the capsule causes a sharp decline in vision;
- poor vision interferes with the patient’s social adaptation;
- problems appear with seeing objects in excessive or poor lighting.
Strict contraindications
Is it always possible to eliminate such a complication as secondary cataract after lens replacement? There are undoubtedly contraindications. Moreover, they can be absolute, excluding the possibility of any manipulation. These include:
- the presence of swelling or scar tissue in the cornea, which prevents the ophthalmologist from clearly seeing the intraocular structures during surgery;
- the occurrence of an inflammatory process in the iris of the eye;
- presence of a retina;
- clouding of the cornea;
- the thickness of the pupil membrane exceeds 1.0 mm.
Relative contraindications
Relative contraindications include conditions in which the risk of secondary complications is increased:
- the period of surgical intervention to remove cataracts for pseudophakia is less than six months, and for aphakia less than 3 months;
- complete contact of the posterior capsule with the IOL;
- pronounced process of neovascularization of the pupil membrane;
- presence of uncompensated glaucoma;
- the presence of inflammatory processes in the anterior segment of the eye.
The operation is performed with great caution if the patient has previously experienced retinal detachment or rupture.
The laser treatment method has its drawbacks. Laser radiation can damage the optical part of the artificial lens.
Complications
What is the effect of the laser method in the treatment of such a disease as secondary cataract after lens replacement? The consequences may be undesirable.
- After replacing the lens with secondary cataracts, black spots may appear, which is caused by damage to the structure of the lens during surgery. This defect has no effect on vision. This type of damage is caused by poor focusing of the laser beam.
- Retinal cystoid edema is considered a dangerous complication. In order not to provoke its appearance, surgical intervention should be carried out only six months after the previous operation.
- eyes. This phenomenon is extremely rare and is caused by myopia.
- Increase in IOP level. Usually this is a quickly passing phenomenon and does not pose any threat to health. If it continues for a long time, this indicates that the patient has glaucoma.
- Subluxation or dislocation of the IOL is observed in rare cases. This process is usually caused by IOLs with a silicone or hydrogel base with disc-shaped haptics.
- The chronic form of endophthalmitis is also uncommon. It is caused by the release of isolated bacteria into the vitreous area.
- Fibrosis (subcapsular opacification) is rare. Sometimes this process develops within a month after the intervention. An early form of the complication can provoke contraction of the anterior capsule and the formation of capsulophimosis. Development is influenced by the model and material from which the IOL is made. Often this deviation is caused by silicone models with haptics in the form of disks and, less commonly, IOLs, which consist of three parts. The basis of their optics is acrylic, and the haptics are made from PMMA.
To prevent complications after surgery, doctors advise regularly using eye drops to prevent the development of cataracts.
Conclusion
From all of the above, we can conclude that after cataract surgery, a complication such as secondary cataract of the lens often occurs. Treatment of the disease using modern methods gives good results, but side reactions are also possible.
Cataract is a complex and quite dangerous disease that often leads a person to blindness. The pathology itself consists of clouding of the lens capsule, which allows ophthalmologists to cope with this disease through surgery. Modern medicine uses an artificial lens for these purposes, which replaces the damaged one. However, even surgery does not completely solve the problem, since secondary cataracts often develop after surgery, which requires repeat surgery. In this case, laser discission of secondary cataracts is often performed. Let's tell you more about this treatment method.
Symptoms of the disease
The main sign of recurrent disease is blurred vision. Visual acuity, as a rule, decreases gradually, and in most cases the patient begins to see a halo around the light source.
Causes of secondary cataracts
Doctors are inclined to believe that secondary cataracts develop because when the lens is removed, not all cells of the lens epithelium may be removed, which subsequently begin to multiply, which leads to a gradual deterioration of vision. According to statistics, the probability of secondary cataracts occurring after surgery varies between 42–90%. This may be due to age (in children and people with diabetes, the disease develops more often). In addition, the appearance of secondary cataracts depends on the type of surgery performed and the material of the lens.
Treatment of secondary cataracts
But a more progressive method of combating this disease is a procedure called laser dissection. The first such operation was carried out more than thirty years ago and since then has been extremely popular. The advantage of discision over other methods of vision correction is the minimum of side effects and possible complications.
This operation is prescribed in the following cases:
- significant decrease in vision due to clouding of the lens capsule;
- visual impairment, which reduces the patient’s quality of life;
- severe vision loss due to too much bright light or poor lighting.
Contraindications for laser discision should also be considered. These include conditions such as:
- inflammation of the iris;
- the presence of scar tissue or swelling on the cornea, which does not allow the doctor to see the intraocular structure;
- macular edema of the retina.
Features of surgery
This surgical intervention is performed with extreme caution in cases where the patient has a rupture or detachment of the retina.
Laser dissection of secondary cataracts is carried out only under local anesthesia, which means the patient does not feel discomfort. Before the procedure begins, medications are dropped into the eyes to dilate the pupils. These may be the following drugs: 2.5% Phenylephrine, 1.0% Tropicamide, and 2% Cyclopentolate. Pupil dilation is necessary in order to better see the posterior capsule. And in order to prevent a possible increase in intraocular pressure in the postoperative period, the patient is prescribed 0.5% Apraclonidine. The patient will be able to go home after the operation literally in 2 hours. Bandages and stitches are usually not applied after this operation. To avoid inflammation, patients are advised to take steroid eye drops.
Complications after surgery
In most cases, there are no complications after this operation, although sometimes the following conditions may occur:
- inflammation or swelling of the cornea;
- retinal detachment or tear;
- displacement of the intraocular lens;
- macular edema of the retina.
It is important not to forget to take Apraclonidine, which will not allow intraocular pressure to rise, and also use local steroids Lotoprednol or Prednisolone for a speedy recovery. Health to your eyes!
Secondary cataract is one of the most common conditions after successful eye lens replacement surgery. Millions of people with visual impairments and blindness are able to see the world around them clearly again after cataract removal, because the implantation of an artificial lens is without a doubt one of the most successful inventions of modern ophthalmic surgery. However, the consequences of this intervention still exist. And one of them is secondary cataract.
Despite its name, it is incorrect to call the changes described after lens replacement cataracts. Once removed, cataracts cannot occur in a person again. The first lens replacement was performed in 1950 by the English ophthalmologist Sir Harold Ridley. After this, the surgical technique was constantly improved, which made it possible to reduce the incidence of secondary cataracts after lens replacement. However, doctors still cannot completely get rid of this complication.
Secondary cataract after lens replacement - what is it?
During the intervention, the ophthalmic surgeon removes the clouded lens, replacing it with an artificial one. The anatomy of the eye is such that the human lens is located in a capsule - the capsular bag. During the operation, the surgeon excises the anterior wall of the capsular bag, removes the clouded lens itself, and implants an artificial lens inside the capsule. The posterior wall of the capsular bag - the posterior capsule - remains intact to ensure a stable position of the artificial lens in the operated eye in the first weeks and months after surgery. Changes in the remaining posterior capsule, its fibrosis and opacification some time after lens replacement are called “secondary cataracts.”
Secondary cataract after lens replacement is a fairly common complication of cataract surgery. The reasons for the development of secondary cataracts determine the development of two forms of this disease:
- Posterior capsule fibrosis - opacification of the capsule and the development of secondary cataracts after lens replacement is caused by fibrous metaplasia of the lens epithelial cells, which leads to compaction and, subsequently, opacification of the posterior capsule, and is accompanied by a significant decrease in visual acuity after lens replacement.
- Pearly dystrophy or, in fact, “secondary cataract” is the most common morphological variant. In this case, secondary cataracts after lens replacement are formed due to the slow growth of epithelial lens cells, which form lens fibers, as would occur normally. However, these lens fibers are anatomically and functionally defective and are called Adamyuk-Elschnig balls. When migrating from the germinal zone to the central optical part, Elschnig ball cells form a dense film-like opacification of the posterior capsule, significantly reducing postoperative vision. The changes described above lead to disruption of the passage of the light beam through the posterior capsule of the lens, which causes a significant decrease in visual acuity.
Secondary cataracts after lens replacement develop in 20%-35% of operated patients within 6-18 months after cataract surgery.
The likelihood of secondary cataracts is greater in young patients. This complication often occurs in children operated on for congenital cataracts. In this case, in elderly patients, as a rule, fibrosis of the posterior capsule of the lens occurs, while in young patients, secondary cataract itself is more often found.
The incidence of secondary cataracts after surgery also depends on the model of artificial lens and the material used in its manufacture. The use of silicone intraocular lenses with rounded optical edges is associated with an increased incidence of secondary cataracts than the use of acrylic artificial lenses with a square edge.
Symptoms of secondary cataracts
Cataract removal and intraocular lens implantation lead to a noticeable improvement in vision. However, some time after replacing the lens - from several months to several years - progressive deterioration of vision is recorded. Since the symptoms are similar to those of the primary disease, this condition is called “secondary cataract.” The main signs that appear after the onset of secondary cataracts are quite characteristic, and, as a rule, their development never occurs unnoticed:
- Progressive decrease in visual acuity and blurred images after marked postoperative improvement.
- An increasing feeling of “fog” or “haze” in the operated eye. In the vast majority of patients, secondary cataracts after lens replacement cause a feeling of a “plastic bag”.
- Black or white spots in the field of vision causing significant visual discomfort.
- Sometimes patients may experience permanent double vision or image distortion after developing secondary cataracts.
- It is not possible to correct the resulting clouding and decreased vision with glasses or contact lenses, as previously with primary cataracts.
The appearance of such symptoms after a previous lens replacement operation should suggest the presence of a secondary cataract. All patients in this situation are advised not to delay contacting a doctor, as the symptoms will only progress, gradually increasing visual discomfort and significantly reducing visual acuity.
Diagnostic algorithm
Before offering a patient discision of a secondary cataract, the doctor conducts an extensive ophthalmological examination, studies the medical history for concomitant diseases and conducts a comprehensive ophthalmological examination and examination:
- Assessment of visual acuity.
- Biomicroscopy of the eye using a slit lamp - to determine the extent and type of opacification of the posterior capsule, as well as to exclude swelling and inflammation in the anterior part of the eyeball.
- Measuring intraocular pressure.
- Examination of the fundus to detect retinal detachment or problems in the macular area, which may reduce the beneficial effect of secondary cataract dissection.
- If macular edema is suspected, which occurs in 30% of patients undergoing cataract surgery, fluorescein angiography or optical coherence tomography may be performed.
Such a diagnostic algorithm is performed to reliably diagnose the disease, as well as to identify a number of conditions in which treatment of secondary cataracts is impossible. We are talking about active inflammatory processes and macular edema.
Discision of a secondary cataract or capsulotomy is the excision of the altered posterior capsule of the lens and is the main method of treating secondary cataracts of the eye.
Since the first implantation of an artificial lens during extracapsular cataract extraction, ophthalmic surgeons have been faced with the need to perform capsulotomy in the late postoperative period. Even before the “laser era,” removal of secondary cataracts was performed mechanically. Despite the outpatient nature of the manipulation and minimal surgical trauma, like any surgical intervention, mechanical discision of secondary cataracts could be accompanied by a number of undesirable complications.
Since 2004, the standard practice of an ophthalmic surgeon in a modern eye clinic involves performing laser capsulotomy, which is distinguished not only by the painless and non-invasive nature of the surgical intervention, but also by a minimal number of postoperative complications.
Today, the gold standard for the treatment of secondary cataracts after lens replacement is considered to be laser dissection of secondary cataracts - laser capsulotomy. The most common option for removing secondary cataracts is based on the use of a neodymium yttrium aluminum garnet laser. Its Latin abbreviation looks like Nd:YAG, and doctors call it YAG laser (YAG laser).
The mechanism of action of the YAG laser is photodestruction of opacified tissues of the posterior capsule of the lens. This laser does not have temperature reactions and coagulation properties, which avoids various complications.
Laser dissection of secondary cataracts involves using a YAG laser to create a round hole in the posterior capsule of the lens along the patient’s visual axis. This allows the light beam to freely reach the central zone of the retina, and all symptoms of visual impairment are stopped.
Removal of secondary cataracts with a YAG laser is indicated when patients have symptoms of secondary cataracts that significantly impair the quality of life and make it difficult to perform daily tasks. Also, laser dissection of secondary cataracts should be carried out if constant monitoring of the condition of the retina in operated patients is necessary.
Contraindications to laser capsulotomy:
- clouding and scarring of the cornea,
- corneal edema,
- inflammatory processes of the eyeball,
- cystoid edema of the macular area,
- various pathologies of the retina and/or macula, in particular, retinal breaks and vitreomacular traction.
Secondary cataract - laser treatment in Moscow
Laser dissection of secondary cataracts is performed on an outpatient basis in the laser office of an ophthalmologist. Hospitalization to a hospital is not required for this intervention.
Removal of secondary cataracts is performed under local anesthesia. 30-60 minutes before surgery, anesthetic and pupil dilating drops are instilled into the patient's eye. The patient should sit comfortably in a chair in front of the slit lamp. Particular attention should be paid to fixing the head in the correct position.
During the procedure, the patient may hear "clicking" sounds as a result of the YAG laser and may also see flashes of light. There is no need to be afraid of this. Sometimes, for better fixation of the eyelid and eyeball during the removal of secondary cataracts, doctors use a special contact lens, similar to a gonioscopic one. This lens has magnifying properties, which allows better visualization of the area of the posterior capsule of the lens.
A YAG laser is used to make a round incision in the posterior capsule area. At this point the intervention can be considered completed. At the end of the operation, antibacterial and anti-inflammatory drops are instilled into the eye.
Despite the outpatient nature of the operation, laser discission of secondary cataracts requires adherence to a certain postoperative regimen.
Postoperative period
Like any ophthalmic surgery, YAG laser dissection of secondary cataracts can have certain complications. The most common is increased intraocular pressure. Its control is necessary 30 and 60 minutes after removal of the secondary cataract. If there is an acceptable level of intraocular pressure, the patient is sent home with recommendations for the use of local anti-inflammatory and antibacterial therapy. The maximum peak increase in intraocular pressure is observed in the first three hours after laser treatment of secondary cataracts; its normalization occurs within 24 hours. Patients with glaucoma, as well as those with a tendency to hypertension, are usually additionally prescribed antihypertensive drops and a repeat examination by an ophthalmologist the day after laser capsulotomy.
The second most common potential complication is the development of anterior uveitis. It can be prevented by local use of antibacterial and anti-inflammatory agents. Relief of the inflammatory reaction is necessary within a week after laser treatment of secondary cataracts. Therefore, drops after secondary cataracts are prescribed for a period of 5-7 days. Other possible complications - retinal detachment, macular edema, damage or displacement of the artificial lens, corneal edema and hemorrhage in the iris after secondary cataracts are extremely rare and, as a rule, are errors in the technique of laser dissection of secondary cataracts.
With successful dissection of a secondary cataract, regardless of the capsulotomy method, maximum visual acuity returns within 1-2 days in 98% of patients.
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The presence of floaters or floaters before the eyes is acceptable for several weeks after secondary cataracts. There is no need to be alarmed - they arise due to the presence of particles of the destroyed posterior capsule in the field of view. Gradually such manifestations will disappear.
The presence of floaters before the eyes for a month or more or the appearance of flashes of light and spots before the eyes cannot be ignored and you should consult your doctor. Medical supervision also requires a gradual decrease in visual acuity after pronounced positive dynamics.
In most cases, secondary cataract discission proceeds without complications and has good long-term results. There is no need to fear such interference. Absolutely painless and non-traumatic removal of secondary cataracts will help restore visual acuity and significantly improve the quality of life.
Cost of treatment for secondary cataracts
The cost of discision of secondary cataracts varies depending on the method of surgery. For mechanical capsulotomy, the price is 6-8 thousand rubles. At the same time, the cost of a non-invasive method that is more gentle on eye tissue - laser dissection of secondary cataracts - is in the range of 8-11 thousand rubles. To this price for treatment of secondary cataracts, it is also necessary to add the cost of an examination performed before capsulotomy, the average price of which is 2-5 thousand rubles.
