Cataract

Cataract
If every various reason wear out, heredity, some nutrition unusual in obstacle, immunity and supersession, traumatism, poisoning, radiation,etc., can cause the supersession of lens to be disorderly, lead to the fact the lens albumen quality changes the sex and happens muddily, it is unable to throw on the retina that the light is hindered, can't see objects clearly, is called cataract. WHO changes the sex and muddy to the lens, turn into opaqueness, so that influence eyesight, and correct eyesight in 0.7 or the following one, include in cataract and diagnose the range.



Cause of disease

Cataract, according to its different several kinds of dividing into development, senile, erupting simultaneously, traumatic, poisoning, supersession obstacle, cortex steroids and late coming etc. reasons Development cataract is also called inborn cataract, there are two kinds of endogeny and other natural disposition. The endogeny reason relates to foetus' development obstacle, have heredity; The reason of the other natural disposition refers to the damage caused toward lens of pathological change of whole body of the mother's body or foetus, if mother suffers from the virus and is infected with in gestation like nettle rash in 6 months of earlier stage, measles, chicken-pox, parotitis, gland function fail and not malnutritive and vitamin scarce, etc by the first form, may cause. Increase of content such as the sex change that senile cataract is mainly protein when formed, insoluble albumen, sodium and calcium, it is scarce that potassium and vitamin C is reduced with that of glutathion like. 85 in the lens albumen is the water soluble albumin, the water soluble albumin can be changed into the insoluble albumen, the larger age is, the more insoluble albumen content is; Vitamin C lack in addition and the intersection of crystal and change and some noxious substance of pH value permeate crystal through, can cause the intersection of crystal and sex change of albumen, produce muddily. It is the initial factor that cataract forms to oxidize damaging as to the the elderly crystal, drink in dangerous factor that cataract forms excessive, excessive smoking, woman bear too much and some whole body diseases etc., but senile cataract forms the reason and is not still totally clear, remain to continue studying so far. Erupting simultaneously cataract is that the lens caused by some diseases are muddy, such as iris cilliary inflammation, chorioid inflammation, eyes diseases such as retinal detachment, retinal pigment changing the sex, glaucoma, highly near-sighted and suppurative corneal ulcer, outmoded eyes traumatism,etc. can cause erupting simultaneously cataract. Traumatic cataract including machinery, radiation, shocking by electricity. See diabetes cataract more clinically in obstacle cataract of the supersession. Cortex steroids cataract because eyes some or whole body use steroids of cortex to cause in a large amount for a long time. Cataract mean cataract pluck, happen skill or linear to pluck, produce postoperative outside the bag, residual cortex and bag membrane happen muddily.


Clinical manifestation

Dual sides, but two had illness coming on successively can have. Eyesight fails, can see fixed black point under the bright background sometimes, because the crystal does not crook all strength to change with the position, how to depend on, the simple eye is replied and looked at, near-sighted degree of increase. General's senile cataract of clinic divides into the cortex, nuclear and three kinds of types under the bag:

It is a main characteristic that cortex cataract is ashen and muddy with the cortex of crystal, its evolution can be divided into four issues: Send issue, mature period, mature period, overdone one for the first time.

The crystal of the nuclear cataract is muddy to begin from the embryo core more, is expanded to the adult core gradually, early and yellow, with muddy to aggravate, color and luster it strengthens to be if getting deep yellow gradually, dark and getting pale brown, the nuclear density increases, crook all index to increase, the patient often tells presbyopia to lighten or increase near-sightedly, the early peripheral department cortex is still transparent, so, distribute great eyesight to promote on the dark place pupil, make myosis eyesight in the strong light and fail instead. Wait for cortex to be totally muddy to do surgery promptly seldom.

Back bag it lays cataract to be because muddy to lie in, look at the intersection of axle and district, early to influence eyesight promptly.

Cortex cataract of senile cataract is a type seen at most, can be divided into four issues according to its evolution:

(1)Send one for the first time: It is muddy to present the radial milky white wedge in the cortex of the department of the equator of lens at first, it is basal in the equator department, the peak is to the pupil centre, the cortex is still transparent between the muddy stripe, break up behind the pupil, with thorough to take France, check, can see the equator of lens part getting red to the black wedge strip shade appears at the background, the light microscopic examination of crack can see muddily and lie in the peripheral department to take the form of feather, it is very slow that it is developed that muddy in initial stage, can reach even several years for several months, some remained at this stage without development for a long time.

(2)Underdone one: The wedge in the intersection of lens and the equator department is muddy to expand and continue developing towards pupil district and deep layer gradually, the muddiness appearing milky white on the whole lens appearance, but muddy irregularity, each original wedge is muddy after merging each other, can still clearly reveal the radial stripe, increase the cortex layers of moisture and last lens, swell, before room shallow, can continue taking place glaucoma, because the cortex has not been totally muddy yet, the iris projection exists.

(3)Mature period: The cortex of lens is totally muddy, present the filling the air milky white on the appearance, the inflation of the lens totally disappears, front room returns to normal deeply, the iris projection does not exist.

(4)Overdone one: The sex change continuation of the albumen quality of the cortex of lens was developed, the fibrous structure has already been totally destroyed, on the appearance, the radial stripe disappears, it is muddy that the lens present homogeneous white, discharge because catabolite and moisture constantly,is it variable and dark in rooms front, iris shake, before bag muddiness and fold. Sent one for the first time and varied with each individual to mature period, it is generally 5- 10 years, also there are the very fast one of developments.


Check the project

Cataract should find out about in front of the skill vitreous body, retina, look at papilla, macula lutea district and chorioid had pathological change, resume having correct estimation to the postoperative eyesight of cataract. Whether have swollen thing in the vitreous pathological change, retinal detachment or eyes to can understand through A type and Model B supersonic wave, can also understand the axle length of eyes and crystal position that dislocate. Electric picture (ERG) of retina There is important value, the patient of cataract of simple eye, in order to get rid of pathological change of the macula lutea on appraising the retinal function, look at the eyesight obstacle due to illness of the way, can bring out the electric potential (VEP) before the skill Check. In addition, can also employ the macula lutea function of checking ripe cataract of the eyesight interferometer.


Treat

Drug therapy

There is no precise result in the drug therapy of cataract, are all at exploring that study stage both at home and abroad at present, some early cataract, the disease is lazy may be slowed down and developed after using medicine, eyesight is slightly improved too, but this might not result from drug therapy, because cataract it develops to be one longer course to being ripe in early days, its probably natural stop is but unlikely to influence eyesight seriously at a certain developing stage. Patient of cataract of some middle period, the eyesight and muddy intensity of lens have not been improved after using medicine, near cataract of mature period, there is no actual meaning even more in drug therapy. Commonly used medicine less than dozens of at being at present clinical, have eye drops or oral the intersection of Chinese and Western and medicine, but there is not a precise therapeutic effect.

Surgery treatment of cataract

1.The cataract supersound emulsifies the skill: For the new cataract operation that is launched both at home and abroad in recent years, this operation mainly centres in more advanced large and medium cities of our country to launch at present. Use supersonic wave to crush the lens core to make it take the form of chyle, then the aspiration together with cortex, the skill finishes the membrane of bag behind keeping the lens, can plant into the artificial lens of house type at the same time. Senile cataract develop into eyesight to be 0.3 below, muddy lens mature period, centre core department relatively soft, suitable for doing the supersound to emulsify the operation, its advantage is cut-outed small, the organization damages few, the time of operation is short, eyesight resumes fast.

2.Excise the skill outside the cataract bag: Different from excising the skill outside the outdated bag, it needs to operate under the operation microscope, cut-out than pluck, produce skill to be little in the bag, discharge the muddy lens core, suck out of the cortex, but the bag behind leaving the lens. Back the intersection of bag and membrane keep, the intersection of house type and artificial lens can plant into at the same time, can recover the eyesight function immediately while being postoperative. So, pluck the regular operation way that has appeared and already become cataract at present outside the cataract bag.

3.Excise the skill in the cataract bag: Muddy lens intact from first surgery that take out under eyes, this operation needs greater operation to cut-out, because the lens bag is excised together at the time of the operation, artificial lens of house type after so can't plant into at the same time.

As modern micro- operation being becoming better and approaching perfection day by day, make it possible that cataract and artificial crystal are planted into as the clinic operation. Try hard, control postoperative astigmatism that produce on one hand perform the operation at present, correct astigmatism in front of the skill in operation on the other hand, try hard to use the viscoplasticity material in the operation in order to reduce the damage of inner cover and other tissue. Enlargement, operation of indication, if one-eyed, diabetes cataract can plant artificial crystal into. The membrane technology of the bag, crystal are nuclear and cortex treatment technology is developed, such respects as new artificial crystal design, size and surface are dealt with have development certainly, yellow artificial crystal comes out, attempt to improve the general artificial crystal to plant into postoperative blindingly and looking at the wild symptom of color. Until the intersection of cataract and supersound emulsify, excise and artificial crystal plant skill into, popularize, the laser is emulsified and applied to clinic, the research and development of the artificial crystal of pouring-in too, will make the cataract operation go up to a new stage even more.


Postoperative attentive matters of cataract

Behind planting into the artificial lens, should generally pay attention to the following several question:

1.Want, pay attention to at the thought, don't think behind the surgery on everything is just fine, should strengthen and observe, whether paying attention to skill eyes has pain, the artificial lens seat is askew or dislocate, whether there is inflammation to ooze out in festival at the moment, whether the adhesion takes place etc. in iris and pupil, go to the hospital to check once postoperative every week, including eyesight, artificial lens and optical fundus situation, follow the doctor's advice one month later, reexamine regularly.

2.Should avoid moving vigorously in postoperative 3 months, the movements of especially bowing, it is overworked to avoid, prevent cold,

3.Clear several times a day in postoperative month to use hormone and antibiotic ophthalmic medicine, and follow the doctor's advice and drip by the more weakly expanding ophthalmic medicine of pupil of function, in order to prevent the pupil adhesion. To the for a long time full persons who use hormone ophthalmic medicine, should pay attention to the intraocular pressure situation, avoid producing hormone glaucoma.

4.Keep the stool unobstructed, eat little stimulating food, avoid tobacco and wine, eat more fruit and vegetables,

5.Postoperative 3 should reach the intersection of hospital and routine inspection month, and make, crook light, check, have, crook all change person, can have an eye test and mix the mirror to correct. Generally can work and study normally one month later,


Postoperative complication

Postoperative cataract can present a plurality of complications, must oppose disease to deal with according to the reason of each complication.

(1)The room advocated sewing up and cut-outing again more before the ones that caused for cut-outing seepage are light; If the intensity is relatively light, can wrap up skill eyes through pressurizing, the room can resume before being light sometimes. If the chorioid breaks away from with should sew up cut-outing again while cut-outing seepaging, room form, if chorioid break away from range to be relatively large, break away from sclera cut guide, can accelerate recovery and chorioid of intraocular pressure break away from and reset behind the district; Such as break away from relatively little range, have obvious the intersection of notch and seepage, can strengthen, resist inflammation, pressurize, wrap up after the several days breaking away from and fade. It can be by strong distributing pupil pharmaceutical that the ones that block on the pupil are early, cortex steroids of some application lightens inflammation or whole body by oozing pharmaceuticals high. However, the most basic measure is the traffic of the front and back room of communicating again, the iris can achieve this purpose while cutting the skill, YAG laser carries on the peripheral iris and cuts more simple and more convenient.

(2)Because the leather damage is irreversible in the cornea, once the continuation cornea edema takes place, cornea optics recovery depend on some penetrating corneal transplantation, as to walk patient that cornea transplant while being inconvenient, can through being high to ooze pharmaceutical, mix soft contact lens or remove pathological change leather cells relieve symptom through the way that the conjunctiva one hides behind layer at the district while being some. Should prevent the apparatus from contacting the cover in the cornea with the artificial crystal in the skill, use and glue and play pharmaceuticals to protect the cover in the cornea, avoid room develop for a long time, punish vitreous body and other organization with leather contact in the cornea as soon as possible while being postoperative, can reduce the hydropic emergence of postoperative continuation cornea on the relatively great intensity.

(3)The room accumulates the blood to generally absorb naturally in several days before small quantity, accumulate blood before full ofing the room should accompany the high intraocular pressure before going on immediately the room is washed. Glass the intersection of volume and blood absorb at the small quantity, should a vitreous body excise skill after going on a large amount of o'clock, the therapeutic effect of the room is not good to get on the cover before planting into, the prognosis is relatively bad, diagnosed, should excise the pathological change district and cut-out the nearby deep sclera immediately, and freeze the hyperplasia epithelial tissue behind of cornea of giving much trouble area, excise the iris given much trouble, freeze or excise the cilliary given much trouble, for not guaranteeing the vitreous body and the cornea adhesion should also excise the first period of vitreous body. Postoperative grape come loose the intersection of pupil and pharmaceutical medicine be controlled, but need to look for the cause of disease at the same time, carry on the treatment of cause of disease.

(4)Cataract suspect inflammation in the eyes, should release, suck the intersection of room and water and vitreous body, carry on bacterium or fungi train until medicine sensitive to test immediately while being postoperative. Excise the vitreous body given much trouble with the cutting device of vitreous body, and to the glass coelom, intravenous and injecting antibiotic under the ball conjunctiva. Postoperative treatment of glaucoma should some going on, stepping down, carrying on the intersection of cause of disease and treatment while not dealing with all over. The artificial lens seat is unusually conservative to generally adopt surgery to reset while failing to respond to any medical treatment, take the artificial lens out or change the artificial lens if necessary. It is a muddy simplest and effectivest method of the membrane of bag after treating to cut the skill with YAG laser bag film, if has already planted into the artificial crystal, the laser should avoid damaging the artificial crystal while cutting; In addition can also with wear bayonet enter eyes from the intersection of cilliary and smooth department, muddy increasing the intersection of bag and membrane cut after the thick central department, to the retina complication, such as a kind of edema of macula lutea bag can employ Indometacin, cortex steroids, and retinal detachment person acts as the surgery treatment.


Prevent

Notice spirit adjusting and taking a photograph of, anything crops up to remain calm, the ambition should be broad, keep mood happy, make anger. Train to cultivate one's taste to the interest planting flower, raising birds, breeding goldfish, talk with young people more, can disperse to the attention of the unpleasant thing, it is hospitable to evoke vigorous life, can play a role in preventing and delaying condition progress.

Strengthen eye hygiene, need hand rub eyes at ordinary times, needn't clean handkerchief, towel wipe eyes, wash eyes. With should relax while being appropriate behind the excessive eyes, sit for a long time worker should stand up, move 10- 15 minutes at intervals of 1- 2 hour, look and look far into the distance, or do eye exercise. There should be sufficient sleeps, resume fatigue in time.

Prevent and cure chronic disease, including illness and whole body disease of eye actively. Especially diabetes is aptest to erupt cataract simultaneously, control blood glucose effectively in time, prevent the further development of the condition.

The diet of nutritive equilibrium, drink the water more, eat little salt, absorb abundant Vitamin E, C, do not smoke, and prevent adult's diseases such as diabetes,etc. actively. The diet should include abundant protein, calcium, microelement, eat more food which includes vitamin A, B, C, D. Eat more fish at ordinary times, can keep normal eyesight, hinder the progress of the slow condition.

Smoking is apt to have suffered from cataract and has already been practised to verify, should give up smoking early.

Prevent the strong sunlight from shining, in the outdoor sports, wear the sunglasses or topee, can prevent the damage to the crystal of ray effectively. Unless the need of curing the disease, avoid taking medicines as much as possible. Because of some medicines, such as steroids, can make cataract further develop. But in daily life, this kind of material will not enter the human body, do not regard it as the main factor which cause cataract progress.


Cataract
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