Initial cataract code. An important but difficult question: will it be possible to preserve vision with a mature cataract? With unspecified complications

Megalocornea refers to ophthalmic diseases. It is characterized by an increase in the diameter of the cornea by at least 2 mm. For example, in a baby, the diameter should be 9 mm, and if it is increased to 11 mm, then this is already considered a disease.

Quite often, this deviation is only a sign of glaucoma, but there is also true megalocornea in children. It should be noted that at the very beginning of the development of the pathology, the cornea is still transparent, turbidity is not observed. But in the chamber of the eyeball in front, there are increases in size, due to which it acquires a deeper shape. It is generally accepted that pathology begins to develop even inside the womb. During this period, the ends in front of the eye cup do not fully close, which leads to the formation of free space for the cornea. The disease may be hereditary. In this case, recessive linkage to the X chromosome occurs. Therefore, a genetic predisposition is observed in boys. Megalocornea - photo:

Distinctive features of megalocornea

1. No clouding of the cornea.
2. There is no thinning of the limbus.
3. There is no limb expansion.
4. Descemet's membranes remain intact.
5. Intraocular pressure is normal.
6. The depth of the anterior chamber changes.
7. The occurrence of iridodonesis.
8. Simultaneous development of ametropia, anisometry, strabismus, amblyopia, mycosis, embryotoxon, ectopia.
9. Pigmentation on the back of the cornea.
10. The lens moves.

The International Classification of Diseases equates this disease to congenital glaucoma, so megalocornea - ICD 10 code is Q15.0.

Possible complications, diagnosis

If megalocornea occurs, you should immediately contact an ophthalmologist, as the disease carries many complications, among which the following should be noted:

1. Increasing the amount of fluid between chambers.
2. Pathological changes in the retina and lens.
3. Cataract.
4. Retinal detachment.
5. Ectopia, that is, when the lens is displaced.
6. Pigmentary glaucoma.
7. spastic miosis.

Diagnosis includes a differentiated examination, ophthalmological examination and measurement of pressure inside the eyes. During the study, all structures of the visual organ are studied, pathological abnormalities and concomitant diseases are revealed.

How to treat megalocornea

As such, the disease does not require treatment. It is enough to carry out preventive measures to avoid the development of ophthalmic diseases. If the pathology is accompanied, for example, by glaucoma, then the treatment is aimed at eliminating the causes of glaucoma. In general, the prognosis is favorable, as visual acuity does not decrease. The most important thing is timely diagnosis, correct diagnosis and a qualified approach to preventive measures. In the presence of megalocornea in children, it is necessary to periodically check with an ophthalmologist.

Preventive actions

No one knows whether a baby will be born with megalocornea or not, so expectant mothers should take preventive measures. First of all, it is necessary to avoid infection and the development of various kinds of diseases. Particular attention should be paid to nutrition. After all, the formation of the fetus depends on this. Therefore, each organ separately. Be sure a pregnant woman should eat seasonal fruits, berries and vegetables. It is very important to eat fresh food, not frozen. You need to eat dairy products, and refuse fatty, salty, smoked dishes. It is strictly forbidden to expose the expectant mother to stressful situations, because the psychological instability of a woman negatively affects the development of the fetus.

IMPORTANT! Only an ophthalmologist should prescribe preventive measures, and even more so treatment for a child with megalocornea. The fact is that each specific case requires an individual approach, since the visual organs have their own characteristics.

Amblyopia: ICD-10 code, causes and treatments

Amblyopia is a visual impairment of a secondary nature. For all types of such visual pathology, it is characteristic that in adulthood the deterioration in the quality of vision persists after the removal of the main problem that caused amblyopia. The diagnosis of "amblyopia" in medical records can be indicated by a code. There is an International Classification of Diseases (ICD), according to which this or that disease is designated. Currently, the tenth classification is used - MBK-10. According to this classification, amblyopia due to anopia (defect in visual fields) is indicated by the code H53.0

Disease Definition

The term "amblyopia" refers to a decrease in visual acuity due to functional disorders of the visual analyzer. Such a problem most often cannot be corrected with glasses (contact lenses). This disease is also called lazy eye syndrome.

There are several types of functional disorder:

• Anisometropic amblyopia, which can manifest itself in case of serious differences in the refractive power of the left and right eyes;
• Deprivation amblyopia develops as a result of deprivation (reduction or complete deprivation of the ability to see) of one of the eyes due to the presence, for example, of a cataract or clouding of the cornea. After the elimination of the problem, low vision persists;
• Dysbinocular amblyopia, which is caused by the presence of strabismus;
• Hysterical amblyopia, which can also be referred to as psychogenic blindness;
• Refractive amblyopia;
• Obscurative amblyopia develops in the presence of congenital (acquired at an early age) clouding of the optical environment of the eyes.

Amblyopia is caused by the non-participation of one of the eyes in the process of "seeing", which is explained by an already existing problem in the area of ​​\u200b\u200bthe organs of vision.

Causes

Since such a functional visual disorder is a secondary pathology, the causes of its occurrence can be called both the factors that caused functional disorders of the visual analyzer and the processes that explain the decrease in vision. The likelihood of amblyopia increases due to the presence of a number of genetic features. There are some types of inherited diseases that can cause amblyopia:

• Benche syndrome, which is characterized by the presence of strabismus and asymmetric facial hyperplasia;
• Reciprocal balanced translocation;
• mental retardation;
• Low growth;
• Kaufman's syndrome;
• Ophthalmoplegia.

In cases where one of the parents suffers from amblyopia, the likelihood of its manifestation in the child is increased. Most often, this visual disorder manifests itself in families whose members suffer from the presence of strabismus and severe refractive errors. The immediate causes of the development of functional visual impairment are a large number of specific factors that cause amblyopia. For example, in the case of amblyopia caused by strabismus, the pathology develops in the squinting eye. This is due to the fact that the brain is forced to suppress the "picture" that comes to it from the squinting eye.

Manifestations of hysterical amblyopia provoke psychogenic factors that cause visual impairment, color perception, photophobia and other functional disorders.

The appearance of obscurative amblyopia is caused by clouding, dystrophy or trauma of the cornea, cataracts, ptosis of the upper eyelid, and serious changes in the vitreous body. The cause of anisometropic amblyopia is a high degree of anisometropia. Visual impairment in this case manifests itself in the eye with more pronounced refractive errors (the process of refraction of light rays in the optical system of the eye). Amblyopia can develop when long-sightedness, nearsightedness, or astigmatism is not corrected for a long time.

A high risk of developing amblyopia occurs when children are born with a deep degree of prematurity or mental retardation.

Symptoms

Different forms of amblyopia also manifest themselves in different ways. Mild amblyopia may not have symptoms. In babies, the possibility of developing amblyopia can be suspected in the presence of diseases that provoke such a visual disorder. The reason for concern may be the inability of a small child to fix his eyes on a bright object.

Amblyopia may be indicated by a deterioration in visual acuity that cannot be corrected. Also, manifestations of a functional disorder can be:

• Violation of the ability to orient in visually unfamiliar places;
• Deviation of one eye from the normal position;
• Developing the habit of covering your eyes when you need to see something qualitatively or when reading;
• Automatic tilt (turn) of the head when looking at something;
• Violation of color perception or adaptation to the dark.

The hysterical form of amblyopia can occur with severe stress or emotional overstrain. This condition manifests itself as a sudden deterioration in vision, lasting from several hours to several months. The deterioration in the quality of vision in amblyopia can be different. This is an almost imperceptible decrease in visual acuity and its almost complete loss.

In order to diagnose amblyopia, it is important to conduct a comprehensive ophthalmological examination.

Possible Complications

In the absence of treatment or untimely correction of visual disorders, visual acuity can be significantly reduced. Over time, this process is steadily progressing.

Treatment

Treatment of this visual pathology can give the most qualitative result if it is carried out in the early stages. Therapeutic methods are selected individually. All ways of "working" with a problem require consistency and perseverance. Correction of this kind of visual disorders is best done at an early age (children 6-7 years old), in patients 11-12 years old, amblyopia may not be correctable. It is important to conduct visual acuity testing for children before the time they enter school.

Methods of treatment of amblyopia are directly dependent on the causes of visual impairment. However, most of the existing methods of treatment consist in reducing or completely eliminating the “competition” of the leading eye with the help of its direct occlusion (“closing” in various ways), which lasts for a long time. In parallel, the function of the amblyopic eye is stimulated.

Therapeutic measures for refractive or anisometropic amblyopia involve the use of conservative methods. This is the optimal vision correction, which is carried out with the help of a careful selection of glasses, night or contact lenses. Laser correction can also be performed. Three weeks after the start of the correction, the doctor prescribes pleoptic treatment (elimination of the predominant role of the better seeing eye, as well as strengthening the functioning of the “weak” eye). Treatment of amblyopia includes physiotherapeutic procedures: vibromassage, reflexology, electrophoresis.

After the end of the pleopty stage, the process of restoring binocular vision begins, which is achieved by the method of orthooptic treatment.

In a medical way

In young children (1-4 years old), the functioning of the organs of vision is corrected using penalization, instilling an atropine solution into the "stronger" eye. This leads to a decrease in visual acuity of the leading eye and activation of the amblyopic eye. In the case of the development of hysterical amblyopia in adults, sedatives may be prescribed, as well as psychotherapy sessions.

With the manifestation of obscurative amblyopia, resolving therapy is performed.

Surgically

In the case of diagnosing obscurative amblyopia, surgical removal of the cataract and correction of ptosis are performed. With dysbinocular amblyopia, strabismus correction is necessary, which is also performed by surgical methods.

Folk remedies

Most of the folk remedies used cannot improve vision with amblyopia. In most cases, this is wasted time, as well as real harm to health.

Prevention

Prevention of this visual disorder consists in measures that allow as early as possible to detect the pathology leading to the development of amblyopia. To do this, it is necessary to conduct regular examinations of babies by ophthalmologists. It is important to carry out such examinations starting from the first month of life. If visual defects are detected, they must be eliminated at an early age.

Levomycetin eye drops: instructions for use

Okovit - eye drops are described in this article.

Hernia of the upper eyelid - treatment without surgery http://eyesdocs.ru/zabolevaniya/gryzha/izlechima-li-nizhnego-veka.html

Video

conclusions

Amblyopia is called lazy eye syndrome. This visual disorder is secondary and is characterized by the non-participation of one of the eyes in the process of vision. Amblyopia is a disease that develops mainly in childhood. That is why it is important to detect and correct it as early as possible.

Treatment of amblyopia brings a qualitative result only with the responsible passage of a long course of treatment and compliance with absolutely all prescriptions of an ophthalmologist.

Also read about children's conjunctivitis and about methods of treating chalazion in children.

Cataract is an eye disease characterized by a change in the state of the substance and the lens capsule, mainly clouding. According to the international classification of diseases: cataract ICD 10. This set of statistical data on diseases and pathological conditions is the main document of the health care of the leading countries of the world.

Loss of vision in cataracts can progress rapidly or gradually decrease over a long period of time, depending on the underlying and concomitant pathological changes.

Disease classification

Cataracts can occur at any age, even in children and newborns. An older adult is more susceptible to changes in the normal state of the eyes.

The ICD disease code consists of certain numerical and alphabetic designations inherent in a certain type of lesion. For example, H28.0 is diabetic cataract and H26.1 is traumatic cataract. Such data is entered into the patient's medical record. A third of patients with eye pathologies are patients with ICD 10 cataracts, and almost half of all operations on the organs of vision are surgical interventions.

According to the clinical classification of diseases, cataracts are divided into two groups according to the time of origin:

• acquired (the disease always worsens the state of vision);
• (relative stability of the pathological process).

Due to the origin of cataracts, there is also a certain classification:

• traumatic (wounds or injuries of the eyes, contusions);
• age-related (violation of tissue trophism due to senile changes in the body);
• radiation (radiation damage);
• a consequence of systemic diseases (diabetes mellitus, hormonal disorders, and others);
• toxic (chemical damage);
• complicated (association of concomitant diseases or complication of an existing lesion).

Also, the clinical classification includes divisions according to the degree of maturation of the cataract, according to the location of the turbidity of the lens, according to morphological features and the form of the cataract itself (membranous, marsupial, layered and other types).

Diagnostic and therapeutic measures

If the first is detected - the appearance of glare, spots, fog in the eyes or other incomprehensible conditions, you should consult a doctor for advice. The examination should be carried out in specialized medical institutions using special equipment.

It is important to know that the treatment is complex and in almost all cases surgical intervention is required in a hospital setting.

The postoperative period is quite short and the prognosis is quite favorable. If the doctor's recommendations are followed, there are no complications. Timely access to specialists reduces the risk of complications.

Cataract- a disease characterized by varying degrees of persistent opacities of the substance and / or capsule of the lens, which are accompanied by a progressive decrease in visual acuity of a person.

Classification of cataract varieties according to ICD-10

H25 Senile cataract.

H25.0 Cataract senile initial.

H25.1 Senile nuclear cataract.

H25.2 Cataract senile Morganiev.

H25.8 Other senile cataracts.

H25.9 Cataract, senile, unspecified.

H26 Other cataracts.

H26.0 Childhood, juvenile and presenile cataracts.

H26.1 Traumatic cataract.

H26.2 Complicated cataract.

H26.3 Cataract caused by drugs.

H26.4 Secondary cataract.

H26.8 Other specified cataract.

H26.9 Cataract, unspecified.

H28 Cataracts and other lesions of the lens in diseases classified elsewhere.

H28.0 Diabetic cataract.

H28.1 Cataracts in other diseases of the endocrine system, metabolic disorders, eating disorders, which are classified elsewhere.

H28.2 Cataract in other diseases classified elsewhere.

A pooled analysis of the world's available data on blindness shows that the disease is a particularly common cause of preventable blindness in economically developed and developing countries. According to the WHO, today there are 20 million blind people in the world due to cataracts, and about 3,000 surgeries need to be performed. extraction operations per million population per year. In the Russian Federation, the prevalence of cataracts according to the criterion of negotiability can be 1201.5 cases per 100 thousand of the surveyed population. This pathology of varying severity is detected in 60-90% of persons aged sixty years.

Patients with cataracts make up about a third of the people hospitalized in specialized eye hospitals. These patients account for up to 35-40% of all operations performed by ophthalmological surgeons. By the mid-1990s, the number of cataract extractions per 1,000 population was: in the United States, 5.4; in the UK - 4.5. Available statistics for Russia are highly variable, depending on the region. For example, in the Samara region, this indicator is 1.75.

In the nosological profile of primary disability due to eye diseases, persons with cataracts occupy the 3rd place (18.9%), second only to patients with the consequences of eye injuries (22.8%) and patients with glaucoma (21.6%).

At the same time, 95% of cases of cataract extraction are successful. This operation is generally considered one of the safest and most effective among interventions on the eyeball.

Clinical classification

Due to the inability to find out the causes of lens opacities, their pathogenetic classification does not exist. Therefore, cataracts are usually classified according to the time of occurrence, localization and form of clouding, the etiology of the disease.

According to the time of occurrence, all cataracts are divided into two groups:

congenital (genetically determined) and acquired. As a rule, congenital cataracts do not progress, being limited or partial. In acquired cataracts, there is always a progressive course.

According to the etiological basis, acquired cataracts are divided into several groups:

Depending on the location of the opacities and according to their morphological characteristics, the pathology is divided as follows:

According to the degree of maturity, all cataracts are divided into: initial, immature, mature, overripe.

Cataract - description, causes, symptoms (signs), diagnosis, treatment.

Etiology. Senile cataract.. A long-term (lifelong) increase in the layers of lens fibers leads to compaction and dehydration of the lens nucleus, causing visual impairment. With age, changes occur in the biochemical and osmotic balance necessary for the transparency of the lens; the outer fibers of the lens become hydrated and cloudy, impairing vision. Other types.. Local changes in the distribution of lens proteins leading to light scattering and manifesting as clouding of the lens. Injuries to the lens capsule lead to the ingress of aqueous humor into the lens, clouding and swelling of the lens substance.

Classification by appearance. Blue - cloudy area has a blue or greenish color. Lenticular - clouding of the lens while maintaining the transparency of its capsule. Membranous - foci of clouding of the lens are located in strands, which mimics the presence of the pupillary membrane. Capsular - the transparency of the lens capsule is broken, but not its substance. Tremolating - overripe cataract, eye movements are accompanied by trembling of the lens due to degeneration of the fibers of the zinn ligament.

Classification according to the degree of progression. Stationary (most often congenital, turbidity does not change over time). Progressive (almost always acquired, clouding of the lens increases over time).

General symptoms .. Painless progressive decrease in visual acuity .. Veil before the eyes, distortion of the shape of objects .. An ophthalmological examination reveals clouding of the lens of various severity and localization.

Senile cataract .. Initial - decreased visual acuity, clouding of the subcapsular layers of the lens substance .. Immature - visual acuity 0.05-0.1; clouding of the nuclear layers of the lens, swelling of the substance can provoke the development of pain and an increase in IOP due to the appearance of secondary phacogenous glaucoma. Mature - visual acuity below 0.05, complete diffuse clouding of the entire lens. liquid), the lens takes on a pearlescent appearance.

With nuclear cataract, myopia initially occurs against the background of existing presbyopia (myopizing phacosclerosis); the patient discovers that he is able to read without glasses, which is usually perceived positively by the patient ("second sight"). This is due to the hydration of the lens during the initial cataract, which leads to an increase in its refractive power.

Special studies. Qualitative assessment of visual acuity and refraction; in the case of a pronounced decrease in visual acuity, tests are shown to determine the localization of a bright light source in space. Possible hyperglycemia in DM can cause osmotic changes in the lens substance and affect the results of studies. Determination of retinal visual acuity (the isolated ability of the retina to perceive visual objects, while the state of the refractive media of the eye is not taken into account; the determination is made using a directed beam of laser radiation). Such a study is often performed in the preoperative period in order to accurately predict postoperative visual acuity. Retinal angiography with fluorescein is indicated to detect comorbidity in case of inconsistency in visual acuity with the degree of lens opacity.

Lead tactics. Senile cataract. The process develops gradually, so the patient usually does not realize how pronounced the pathological changes are. Against the background of formed habits and skills, even a significant clouding of the lens is perceived as a natural age-related weakening of vision. Hence the need for a thorough explanation to the patient of his condition. However, in the future, there is almost always a need for surgical treatment (cataract extraction). In diabetic cataract, drug antidiabetic therapy can slow down the development of the process, however, with a decrease in visual acuity below 0.1, surgical treatment is indicated. With hypoparathyroidism - correction of metabolic disorders (introduction of calcium, thyroid hormone preparations), with a decrease in visual acuity below 0.1-0.2 - surgical treatment. Tactics for traumatic cataract - surgical treatment 6-12 months after the injury; the delay is necessary for the healing of damaged tissues. Uveal cataract - drugs that slow down the development of the disease, mydriatics. With inefficiency and a drop in visual acuity below 0.1-0.2, surgical treatment is indicated, carried out only in the absence of an active process. Diet. Depending on the etiology of the disease (with diabetes - diet No. 9; with hypothyroidism - an increase in protein content, restriction of fats and easily digestible carbohydrates).

observation. With the progression of cataracts, visual acuity correction with lenses is used until surgery. In the postoperative period, correction of the resulting ametropia due to aphakia is shown. Due to the rapid changes in postoperative visual acuity, frequent examinations and appropriate correction are necessary.

Short description

Cataract- partial or complete clouding of the substance or capsule of the lens, leading to a decrease in visual acuity up to its almost complete loss. Frequency. Senile cataract accounts for more than 90% of all cases. 52-62 years old - 5% of people. 75-85 years old - 46% have a significant decrease in visual acuity (0.6 and below). In 92%, the initial stages of cataract can be detected. Incidence: 320.8 per 100,000 population in 2001

The reasons

Risk factors. Age over 50 years. The presence of diabetes, hypoparathyroidism, uveitis, systemic diseases of the connective tissue. Lens injury. History of cataract removal (secondary cataract).

Stages. The initial stage - wedge-shaped opacities are located in the deep layers of the cortex of the peripheral parts of the lens, gradually merge along its equator, moving towards the axial part of the cortex and towards the capsule. Immature (swelling) stage - opacities occupy only part of the lens cortex; signs of its hydration are observed: an increase in the volume of the lens, a decrease in the depth of the anterior chamber of the eye, in some cases an increase in IOP. Mature stage - opacities occupy all layers of the lens, vision is reduced to light perception. Overripe - the last stage of development of senile cataract, characterized by dehydration of the clouded lens, a decrease in its volume, compaction and degenerative degeneration of the capsule.

Classification by etiology

congenital

Acquired .. Senile - dystrophic processes in the substance of the lens. Types of senile cataract... Stratified - clouding is located between the surface of the mature nucleus and the anterior surface of the embryonic nucleus of the lens... Dairy (Morganian cataract) is characterized by the transformation of the clouded cortical layers of the lens substance into a milky-white liquid; the nucleus of the lens moves when the position of the eyeball changes ... Brown cataract (Bourle's cataract) is characterized by diffuse clouding of the lens nucleus and the gradual development of sclerosis, and then clouding of its cortical layers with the acquisition of a brown color of various shades, up to black ... Nuclear cataract is characterized by diffuse homogeneous opacification of the lens nucleus... Posterior capsular cataract - opacification is located in the central parts of the posterior capsule in the form of frost deposition on the glass. myopia, uveitis, melanoma, retinoblastoma), skin diseases (dermatogenic), long-term use of GCs (steroid) .. Copper (lens chalcosis) - anterior subcapsular cataract that occurs when there is a foreign body containing copper in the eyeball and is caused by the deposition of its salts in the lens; with ophthalmoscopy, clouding of the lens is observed, resembling a sunflower flower. .. Traumatic cataract - mechanical impact, exposure to heat (infrared radiation), electric shock (electrical), radiation (radiation), concussion (contusion cataract) ... Hemorrhagic cataract - due to impregnation of the lens with blood; rarely observed ... Ring-shaped cataract (Fossius cataract) - clouding of the anterior part of the lens capsule observed after contusion of the eyeball, due to the deposition of iris pigment particles on it ... Luxed - with dislocation of the lens ... Perforation - with damage to the lens capsule (usually , progresses) ... Rosette - turbidity of the pinnate appearance is located in a thin layer under the lens capsule along the seams of its cortex ... Subluxed - with subluxation of the lens. . Secondary - occurs after cataract removal; in this case, clouding of the posterior capsule of the lens occurs, usually left during its removal ... True (residual) - cataract, caused by leaving elements of the lens in the eye during extracapsular cataract extraction ... False cataract - clouding of the anterior border plate of the vitreous body, due to cicatricial changes after intracapsular cataract extraction.

Classification according to localization in the lens substance. Capsular. Subcapsular. Cortical (anterior and posterior). Zonular. Cup-shaped. Complete (total).

Symptoms (signs)

Clinical picture

Diagnostics

Laboratory research. Examination of peripheral blood for glucose and calcium. Biochemical blood test with the definition of RF, ANAT and other indicators in the presence of a characteristic clinical picture. Active detection of tuberculosis.

Differential diagnosis. Other causes of decreased visual acuity are superficial clouding of the cornea due to cicatricial changes, tumors (including retinoblastoma requiring immediate surgical treatment due to a high risk of metastasis), retinal detachment, retinal scars, glaucoma. A biomicroscopic or ophthalmoscopic examination is indicated. Visual impairment in the elderly often occurs due to the interaction of several factors, such as cataracts and macular degeneration, therefore, when establishing the cause of visual acuity loss, one should not be limited to identifying only one pathology.

Surgery. The main indication for surgical treatment is visual acuity below 0.1-0.4. The main types of surgical treatment are extracapsular extraction or cataract phacoemulsification. The issue of intraocular lens implantation is decided individually. Contraindications .. Severe somatic diseases (tuberculosis, collagenosis, hormonal disorders, severe forms of diabetes) .. Concomitant eye pathology (secondary uncompensated glaucoma, hemophthalmia, recurrent iridocyclitis, endophthalmitis, retinal detachment). Postoperative care.. For 10-12 days, a bandage is applied with daily dressing.. After removing the bandage, 3-6 r / day, instill antibacterial, mydriatic drugs, HA.. Stitches are removed after 3-3.5 months.. Heavy lifting should be avoided. , slopes for several weeks .. Optical correction is prescribed after 2-3 months.

Drug therapy(only by appointment of an ophthalmologist). To slow down the development of cataracts (to improve the trophism of the lens) - eye drops: cytochrome C + sodium succinate + adenosine + nicotinamide + benzalkonium chloride, azapentacene.

Complications. Exotropia. Phacogenic glaucoma.

Current and forecast. In the absence of primary eye disease and cataract extraction, the prognosis is favorable. Progressive development leads to a complete loss of object vision.

Associated pathology. SD. Hypoparathyroidism. Systemic connective tissue diseases. Eye diseases (myopia, glaucoma, uveitis, retinal detachment, pigmentary retinal degeneration).

ICD-10. H25 Senile cataract. H26 Other cataracts.

Application. Galactosemia- congenital metabolic disorders in the form of galactosemia, the development of cataracts, hepatomegaly, mental retardation. Characterized by vomiting, jaundice. Possible sensorineural hearing loss, hypogonadotropic hypogonadism, hemolytic anemia. The reasons congenital deficiency of galactokinase (230200, EC 2.7.1.6), galactose epimerase (*230350, EC 5.1.3.2) or galactose-1-phosphate uridyltransferase (*230400, EC 2.7.7.10). ICD-10. E74.2 Disorders of galactose metabolism.

Artifakia Code Mkb

Artifakia. artifakia - lens held earlier. pseudophakia with other diseases of both or better seeing eyes of the eye. Code according to ICD 10. International Classification of Diseases 10th revision (ICD-10, By code, Enter at least three characters of the name or characters of the nosology code.

Class III - Diseases of the blood, hematopoietic organs and certain disorders involving the immune mechanism (164) >. Class XV - Pregnancy, childbirth and the puerperium (423) >. Class XVI - Certain conditions arising in the perinatal period (335) >.

Artifakia of the right eye. Primary cataract Russian Artifakia mkb 10 Artifakia of the eye mkb English Artifakia of the eye code mkb.

ICD 10 code: H26 Other cataracts. If it is necessary to identify the cause, use an additional external cause code (class XX). ICD code - 10. H 52.4. Signs and criteria for diagnosis: Presbyopia - senile farsightedness. Develops due to progressive loss. Artifakia. (ICB H25-H28). The degree of violation of body functions, Clinical and functional characteristics of disorders, Degree of limitation.

Class XVII - Congenital anomalies [malformations], deformities and chromosomal abnormalities (624) >. Class XVIII - Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (330) >.

Class XIX - Injury, poisoning, and certain other effects of external causes (1278) >. Class XX - External causes of morbidity and mortality (1357) >.

ICb code 10 post-traumatic cataract

Note. All neoplasms (both functionally active and inactive) are included in class II. Appropriate codes in this class (for example, E05.8, E07.0, E16-E31, E34.-) can be used as additional codes, if necessary, to identify functionally active neoplasms and ectopic endocrine tissue, as well as hyperfunction and hypofunction of the endocrine glands, associated with neoplasms and other disorders classified elsewhere.

Excludes: complications of pregnancy, childbirth and the puerperium (O00-O99) symptoms, signs and abnormal findings in clinical and laboratory investigations, not elsewhere classified (R00-R99) transient endocrine and metabolic disorders specific to the fetus and newborn (P70-P74)

This class contains the following blocks:

E00-E07 Diseases of the thyroid gland

E10-E14 Diabetes mellitus

E15-E16 Other disorders of glucose regulation and pancreatic endocrine secretion

E20-E35 Disorders of other endocrine glands

E40-E46 Malnutrition

E50-E64 Other types of malnutrition

E65-E68 Obesity and other types of malnutrition

E70-E90 Metabolic disorders

The following categories are marked with an asterisk:

E35 Disorders of the endocrine glands in diseases classified elsewhere

E90 Nutritional and metabolic disorders in diseases classified elsewhere

E10-E14 DIABETES

If necessary, to identify the drug that caused diabetes, use an additional external cause code (class XX).

The following fourth characters are used with categories E10-E14:

.1 With ketoacidosis

Diabetic:

.2+ With kidney damage

.3+ With eye lesions

.4+ With neurological complications

Diabetic:

.5 With peripheral circulatory disorders

.6 With other specified complications

.7 With multiple complications

.8 With unspecified complications

.9 No complications

E15-E16 OTHER DISORDERS OF GLUCOSE AND PANCREATIC INTERNAL SECRETION

Excludes: galactorrhea (N64.3) gynecomastia (N62)

Note. The degree of malnutrition is usually assessed in terms of body weight, expressed in standard deviations from the mean value for the reference population. Lack of weight gain in children, or evidence of weight loss in children or adults with one or more previous body weight measurements, is usually an indicator of malnutrition. If there is evidence from only a single measurement of body weight, the diagnosis is based on assumptions and is not considered definitive unless other clinical and laboratory studies are performed. In exceptional cases, when there is no information about body weight, clinical data are taken as the basis. If the individual's body weight is below the mean for the reference population, then severe malnutrition is highly likely when the observed value is 3 or more standard deviations below the mean for the reference group; moderate malnutrition if the observed value is 2 or more but less than 3 standard deviations below the mean, and mild malnutrition if the observed body weight is 1 or more but less than 2 standard deviations below the mean for the reference group.

Excludes: intestinal malabsorption (K90.-) nutritional anemia (D50-D53) consequences of protein-energy malnutrition (E64.0) wasting disease (B22.2) starvation (T73.0)

Excludes: nutritional anemia (D50-D53)

E70-E90 METABOLIC DISORDERS

Excludes: androgen resistance syndrome (E34.5) congenital adrenal hyperplasia (E25.0) Ehlers-Danlos syndrome (Q79.6) hemolytic anemia due to enzyme disorders (D55.-) Marfan syndrome (Q87.4) 5-alpha-deficiency reductase (E29.1)

Arterial hypertension - ICD code 10

Cardiovascular diseases occupy a leading position in terms of prevalence. This is due to stress, unfavorable environmental conditions, heredity and other factors.

Arterial hypertension code according to ICD-10

The separation depends on the causes and severity of the disease, the age of the victim, damaged organs, etc. Doctors around the world use it to systematize and analyze the clinical course of the disease.

According to the International Classification, an increase in blood pressure is included in the extensive section "Diseases characterized by increased blood pressure" code I10-I15:

I10 Primary hypertension:

I11 Hypertension causing predominantly damage to the heart

I12 Hypertension causing predominantly kidney damage

I13 Hypertension causing predominant damage to the heart and kidneys

I15 Secondary (symptomatic) hypertension includes:

I60-I69 Hypertension involving cerebral vessels.

H35 With damage to the vessels of the eye.

I27.0 Primary pulmonary hypertension

P29.2 In a newborn.

20-I25 With damage to the coronary vessels.

O10 Pre-existing hypertension complicating pregnancy, childbirth and the puerperium

O11 Pre-existing hypertension with associated proteinuria.

O13 Pregnancy-induced without significant proteinuria

O15 Eclampsia

O16 Exlampsia in mother, unspecified.

Definition of hypertension

What is a disease? This is a persistent increase in blood pressure with indicators of at least 140/90. The disease is characterized by a deterioration in the general condition. In medicine, there are 3 degrees of hypertension:

Blood puts more pressure on the vessels, over time, the heart becomes larger due to the load. The left muscle expands and thickens.

Types of classifications

Essential hypertension

In another way, it is called primary. The disease is dangerous because it is constantly progressing. The entire body is damaged.

In 90% of cases, the cause of the disease cannot be found. Most experts believe that the onset of development is caused by some factors, and the transition to a stable form is caused by others.

The following prerequisites for primary hypertension are distinguished:

Symptoms of essential hypertension:

The disease goes through several stages:

1. The first is a periodic increase in blood pressure. Organs are not damaged.
2. There is a persistent increase in blood pressure. The condition is normalized after taking medication. Possible hypertensive crises.
3. The most dangerous period. It is characterized by complications in the form of heart attacks, strokes. The pressure is reduced after a combination of different means.

Arterial hypertension with heart damage

This form of the disease is typical for people over 40 years old. It is caused by an increase in intravascular tension, accompanied by an increase in heart rate and stroke volume.

If the necessary actions are not taken in a timely manner, then hypertrophy (an increase in the size of the left ventricle) is possible. The body needs oxygen.

The characteristic symptoms of this disease are:

• Compressive pain behind the sternum in the form of seizures;
• Dyspnea;
• Angina.

There are three stages of heart damage:

• No damage.
• Enlargement of the left ventricle.
• Heart failure of various degrees.

If even one of the symptoms is found, it is necessary to contact a specialist to solve the problem. If you do not deal with this issue, then a myocardial infarction is possible.

Hypertension with kidney damage

The ICD-10 code corresponds to I12.

What is the relationship between these organs? What are the causes and signs of the disease?

The kidneys act as a filter, helping to remove decay products from the body. If their functioning is disturbed, fluid accumulates, the walls of blood vessels increase. This contributes to hypertension.

The task of the kidneys is to regulate the water-salt balance. In addition, thanks to the production of renin and hormones, they control the activity of blood vessels.

Causes of the disease:

• Stressful situations, nervous strain.
• Unbalanced nutrition.
• Nephrological ailments of various origins (chronic pyelonephritis, urolithiasis, cysts, tumors, etc.).
• Diabetes.
• Abnormal structure and development of the kidneys and adrenal glands.
• Congenital and acquired vascular pathologies.
• Failure of the thyroid gland, pituitary gland, central nervous system.

Hypertension with damage to the heart and kidneys

In this case, the following conditions are distinguished separately:

• hypertension with damage to the heart and kidneys with heart failure (I13.0);
• GB with a predominance of nephropathy (I13.1);
• hypertension with heart and kidney failure (I13.2);
• HD involving the kidneys and heart, unspecified (I13.9).

For diseases of this group, violations of both organs are characteristic. Doctors assess the condition of the victim as severe, requiring constant monitoring and taking appropriate medications.

Symptomatic hypertension

Another naming is secondary, since it is not an independent disease. It is formed as a result of dysfunction of several organs at the same time. This form occurs in 15% of cases of hypertension.

The symptomatology depends on the disease against which it appeared. Signs:

• Increased blood pressure.
• Headache.
• Noise in ears.
• Unpleasant sensations in the region of the heart, etc.

Vascular pathology of the brain and hypertension

An increase in ICP is a fairly common form of the disease. It is formed due to the accumulation of fluid inside the skull. Causes of occurrence:

• Sealing of the walls of blood vessels.
• Atherosclerosis. Caused by failure of fat metabolism.
• Tumors and hematomas, which, when enlarged, compress nearby organs, disrupt blood flow.

and other types, if any

Hypertension with damage to the vessels of the eyes.

An increase in blood pressure entails pathological processes in the visual organ: the retinal arteries become denser and can be damaged. Prolonged ignoring of the symptoms leads to hemorrhage, swelling, complete or partial loss of vision.

There are a lot of factors contributing to the appearance and development of arterial hypertension. Among them are:

• Heredity;
• Dysfunction of the thyroid gland;
• Disease of the central nervous system;
• Traumatic brain injury;
• Diabetes;
• Overweight;
• Excessive alcohol consumption;
• Psycho-emotional disorders;
• Hypodynamia;
• Menopause.

Symptoms

Unfortunately, hypertension can be latent for a long time.

General signs of the disease:

• Increased blood pressure.
• Irritability.
• Head and heart pains.
• Insomnia.
• fatigue.

Additional symptoms:

• dyspnea,
• obesity,
• murmurs in the heart area,
• rare urination,
• increased sweating,
• stretch marks,
• liver enlargement,
• limb edema,
• labored breathing,
• nausea,
• malfunction of the central nervous system and digestion,
• ascites

How to recognize arterial hypertension?

The main difference of any of the forms is the increase in pressure. When examining a patient, procedures such as:

• blood chemistry;
• An electrocardiogram, which may indicate left ventricular enlargement;
• EchoCG. Detects thickening of blood vessels, the condition of the valves.
• Arteriography.
• Dopplerography. Reflects the assessment of blood flow.

Treatment

When the first signs of the disease appear, it is necessary to contact a therapist who will study the history of the disease, prescribe the appropriate diagnosis and give a referral to another doctor, usually a cardiologist. The course of treatment depends on the form of hypertension, lesions. Of the drugs prescribed are the following:

• diuretics;
• means to reduce pressure;
• statins directed against "bad" cholesterol;
• blockers for blood pressure and reducing the oxygen that the heart uses;
• aspirin. Prevents the formation of blood clots.

In addition to medication, the patient must adhere to a certain diet. What is its essence?

• Restriction or complete exclusion of salt.
• Replacement of animal fats with vegetable ones.
• Refusal of certain types of meat, spicy foods, preservatives, marinades.
• Stop smoking and drinking alcoholic beverages.

As preventive measures, it is necessary to control weight, adhere to a healthy lifestyle, walk more in the fresh air, play sports, organize the correct daily routine (alternating work and rest), and avoid stressful situations.

You can also use folk methods. But remember that a preliminary consultation with a specialist is necessary.

Since ancient times, chamomile, lemon balm, valerian, mint have been used as sedatives, and rosehip tincture will help in removing excess fluid from the body.

Clouding of the lens of the eye, leading to loss of vision.

Most often cataract develops in people over the age of 75, but there are also cases of congenital cataracts. Sometimes cause cataracts becomes a chromosomal abnormality. Risk factors include contact sports and frequent sun exposure. Gender doesn't matter.

At cataract the lens of the eye, normally transparent, becomes cloudy as a result of changes that occur with the protein fibers of the lens. In cases of congenital cataracts possible complete loss of vision. However, children and young people rarely suffer from this condition. Most people over the age of 75 cataract is formed to varying degrees, but if the disease has affected only the outer edge of the lens, the loss of vision is minimal.

In most cases cataract develops in both eyes, but one of the eyes is damaged to a greater extent.

All varieties cataracts arise as a result of structural changes in the protein fibers of the lens, which leads to its complete or partial clouding.

Changes in protein fibers are part of the normal aging process, but development cataracts can also occur at a younger age, as a result of an eye injury or prolonged exposure to bright sun. The reason for the appearance cataracts may become, or long-term treatment with corticosteroid drugs. Often found in people suffering.

Usually cataract develops over months or even years. In most cases cataract proceeds painlessly. Manifesting symptoms cataracts relate only to the quality of vision and include:

Blurry or distorted vision;

The appearance of an areola around a bright light source in the form of a cluster of stars, especially at night;

A change in color perception, as a result of which objects are seen reddish or yellowish.

People who are farsighted may temporarily improve their near vision.

In severe cases cataracts a cloudy lens can be seen through the pupil of the eye.

To confirm the diagnosis, the doctor performs an eye examination using a slit lamp and an ophthalmoscope. If visual impairment is significant, remove cataract surgically with the implantation of an artificial lens. If a cataract- the only reason for the weakening of vision, after the operation there should be a significant improvement in it, but subsequently the patient may need glasses.

Treatment standards:

The Ministry of Health and Social Development of the Russian Federation has developed a set of standards for the provision of outpatient, inpatient and sanatorium care to patients with various diseases

These standards are a formalized description of the minimum required amount of medical care that should be provided to a patient with a specific nosological form (disease), syndrome, or in a specific clinical situation.

The approved standards of medical care form the regulatory framework for the multi-level system of normative documents being created in the Russian Federation that regulates the provision of medical care to patients: patient management protocols at the national (federal) level; clinical and economic protocols at the level of the region and municipality; clinical protocols of a medical organization. It is assumed that as this multilevel system is formed, the requirements of these standards will be revised and become part of the protocols for managing patients with the corresponding diseases.

MINISTRY OF HEALTH AND SOCIAL DEVELOPMENT OF THE RUSSIAN FEDERATION

ON APPROVAL OF THE STANDARD OF MEDICAL CARE FOR PATIENTS WITH CATARACT

In accordance with Art. 40 Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens of July 22, 1993 No. 5487-1 (Bulletin of the Congress of People's Deputies of the Russian Federation and the Supreme Council of the Russian Federation, 1993, No. 33, Art. 1318; Collection of Legislation of the Russian Federation, 2003, No. 2, article 167; 2004, No. 35, article 3607; 2005, No. 10, article 763)

I ORDER:

1. Approve the attached standard of care for patients with cataracts.

2. Recommend the heads of federal specialized medical institutions to use the standard of medical care for patients with cataracts when providing expensive (high-tech) medical care.

Deputy Minister

IN AND. STARODUBOV

APPENDIX

to the order of the Ministry of Health and Social Development of the Russian Federation dated September 6, 2005 No. 550

STANDARD OF MEDICAL CARE FOR PATIENTS WITH CATARACT

1. PATIENT MODEL

ICD-10 code: H25; H26.0; H26.1; H28; H28.0

Phase: any

Stage: immature and mature

Complication: without complications or complicated by lens subluxation, glaucoma, pathology of the vitreous body, retina, choroid.

Condition of rendering: inpatient care, surgical department.

1.1. DIAGNOSTICS

The code	Name	Delivery frequency	Average quantity
А01.26.001		1	1
А01.26.002	Visual examination of the eyes	1	1
А01.26.003	Palpation for eye pathology	1	1
А02.26.001		1	1
A02.26.002		1	1
А02.26.003	Ophthalmoscopy	1	1
А02.26.004	Visometry	1	1
А02.26.005	Perimetry	0,9	1
А02.26.013	Determination of refraction with a set of trial lenses	0,5	1
А02.26.014	Skiascopy	0,2	1
А02.26.015	Tonometry of the eye	1	1
A03.26.001	Biomicroscopy of the eye	1	1
A03.26.002	Gonioscopy	0,25	1
A03.26.007	Laser retinometry	0,6	1
А03.26.008	Refractometry	0,2	1
А03.26.009	Ophthalmometry	1	1
A03.26.012	Examination of the posterior corneal epithelium (PER)	0,2	1
A03.26.015	Tonography	0,2	1
A03.26.001		1	1
A04.26.004	Ultrasound biometrics of the eye	1	1
А05.26.001		0,9	1
А05.26.002		0,2	1
А05.26.003		1	1
А05.26.004		1	1
А06.26.001	Orbital x-ray	0,01	1
А06.26.005	Radiography of the eyeball with a Komberg-Baltin indicator prosthesis	0,005	1


1.2. TREATMENT AT THE CALCULATION OF 6 DAYS

The code	Name	Delivery frequency	Average quantity
А01.26.001	Collection of anamnesis and complaints in case of eye pathology	1	8
А01.26.002	Visual examination of the eyes	1	8
А01.26.003	Palpation for eye pathology	1	8
А02.26.001	Examination of the anterior segment of the eye by lateral illumination	1	8
A02.26.002	Study of the media of the eye in transmitted light	1	8
А02.26.003	Ophthalmoscopy	1	8
А02.26.004	Visometry	1	8
А02.26.005	Perimetry	1	1
А02.26.006	Campimetry	0,05	1
А02.26.015	Tonometry of the eye	1	1
A03.26.001	Biomicroscopy of the eye	1	5
A03.26.002	Gonioscopy	0,25	2
А03.26.018	Biomicroscopy of the fundus	1	5
А03.26.021	Computer perimetry	0,25	1
А03.26.019	Optical examination of the retina using a computer analyzer	0,05	1
А04.26.001	Ultrasound examination of the eyeball	1	2
А05.26.001	Registration of an electroretinogram	0,2	1
А05.26.002	Registration of visual evoked potentials of the cerebral cortex	0,01	1
А05.26.003	Registration of sensitivity and lability of the visual analyzer	0,01	1
А05.26.004	Decoding, description and interpretation of data from electrophysiological studies of the visual analyzer	0,2	1
А11.02.002	Intramuscular administration of drugs	0,5	5
A11.05.001	Taking blood from a finger	1	1
А11.12.009	Taking blood from a peripheral vein	1	1
A11.26.011	Para- and retrobulbar injections	0,9	3
А14.31.003	Transportation of a seriously ill person within the institution	1	1
A15.26.001	Dressings for operations on the organ of vision	1	5
A15.26.002	Applying a monocular and binocular dressing (stickers, curtains) to the orbit	1	5
А16.26.070	Trabeculectomy (sinustrabeculectomy)	0,07	1
A16.26.089	vitreectomy	0,05	1
А16.26.094	Intraocular lens implantation	1	1
А16.26.093	phacoemulsification, phacofragmentation, phacoaspiration	0,95	1
A16.26.092. 001	Laser extraction of the lens	0,05	1
A16.26.114	Non-penetrating deep sclerectomy	0,06	1
A16.26.107	Deep sclerectomy	0,06	1
A17.26.001	Electrophoresis of drugs in diseases of the organ of vision	0,001	5
A22.26.017	Endolasercoagulation	0,005	1
A23.26.001	Spectacle correction selection	1	1
A25.26.001	The appointment of drug therapy for diseases of the organs of vision	1	1
A25.26.002	Prescribing dietary therapy for diseases of the organs of vision	1	1
А25.26.003	Appointment of a therapeutic regimen for diseases of the organs of vision<	1	1
В01.003.01	Examination (consultation) of an anesthesiologist	1	1
В01.003.04	Anesthesia support (including early postoperative management)	1	1
В01.028.01	Primary appointment (examination, consultation) with an otorhinolaryngologist	1	1
В01.031.01	Reception (examination, consultation) of a pediatrician primary	0,05	1
В01.031.02	Repeated appointment (examination, consultation) with a pediatrician	0,05	1
В01.047.01	Reception (examination, consultation) of a general practitioner primary	0,95	1
В01.047.02	Repeated appointment (examination, consultation) with a general practitioner	0,02	1
В01.065.01	Appointment (examination, consultation) of a dentist therapist primary	1	1
B02.057.01	Nursing Procedures in Preparing a Patient for Surgery	1	1
B03.003.01	A complex of preoperative studies for a planned patient	1	1
B03.003.03	A set of studies during artificial lung ventilation	0,5	1
B03.016.03	General (clinical) blood test detailed	1	1
B03.016.04	General therapeutic biochemical blood test	1	1
В03.016.06	General urinalysis	1	1

Pharmacotherapeutic group	ATX group*	International non-proprietary name	Assignment Frequency	ODD**	ECD***
Anesthetics, muscle relaxants			1
	Means for anesthesia		0,07
		Propofol	1	200 mg	200 mg
	Local anesthetics		1
		Lidocaine	1	160 mg	160 mg
		procaine	1	125 mg	125 mg
	Muscle relaxants		0,07
		Suxamethonium chloride	0,5	100 mg	100 mg
		Pipecuronium bromide	0,5	8 mg	8 mg
Analgesics, non-steroidal anti-inflammatory drugs, drugs for the treatment of rheumatic diseases and gout			1
	Narcotic analgesics		0,07
		Fentanyl	0,5	0.4 mg	0.4 mg
		Trimeperidine	0,5	20 mg	20 mg
	Non-narcotic analgesics and non-steroidal anti-inflammatory drugs		1
		Ketorolac	1	30 mg	30 mg
		Diclofenac sodium	0,2	0.5 mg	3 mg
Medications used to treat allergic reactions			1
	Antihistamines		1
		Diphenhydramine	1	10 mg	10 mg
Means affecting the central nervous system			1
	Sedatives and anxiolytics, drugs for the treatment of psychotic disorders		1
		Diazepam	0,5	60 mg	60 mg
		Midazolam	0,5	5 mg	5 mg
	Other funds		0,1
		flumazenil	1	1 mg	1 mg
Means for the prevention and treatment of infections			1
	Antibacterial agents		1
		Chloramphenicol	0,8	1.25 mg	7.5 mg
		Gentamicin	0,05	1.67 mg	10 mg
		Tobramycin	0.05 mg	1,67	10 mg
		Ciprofloxacin	0,05	1.67 mg	10 mg
		Ceftriaxone	0,05	1 g	6 g
		Sulfacetamide	1	100 mg	600 mg
Drugs affecting the blood			1
	Means affecting the blood coagulation system		1
		Etamzilat	1	500 mg	2 g
Drugs affecting the cardiovascular system			0,9
	Vasopressors		1
		Phenylephrine	1	50 mg	100 mg
Means for the treatment of diseases of the gastrointestinal tract			0,3
	Antispasmodics		0,04
		Atropine	0,5	5 mg	5 mg
		Tropicamide	0,5	5 mg	20 mg
	Antienzymes		0,3
		Aprotinin	1	100000 cues	100000 cues
Hormones and drugs that affect the endocrine system			1
	Non-sex hormones, synthetic substances and antihormones		1
		Dexamethasone	0,95	0.5 mg	3 mg
		Hydrocortisone	0,05	2.5 mg	15 mg
Remedies for the treatment of diseases of the kidneys and urinary tract			0,1
	Diuretics		1
		Acetazolamide	1	0.5 g	1 g
Medicines for the treatment of ophthalmic diseases, not elsewhere specified			1
	Miotics and Glaucoma Treatments		1
		Timolol	0,25	1.25 mg	3.8 mg
		Pilocarpine	0,2	5 mg	15 mg
		Betaxolol	0,05	1.25 mg	3.8 mg
		Brinzolamide	0,25	5 mg	15 mg
		Dorzolamide	0,25	10 mg	30 mg
Solutions, electrolytes, means of correcting acid balance, nutritional products			1
	Electrolytes, means of correcting acid balance		1
		Sodium chloride	1	9 g	9 g
		calcium chloride	0,1	1 g	1 g
		Potassium and magnesium asparaginate	1	500 mg	2 g

*anatomical-therapeutic-chemical classification

RCHD (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical Protocols of the Ministry of Health of the Republic of Kazakhstan - 2017

Congenital cataract (Q12.0), Lens luxation (H27.1), Diabetic cataract (E10-E14+ COMMON FOURTH SIGN.3), Other cataracts (H26), Cataract, unspecified (H26.9), Senile cataract (H25), Traumatic cataract (H26.1)

Ophthalmology

general information

Short description

Approved
Joint Commission on the quality of medical services
Ministry of Health of the Republic of Kazakhstan
dated September 15, 2017
Protocol No. 27

Cataract- any congenital or acquired opacity of the capsule or lens substance, accompanied by a deterioration in its optical properties.

INTRODUCTION

ICD-10 code(s):

Classification

Clinical classification

By time of occurrence:

congenital;
acquired.

Origin:
congenital (intrauterine, hereditary);
age;
Complicated (caused by certain diseases of the eye, general diseases of the body, as a result of side effects of prolonged use of certain drugs or exposure to certain physical or chemical factors);
Traumatic (as a result of a blunt or penetrating eye injury);
secondary cataract - a late complication of cataract surgery, which develops as a result of the migration of Adamyuk-Elschnig balls into the optical zone, fibrosis of the posterior lens capsule.

By localization:
· nuclear;
· cortical;
Zonular
subcapsular;
capsular (anterior, posterior);
complete.

By stage (age-related cataract):
initial;
immature;
· mature;
Overripe (Morganiev).

Separately allocate
swelling cataract- an acute disease, accompanied by hyperhydration of the lens tissues, the occurrence of secondary phacomorphic glaucoma.

Diagnostics

METHODS, APPROACHES AND DIAGNOSIS PROCEDURES

Diagnostic criteria

Complaints and anamnesis
painless progressive decrease in corrected and uncorrected visual acuity,
veil before the eyes
Distortion of the shape of objects
change in refraction
Deterioration of color perception
Violation of deep perception, binocular vision.
In swelling cataract, the presence of acute severe pain in the eye, radiating to the corresponding half of the head.

Physical examination: No.

Laboratory research: no.

Instrumental research:
Visometry: decrease in uncorrected and / or corrected visual acuity;
biomicroscopy: the presence of dystrophic changes in the anterior segment of the eye, clouding of the lens of varying intensity, with a pearly tint. With a swelling cataract, there may be an injection of the eyeball, corneal edema, a shallow anterior chamber;
· ophthalmoscopy: depending on the intensity of opacification, the fundus may not be available for inspection;
Gonioscopy: different degrees of opening of the angle of the anterior chamber, depending on the characteristics of the anterior chamber, the thickness of the lens;
perimetry: in the absence of concomitant pathology of the fundus within the normal range;
Tonometry: within the normal range in the absence of concomitant pathology (glaucoma). With a swelling cataract - an increase in ophthalmotonus;
A-B scan: echographic indicators, in the absence of concomitant pathology, there are no pathological echo signals;
EFI: the results depend on the functional state of the retina and optic nerve;
Spectral endothelial microscopy and pachymetry: the number of endothelial cells (the inner protective layer of corneal cells) per 1 sq. mm. corneal thickness;
· morphometric analysis of the retina: morphometric parameters of the fundus structures;
· ultrasonic biomicroscopy: anatomical and topographic features of the anterior segment (thick lens, position of the lens, features of the angle of the anterior chamber, the state of the posterior chamber, the state of the zonular ligaments, etc.).

Indications for expert advice: 
in the presence of a general pathology, the conclusion of the relevant narrow specialist about the absence of contraindications to surgical treatment is necessary. Without fail, the conclusion of the otolaryngologist and dentist for the absence of chronic foci of infection.

Diagnostic algorithmwith cataract:

Differential Diagnosis

Differential diagnosis and rationale for additional studies:

Treatment abroad

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Treatment

Drugs (active substances) used in the treatment

Treatment (ambulatory)

TACTICS OF TREATMENT AT THE OUTPATIENT LEVEL
Treatment tactics depend on the degree of clouding of the lens. With a slight decrease in vision and initial opacities, it is possible to observe in dynamics with drug treatment in order to slow down the progression of cataracts. If there are indications for surgical treatment, referral to a day hospital or a round-the-clock hospital.

Non-drug treatment:
Mode - III B.
Diet - table number 15 (in the absence of concomitant diseases), the corresponding correction of ametropia.

Medical treatment: on an outpatient basis, it is performed at the initial stages of cataract in order to reduce its progression, with the appointment of drugs that stimulate metabolic processes. And also, for the purpose of pharmacological support of the postoperative period with the appointment of anti-inflammatory and antibacterial drugs.

List of Essential Medicines(having a 100% cast chance):

Treatment (hospital)

TACTICS OF TREATMENT AT THE STATIONARY LEVEL

Treatment for cataract

FEC + IOL
Femtolaser cataract extraction with intraocular lens implantation (FLEK with IOL implantation)
Tunneled extracapsular cataract extraction with or without IOL implantation

Phacoemulsification of cataract with implantation of VKK and IOL

Cataract phacoemulsification with or without IOL implantation with ranscleral fixation

Femtolaser cataract extraction with intraocular lens implantation (FLEK with IOL implantation) + VKK

Tunneled extracapsular cataract extraction with or without IOL implantation with transcleral fixation

Intracapsular cataract extraction with anterior vitrectomy + IOL implantation with transcleral fixation

Non-drug treatment:
Mode 4;
Diet: taking into account the presence or absence of concomitant diseases;
appropriate correction of ametropia.

Medical treatment: In the postoperative period, pharmacological support is carried out with the appointment of antibacterial and anti-inflammatory therapy. With high intraocular pressure, dehydration and local antihypertensive therapy are prescribed.
· Preoperative preparation
List of essential medicines (having 100% probability of use)

List of additional medicines (less than 100% probability of use)

cataract phacoemulsification with or without IOL implantation;
femtolaser cataract extraction with intraocular lens implantation (FLEK with IOL implantation);
phacoemulsification of cataract with implantation of ICC and IOL;
Phacoemulsification of cataracts with or without IOL implantation with transcleral fixation;
tunnel extracapsular cataract extraction with or without IOL implantation;
Tunnel extracapsular cataract extraction with or without IOL implantation with transcleral fixation;
extracapsular cataract extraction with or without IOL implantation;
Intracapsular cataract extraction with anterior vitrectomy + IOL implantation with transcleral fixation.

Further management:
Outpatient follow-up with an ophthalmologist within 10 days, 1, 3, 6, 12 months from the date of surgery;
instillation of antibacterial and anti-inflammatory drugs for 2 weeks to 1 month after surgery;
if necessary, selection of spectacle correction within 3 months from the date of surgery;
In the presence of a concomitant disease, regular monitoring of the latter.

Treatment effectiveness indicators:
absence of inflammatory reaction of the eye in the early postoperative period;
Finding the IOL during its implantation in the capsular bag, in the sulcus or in the anterior / posterior chamber, depending on the chosen IOL model;
restoration of the transparency of the optical media of the eye as a result of cataract removal.

Improvement of visual functions as a result of cataract surgery is characterized by:
improvement of corrected visual acuity;
Improving uncorrected visual acuity and reducing dependence on glasses;
Improving the ability to read and work close;
Improving sensitivity to blinding light;
Improvement of deep perception and binocular vision, elimination of anisometropia and good functional visual acuity in both eyes;
Improvement in color perception.

Improving physical capabilities as a result of cataract surgery is characterized by:
Increased ability to carry out daily activities;
· increased ability to maintain or resume employment;
Increased mobility (walking, driving).

Improvement in mental health and emotional well-being as a result of surgical treatment can be characterized by:
Improving self-esteem of independence;
Improving the ability to avoid injury;
increase in social contacts and the ability to participate in social activities;
liberation from the fear of blindness;

Hospitalization

INDICATIONS FOR HOSPITALIZATION WITH INDICATING THE TYPE OF HOSPITALIZATION:

Indications for planned hospitalization

a decrease in visual function that no longer satisfies the needs of the patient and surgery implies a reasonable likelihood of improvement in vision;
the presence of clinically significant anisometropia in the presence of cataracts;
clouding of the lens, which makes it difficult to optimally diagnose and treat the pathology of the posterior segment of the eye;
Phacogenic uveitis or secondary glaucoma (phacolysis, phacoanaphylaxis);
The lens contributes to the closure of the angle of the anterior chamber (phacomorphic);
Subluxation of the lens with cataract elements and / or with ophthalmohypertension.

Indications for emergency hospitalization(day hospital level, except for cases subject to treatment according to HTMS):
swelling cataract.

Information

Sources and literature

1. Minutes of the meetings of the Joint Commission on the quality of medical services of the Ministry of Health of the Republic of Kazakhstan, 2017
   1. 1) American Academy of Ophthalmology. guideline. Cataract in the Adult Eye. 2001 2) Panchapakesan J, Mitchell P, Tumuluri K, et al. Five year incidence of cataract surgery: the Blue Mountains Eye Study. Br J Ophthalmol 2008;87:168-72 3) Leske MC, Wu SY, Nemesure B, et al. Nine-year incidence of lens opacities in the Barbados Eye Studies. Ophthalmology 2010;111:483-90 4) McCarty CA, Mukesh BN, Dimitrov PN, Taylor HR. Incidence and progression of cataract in the Melbourne Visual Impairment Project. Am J Ophthalmol 2011;136:10-7 5) Yamaguchi T, Negishi K, Tsubota K. Functional visual acuity measurement in cataract and intraocular lens implantation. CurrOpinOphthalmol 2011;22:31-6. 6) Gus PI, Kwitko I, Roehe D, Kwitko S. Potential acuity meter accuracy in cataract patients. J Cataract Refract Surg 2010;26:1238-41 7) 7. Huang HY, Caballero B, Chang S, et al. Multivitamin/Mineral Supplements and Prevention of Chronic Disease. Evidence Report/Technology Assessment No. 139. (Prepared by The Johns Hopkins University Evidence-Based Practice Center under Contract No. 290-02-0018.) AHRQ Publication No. 06-E012. Rockville, MD: Agency for Healthcare Research and Quality. May 2009. 8) 8. Findl O, Kriechbaum K, Sacu S, et al. Influence of operator experience on the performance of ultrasound biometry compared to optical biometry before cataract surgery. J Cataract Refract Surg 2010;29:1950-5 9) 9. Eleftheriadis H. IOLMaster biometry: refractive results of 100 consecutive cases. Br J Ophthalmol 2011;87:960-3 10) Analeyz, Inc. 2010 survey practice styles and preferences of U.S. ASCRS members. Available at: www.analeyz.com/. Accessed June 24, 2011 11) Liyanage SE, Angunawela RI, Wong SC, Little BC. Anterior chamber instability caused by incisional leakage in coaxial phacoemulsification. J Cataract Refract Surg 2011;35:1003-5. 12) Bissen-Miyajima H. ​​Ophthalmic viscosurgical devices. CurrOpinOphthalmol 2011;19:50-4. 13) Gimbel HV, Neuhann T. Development, advantages, and methods of the continuous circular capsulorhexis technique. J Cataract Refract Surg 2012;16:31-7. 14. Nixon DR. In vivo digital imaging of the square-edged barrier effect of a silicone intraocular lens. J Cataract Refract Surg 2011;30:2574-84 14) Koch DD, Liu JF. Multilamellarhydrodissection in phacoemulsification and planned extracapsular surgery. J Cataract Refract Surg 2011;16:559-62. 15) Peng Q, Apple DJ, Visessook N, et al. Surgical prevention of posterior capsule opacification. Part 2: Enhancement of cortical cleanup by focusing on hydrodissection. J Cataract Refract Surg 2010;26:188-97. 16) Vasavada AR, Dholakia SA, Raj SM, Singh R. Effect of cortical cleaving hydrodissection on posterior capsule opacification in age-related nuclear cataract. J Cataract Refract Surg 2010;32:1196-200. 17) Gimbel H.V. Divide and conquer nucleofractis phacoemulsification: development and variations. J Cataract Refract Surg 2011;17:281-91. 18) Packer M, Fine IH, Hoffman RS, Smith JH. Techniques of phacoemulsification. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology on DVD-ROM. 2012 edition. Philadelphia, PA: Lippincott Williams & Wilkins, 2012. 19) Mardelli PG, Mehanna CJ. Phacoanaphylacticendophthalmitis secondary to capsular block syndrome. J Cataract Refract Surg 2012;33:921-2. 124 20) Chang DF, Masket S, Miller KM, et al, ASCRS Cataract Clinical Committee Complications of sulcus placement of single-piece acrylic intraocular lenses: recommendations for backup IOL implantation following posterior capsule rupture J Cataract Refract Surg 2012;35: 1445-58 21) Hoffman RS, Fine IH, Packer M. Scleral fixation without conjunctival dissection J Cataract Refract Surg 2012;32:1907-12 22) Rainer G, Stifter E, Luksch A, Menapace R. Comparison of the effect of Viscoat and DuoVisc on postoperative intraocular pressure after small-incision cataract surgery J Cataract Refract Surg 2012;34:253-7 23) Lundstrom M, Wejde G, Stenevi U, et al Endophthalmitis after cataract surgery: a nationwide prospective study evaluating incidence in relation to incision type and location. Ophthalmology 2012;114:866-70. 24) Fine IH, Hoffman RS, Packer M. Profile of clear corneal cataract incisions demonstrated by ocular coherence tomography. J Cataract Refract Surg 2012;33:94-7. 26. Vasavada AR, Praveen MR, Pandita D, et al. Effect of stromal hydration of clear corneal incisions: quantifying ingress of trypan blue into the anterior chamber after phacoemulsification. J Cataract Refract Surg 2011;33:623-7. 25) Deramo VA, Lai JC, Winokur J, et al. Visual outcome and bacterial sensitivity after methicillin-resistant Staphylococcus aureus-associated acute endophthalmitis. Am J Ophthalmol 2012;145:413-7. 26) Altan T, Acar N, Kapran Z, et al. Acute-onset endophthalmitis after cataract surgery: success of initial therapy, visual outcomes, and related factors. Retina 2012;29:606-12. 27) American Academy of Ophthalmology. Code of Ethics; rules of ethics #7 and #8. Available at: www.aao.org/about/ethics/code_ethics.cfm. Accessed May 4, 2011. 28) Lemley CA, Han DP. Endophthalmitis: a review of current evaluation and management. Retina 2012;27:662-80 29) Kernt M, Kampik A. Endophthalmitis: pathogenesis, clinical presentation, management, and perspectives. ClinOphthalmol 2011;4:121-35 30) Wallin T, Parker J, Jin Y, et al. Cohort study of 27 cases of endophthalmitis at a single institution. J Cataract Refract Surg 2011;31:735-41.

Information

ORGANIZATIONAL ASPECTS OF PROTOCOL IMPLEMENTATION

List of protocol developers:
1) Bulgakova Almira Abdulkhakovna - candidate of medical sciences, doctor of the highest category of JSC "Kazakh Research Institute of Eye Diseases".
2) Tuletova Aigerim Serikbaevna - candidate of medical sciences, doctor of the highest category, director of JSC "Kazakh Research Institute of Eye Diseases" branch of Astana.
3) Zhakybekov Ruslan Adilovich - candidate of medical sciences, doctor of the highest category of JSC "Kazakh Research Institute of Eye Diseases" branch of Astana.
4) Urich Konstantin Alexandrovich - Candidate of Medical Sciences, doctor of the highest category of the Republican Public Organization "Kazakhstan Society of Ophthalmologists".
5) Baigabulov Marat Zhandarbekovich - doctor of the highest category of JSC "Kazakh Research Institute of Eye Diseases".
6) Smagulova Gaziza Azhmagievna - Candidate of Medical Sciences, Associate Professor, Head of the Department of Propaedeutics of Internal Diseases and Clinical Pharmacology of the Republican State Enterprise on the REM "West Kazakhstan State Medical University. M. Ospanova - clinical pharmacologist

Indication of no conflict of interest: No.

Reviewer:
Utelbayeva Zaure Tursunovna - Doctor of Medical Sciences, Professor of the Department of Ophthalmology of the RSE on REM "Kazakh National Medical University. S.D. Asfendiyarov".

Conditions for revision of the protocol: revision of the protocol after 5 years and / or when new diagnostic / treatment methods with a higher level of evidence appear.

Attached files

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