Elimination of cataract. Operations for cataracts. Phacoemulsification of cataracts. Is it possible to perform an operation with the simultaneous presence of cataracts and other eye pathologies?

A cataract is an eye disease during which the lens becomes cloudy and loses its transparency, followed by a violation of visual function. In this case, the patient loses the ability to clearly see the outlines of objects, they become blurry and poorly distinguishable.

It is believed that this pathology is the result of the natural aging of the lens, however, a similar process can be observed in people of a fairly young age. At the first symptoms of a cataract, you should immediately contact a specialist, since the operation to remove it in the early stages of the development of the disease is much easier and much cheaper for the patient.

Why cataract develops: causes

As a rule, the pathology develops gradually, affecting first one eye and then the other. The disease is not rare - its symptoms are present to varying degrees almost 60% of people who turned to the ophthalmologist.

The reasons for the development of the disease have not yet been fully elucidated, and the basis for the operation is changes in the composition of the protein components, which leads to a gradual clouding of the lens of the eye.

Modern medicine identifies several basic prerequisites for the formation of cataracts:

• Diabetes;
• mechanical damage to the eye;
• radioactive exposure;
• hereditary diseases;
• inflammation in the optic nerves;
• the use of certain pharmacological drugs;
• smoking tobacco products;
• excessive exposure to ultraviolet light;
• previous surgical interventions on the organs of vision.

If we focus on the visual sensations that arise in patients, then the development of a cataract can be compared with a fatty film that cannot be removed from the eye or with a clouded glass of a car.

Cataract is a very dangerous disease. which is characterized by the following symptoms:

• double vision;
• myopia;
• lowering the level of visibility of bright color shades;
• violation of visual functions;
• discomfort in bright light.

At the initial stage of the development of the pathology, one can still try to improve vision with the help of glasses, however, further progression of the cataract leads to a deterioration in vision, which becomes blurry. At this stage, vision correction with lenses and glasses is no longer possible.

Often, the development of pathology occurs gradually, without any pain, redness of the eyes, as well as other symptoms characteristic of cataracts. If, nevertheless, the disease progresses very quickly or if pain occurs in the eye area, it is urgent to consult a doctor for timely diagnosis and, of course, treatment.

In principle, it is not difficult to detect a cataract in the eye. A specialist, when examining a patient, will immediately notice turbidity. This is diagnosed at the very first stage of the development of pathology, then the pupil has a white or whitish tint. In order to detect the disease, special tools and objects are also used to give a correct assessment of visibility. Carrying out diagnostic measures, the ophthalmologist reveals the degree of significance of the disease, as well as the level of its influence on the quality of life of the patient.

The range of examination includes such indicators as visual contrast, eye sensitivity, visual acuity, as well as a complete examination of each element of the organ of vision.

Since cataracts are mainly senile disease, most patients do not take into account the decrease in vision until the changes become pronounced. The vast majority of ophthalmologists advise removing cataracts in the early stages of the disease, without waiting for further progression of the pathology. However, another part of the experts in this field holds a completely opposite point of view: the development of cataracts at the initial stage can be stopped with the help of conservative therapy.

Which of these methods to choose is decided by the ophthalmologist in each case individually: important factors here are the identification of possible contraindications, the establishment of the duration of the course of treatment and the correct approach of the doctor to the patient's problem.

Types of cataract surgery

As a rule, such operations are carried out in specialized centers.

There are three types of surgery:

Phacoemulsification. This method is the most popular and common, the maximum operation time is approximately fifteen minutes. Since the area of ​​the wound channel heals on its own a few hours after surgery, suturing is not required. However, the cost of the operation in this case will be slightly higher than others.

The operation using the method of ultrasonic phacoemulsification has a number of advantages: since it is performed through small (1.0-1.8 mm) punctures in the cornea. Bleeding is completely absent. Artificial lenses have high elasticity and shape memory, which makes it possible to introduce them into the eye in a folded form through a micro-puncture.

An important factor is that the rehabilitation period is only 2-3 days. In addition, small incisions contribute to a significant reduction in the risk of developing inflammatory processes in the eyes after the intervention of a surgeon, and also allow the procedure to be performed without hospitalization of the patient, that is, on an outpatient basis.

cataract surgery method ultrasonic seamless phacoemulsification is carried out in several stages.

1. Using a medical diamond instrument, the doctor makes an incision at the base of the cornea, and it is through it that all subsequent procedures take place.
2. At the next stage, a viscoelastic is introduced into the chamber located on the front side using a cannula. This substance protects the internal structure of the visual organ from ultraviolet rays during the operation, and also allows the ophthalmologist to carry out the necessary manipulations.
3. A special probe is inserted through the incision, which acts on the lens with ultrasound, which contributes to the transformation of the first into an emulsion.
4. Then, in place of the old lens, an artificial lens is placed in a folded state. Inside, it unfolds, takes the necessary location and is conveniently fixed.
5. At the end of the operation, the viscoelastic is washed out of the chamber with an irrigation solution.

The micro-incision has the ability to seal itself and heal quickly. Subsequently, thanks to this, the patient has absolutely no restrictions in terms of visual and physical activity.

Extracapsular removal. A similar method is used in the case of an increase in the size of the cataract and compaction of its structure. The incision in this case is made slightly larger than with phacoemulsification. After removing the damaged lens and installing an artificial substitute in its place, the walls of the capsule are sutured. Since this method requires suturing, the healing time of the wound channel increases.

Intracapsular removal. This type of surgery is considered the most traumatic, since part of the capsule is removed along with the lens. For this, a special technique is used, in which an artificial lens is placed in front of the iris. This method of cataract removal is used quite rarely, however, it still remains relevant: with severe damage to the eye, there is simply no other way to heal.

Cost of cataract surgery

The cost of surgery for this disease is determined by many factors and varies in a fairly large range. The minimum amount required for phacoemulsification (laser removal), is 25 thousand rubles. Upper limit - about 150 thousand rubles. This amount is due to the choice of the patient himself, based on the operation in an expensive private clinic using a premium model of an artificial lens.

What is the cost of the operation?

The factors affecting the price of the service offered are quite different depending on whether the clinic belongs to the clinic (private or public). The conditions that have a major impact on pricing can be the following:

• The complexity of the operation. It is quite logical that the operation to remove a complicated cataract is more expensive and requires the maximum amount of effort on the part of the surgeon. Therefore, the cost of such a service will be higher.
• Category ophthalmological center a. Economy class clinics, business and VIP categories evaluate their services in completely different ways.
• Modification of the artificial lens. Basic models of artificial lenses perform only minimal functions: focusing light rays on the retina and restoring visibility. Premium models made using innovative technologies are able to give the patient more options: complete disposal of glasses, correction of astigmatism, maximum quality of vision.
• The work of an anesthesiologist. The outcome of the operation largely depends on this specialist, because the behavior of the patient on the operating table determines the final result.
• The authority and professionalism of the surgeon. Only an experienced specialist will be able to realize absolutely all the advantages of an artificial lens and modern medicine. For example, a premium lens installed with impairments can greatly affect the quality of the patient's vision. It follows from this that the degree and authority of the surgeon should be valued more highly.
• Postoperative follow-up. A well-performed operation is only half of the successful treatment of cataracts, because it is still necessary to bring the visual organ of the operated person to full recovery. In accordance with the rules, it is necessary to undergo examinations by an ophthalmologist 5-8 times within a month after surgery. It is advisable to do this in the same clinic where the operation was performed.

Cataract surgery for senior citizens

It is known that this category of the population is the most unprotected, including in terms of providing medical services. Therefore, on the basis of state clinics, ophthalmological centers have been created that provide free services for the diagnosis and treatment of eye diseases.

Pensioners and other low-income segments of the population are provided with a full range of diagnostic examinations and specialist advice. When indications for surgery, the lens is replaced with an artificial lens.

Free lens replacement surgery carried out for the following categories of persons:

• Participants of the Great Patriotic War and persons equated to them;
• disabled people of I, II and III groups;
• labor veterans and pensioners.

What do you need to have a free cataract surgery?

First of all, you should get a referral to your clinic for a consultation at the Ophthalmological Center.

Collect the necessary documents(passport, compulsory medical insurance policy and its copy, certificate of a pensioner, disabled person or participant in the Great Patriotic War).

Sign up for a consultation to the nearest Eye Diagnostic and Surgery Center.

Modern medicine provides a large number of options for safe and high-quality cataract removal. In no case should you ignore the symptoms of the disease and, having passed the diagnosis, you should immediately begin to treat the pathology. Moreover, at the initial stage, it is possible to remove the cataract without surgery. Therefore, you should not put off taking care of your health and think about treatment until the disease has developed further.

A cataract is an eye disease in which the normally transparent lens becomes opaque - it becomes cloudy. The main role of the lens of a healthy eye is the refraction of light rays, which ensures that they reach the retina. After transmitting information and analyzing it with the brain, a person clearly sees the objects around him. Blurring leads to deterioration and distortion of vision. Cataract formation is a gradual process that affects all people to some extent as we age.

A reliable etiological factor in the development of cataracts is unknown. From the point of view of pathophysiology, there is a change and aggregation of the protein structures of the lens, which leads to a violation of its transparency. It is extremely rare for cataracts to present early in life, and this scenario is most often associated with congenital enzymatic defects, genetic diseases, or systemic congenital infections. Severe traumatic injuries, surgical interventions, intraocular inflammatory processes can also be a trigger for the development of cataracts, as well as ionizing radiation, smoking and diabetes mellitus. However, it is the age of the patient that is still the main reason for the development of ocular cataracts.

Cataract symptoms, indications for surgery

Cataracts always form gradually and are not accompanied by redness or pain. There are no pronounced external signs. The exception is a heavily running process.

A person who develops a cataract sees the world around him as if through dirty glass - a cloudy veil forms before his eyes. Symptoms of clouding of the lens has various variations:

Blurred vision, which has already been mentioned above.

Pronounced glare, especially in bright sunlight or at night from cars with headlights on.

Colors become dull and dull.

Frequent replacement of glasses or contact lenses is required due to progressive deterioration of vision. However, as the cataract progresses, the selection of glasses or lenses no longer helps to cope with poor vision.

Double vision.

Previously, it was believed that for cataract surgery, you need to wait for it to “ripen”. That is, the development of an advanced stage of the disease. Now, thanks to the development of microsurgical technologies, approaches to cataract surgery have changed dramatically. The mere fact of having a cataract is not an indication for its removal until the clinical manifestations begin to significantly affect daily life. Think about whether you can drive a car, work and perform household chores without outside help and severe discomfort?

Waiting for cataract surgery within reasonable limits does not complicate the work of the surgeon and does not increase the risk of complications. The attending physician after a thorough examination will always advise the optimal timing of surgery.

After the patient has decided to undergo surgery, he needs to undergo a standard preoperative examination and a number of diagnostic procedures. First of all, an ophthalmologist conducts a thorough examination of the organ of vision. It is necessary to make sure that the loss of vision is associated with cataracts, especially in the presence of comorbidities such as diabetic retinopathy, glaucoma, or macular degeneration.

Visual acuity, intraocular pressure are measured, color perception and contrast sensitivity are assessed, the fundus is examined. If necessary, an ultrasound, optical coherence tomography or fluorescein angiography is prescribed.

In addition to studying the ophthalmological status, an assessment of the general condition of the patient is equally important. During preoperative preparation, the patient is assigned:

General and biochemical blood test

General urine analysis.

Evaluation of coagulation if indicated.

Electrocardiography.

Fluorography or X-ray of the chest.

Test for HIV, syphilis and hepatitis markers.

Sanitation of the oral cavity.

In the presence of concomitant cardiovascular and other diseases, a consultation of specialized specialists is carried out.

After a comprehensive examination and in the absence of contraindications, the date of the operation is set. The surgeon talks in detail about the course of cataract surgery, possible risks and complications, after which the patient signs an informed consent for surgical treatment.

Hospitalization and lens prosthetics

The patient is admitted to the clinic on the eve of the date of the operation. If necessary, he repeats some laboratory and instrumental studies. Tell your doctor about any medications you take on a regular basis, especially anticoagulants and antiplatelet agents. The specialist will give appropriate recommendations. On the day of surgery, you need to be on an empty stomach, refuse to eat and drink.

Anesthesia during cataract surgery is used exclusively local - eye drops with a local anesthetic. Thanks to minimally invasive technologies, the operation is almost painless. 1-2 hours before the operation, the patient is instilled with mydriatics - drugs that dilate the pupil, which is necessary for the surgeon to complete his work.

The surgical field is treated with an iodine-containing antiseptic, an eyelid expander is used to prevent involuntary blinking of the eyelids. The patient is positioned supine. Under visual control through a microscope, the surgeon performs a self-sealing puncture of the cornea, the width of which does not exceed 2-3 mm. Due to this, suturing at the end of the operation is not required, which significantly speeds up the recovery process. Then a viscoelastic preparation is introduced into the eye cavity, which plays a protective role for adjacent intraocular anatomical structures.

The next stage is capsulorhexis, or an incision in the anterior lens capsule. The posterior capsule is not removed during the operation - it serves to fix the intraocular lens. Capsulorhexis provides the surgeon with access to the cloudy lens. Then a phacoemulsifier is inserted into the eye, the titanium needle of which emits ultrasonic waves, which leads to grinding the lens substance to a suspension state. This process is called phacoemulsification. The mass obtained after grinding is removed by aspiration.

Then, through the previously made access, an intraocular lens rolled into a tube is introduced - an artificial lens. Such an artificial lens is straightened directly in the eye and fixed in the correct position. At the end of the operation, the eye is covered with a protective bandage.

Taking medication after cataract surgery

Depending on the clinic and the patient's condition, the latter is allowed to go home on the day of the operation or the next day. At the same time, the doctor appoints the date and time of the subsequent control visit, and also gives recommendations on the behavior, regimen, restrictions and use of drugs. All appointments must be strictly observed, this is the key to a quick recovery of vision.

In the postoperative period, as a rule, the following drugs are prescribed:

Nonsteroidal and steroidal anti-inflammatory eye drops. For the first few days, patients feel pain, burning, itching, and pronounced redness of the operated eye. To relieve discomfort, let's take painkillers according to the generally accepted dosing regimen.

In the early postoperative period, it is necessary to wash the eyelids with antiseptic solutions - furatsilin and chloramphenicol. The goal is to prevent infection.

Antibacterial eye drops are necessary to prevent the addition of a bacterial infection. A broad-spectrum drug is selected that is active against many microorganisms.

Drops to reduce intraocular pressure. Appointed under the control of the latter, the decision on the appointment and cancellation is made only by the doctor.

Complex local remedies containing preparations for corneal regeneration and elimination of excessive dryness.

All medicines are prescribed only by the attending physician. If adverse reactions occur, it is important to contact a specialist immediately.

Rules for the use of eye drops

The vast majority of drugs in ophthalmology are administered topically in the form of eye drops. Therefore, it is important for patients to know how to properly bury their eyes in order not to harm themselves and to ensure adequate delivery of the drug to the target.

Download and print the rules

Some rules:

Before starting manipulation, it is important to wash your hands thoroughly with soap and water.

You need to bury lying down or sitting on an armchair / couch, well tilting your head back.

It is better if an assistant will dig in the eyes.

It is necessary to gently pull the lower eyelid and drip the drug into the conjunctival sac.

The pipette should not touch the eye, eyelid or conjunctiva.

After instillation, it is advisable to lie down / sit quietly for several minutes, press the lower eyelid with a clean, if possible sterile, gauze pad.

Complications in the postoperative period

Cataract surgery is one of the most frequently performed and safest surgical procedures in the world. However, after this operation there is a risk of complications. Here is some of them:

Dislocation of the intraocular lens.

Endophthalmitis - inflammation of the eyeball.

Increased photosensitivity.

Photopsy.

Macular edema.

Retinal disinsertion.

Hemorrhage into the vitreous body (hemophthalmos).

Intraocular hypertension and the development of glaucoma.

The formation of a secondary cataract is a process in which, due to cell division, an opacity of the posterior lens capsule is formed. The symptomatology resembles that of a normal senile cataract. Treatment consists of laser exposure.

Almost all complications respond well to treatment with timely diagnosis. That is why it is important to visit the doctor according to the appointed time. With a deterioration in the condition and the appearance of pain, a sharp deterioration in vision against the background of positive dynamics, it is urgent to visit a specialist.

Recovery period

The timing of vision recovery after IOL implantation for cataracts is individual. Some patients notice improvement within 1-2 days. The total duration of the recovery period is approximately one month, during which the following recommendations must be observed:

The first day to observe bed rest.

Avoid mechanical impact on the operated eye (do not press or rub the eye).

Avoid direct sunlight, wear sunglasses.

Limit the use of eye makeup for 2-3 weeks.

Make sure that shampoos and detergents do not get into your eyes during hygiene procedures.

Avoid intense physical activity, lifting weights over 10 kg.

Self-care helps to quickly restore vision and minimize the risk of complications.

Cost of cataract surgery, public and private clinics

Cataract surgery can be performed free of charge at a public health facility. There are quotas for such interventions, their number depends on the region. More often, interventions are carried out free of charge for social categories of citizens - pensioners, disabled people of all groups. However, in such a situation, you must wait for your turn. If the patient wishes to implant an imported lens, it must be purchased for a fee.

For a fee, cataract surgery can be performed without a queue. The cost varies depending on the complexity of the intervention, the degree of maturity of the cataract, the type of artificial lens, the reputation and equipment of the clinic. There are a lot of ophthalmological clinics, but not all of them have a good reputation. You can get acquainted with the cents on their websites on the Internet and according to patient reviews. On average, the cost of a cataract operation is 45,000-100,000 rubles, depending on the authority of the clinic and the surgeon, the model of the artificial lens and the complexity of the operation. Trust won the following Moscow clinics:

Clinic them. Svyatoslav Fedorov - named after the founder of ophthalmic microsurgery in Russia. Many years of tradition and scientific activity make the Fedorov Clinic one of the most sought after among patients.

Center for Diagnostics and Eye Surgery. He won the trust of patients thanks to modern equipment and experienced specialists, which allows cataract surgery to be performed in the most difficult cases, including comorbidities.

Research Institute of Eye Diseases. Gelholtz. He is known for his good attitude towards patients and good treatment results. It is one of the very first Moscow eye clinics.

The number of people suffering from cataracts is on the rise worldwide. It is important to understand that surgery is the only way to restore good vision to people with this disease.

Video: cataract, operation progress, rehabilitation

The lens is a transparent biconvex structure suspended in a natural position by stretched fibers of the ciliary body. It contains a capsule, epithelium, cortex and inner core. Its biological role is to refract light rays to focus a clear image on the retina. Constantly changing its shape, it adjusts the focal length. The organ contains three classes of structural proteins. Are they specific? and? crystallins and make up about 90% of the total mass. The light refractive base includes sugars, lipids, water, several antioxidants and low weight molecules. Most proteins are in the soluble phase, and it is this phase that provides transparency. Gradually, most of them leave the soluble state and form heavy high-molecular aggregates.

Cataract of the eye is a serious ophthalmic disease in which pathological clouding of the lens occurs, which subsequently leads to impaired visual function. The risk of developing ophthalmopathology is increased in people over 50 years of age. Etiopathogenesis is currently poorly understood.

With age, there is a decrease in natural transparency, an increase in scattering and light waves, as well as a deterioration in the optical properties of the eye media.

Involutional changes:

Reducing the diffusion of water from the outside into the internal system;

Accumulation of high molecular weight aggregates and insoluble proteins;

Production of glycation products, accumulation of lipids, reduction of glutathione and destruction of ascorbic acid.

Etiology

Causes of congenital karatogenesis:

Intrauterine infection (rubella, measles, herpes simplex, chicken pox, Epstein-Barr virus, influenza, syphilis, toxoplasmosis);

Genetic mutations (galactosemia, trisomy 21, Patau and Low syndrome).

Causes of acquired pathology:

Aging of the body;

Chronic intoxication (eg, smoking, alcoholism);

Radiation;

Systemic processes and metabolic disorders (eg, diabetes, atopic dermatitis, hypocalcemia);

Ocular problems (uveitis, infections, glaucoma);

Traumatic injuries.

Hereditary opacity is diagnosed in a newborn child or occurs in the first year of life. In most cases, it is limited in area and stationary.

However, the most common type of ophthalmopathology is considered to be senile (or hydrocyanic), which has three main varieties: peripheral, nuclear and posterior subcapsular opacity. Clinical symptoms are directly dependent on the type of lesion: for example, central nuclear opacity reduces the ability to perceive two points separately, and subcapsular opacity makes the individual very sensitive to glare. complaints, as a rule, are not accompanied by pain.

With untimely access to a specialist, complete blindness is possible.

Clinical picture

The person loses the ability to see clearly. He complains about the yellowish tint of some objects, poor night vision, weakening of clarity and color perception, the appearance of a "glowing halo".

There is periodic dizziness, photophobia, difficulty in reading and working with small details. He does not recognize his relatives and acquaintances on the street, professional and social maladjustment occurs.

The patient's vision becomes blurred, as if he is looking at the world around him through a white veil or curtain. Some people first try to overcome the difficulties themselves and use glasses. The ophthalmologist is able to detect the problem with slit lamp biomicroscopy after pupil dilation. Thus, it is possible to accurately determine the location and degree of opacity, and its relationship to the optical axis.

Surgical treatment

Drug therapy is prescribed only in the early stages, its meaning is to prevent the progression of the pathology. However, there are no drugs yet that have been able to restore translucency.

If the disease becomes visually significant, surgery will be the only effective treatment. The definition of "visually significant" has evolved, his current visual acuity reading being 20/40 or worse.

When cataract surgery was in its infancy, this term was used to describe the already mature stage. Thanks to advances in ophthalmic surgery and innovative technologies, the removal of the lens of the eye can be performed even with the appearance of small whitish inclusions.

The main signal for intervention will be a significant increase in visual dysfunction, which greatly limits work activity and causes discomfort in everyday life. Before manipulation, the specialist must select an intraocular lens in advance.

Indications:

Overripe form;

swelling form;

dislocation and subluxation;

Anomalous kinds of opacity;

secondary glaucoma.

Not infrequently, people whose professional activities are associated with high requirements for eye health (for example, drivers, pilots, operators) turn to doctors.

Contraindications:

Infectious diseases;

Exacerbation of a chronic illness;

• Pregnancy and breastfeeding;

  a recent history of heart attack or stroke;

  Oncology;

  Mental disorders.

Age under 18 is considered a relative contraindication to manipulation. The doctor must make an individual decision for each patient.

It is very dangerous to remove the lens in cataracts with decompensated glaucoma, as hemorrhage can be provoked, which will lead to complete blindness. Therefore, the best option would be preoperative reduction of intraocular pressure.

If during the examination of the patient it was revealed that he had lost light perception, then the intervention does not make sense, since irreversible transformations began in the retina.

Be sure to perform preoperative diagnostics. Carrying out for an exception of other ocular diseases is shown. Be sure to measure the refractive power of the cornea, the depth and length of the anterior chamber. This is necessary to calculate the diopter power of the IOL.

Some people are simultaneously diagnosed with age-related macular degeneration or diabetic retinopathy. In these situations, the procedure does not lead to a noticeable improvement.

The optometrist is obliged to inform the person in advance about the advantages and disadvantages of all types of therapy.

Operation technology

	Initially, a tunnel micro-incision of the eye wall is performed, the size of which is 1.8-3.2 mm. For this, a special diamond knife is used;
	The anterior lens capsule is removed using tweezers;
	Fragmentation of the native lens occurs by using an ultrasonic needle, after which each individual fragment is modified into an emulsion, which is removed (aspirated) with special tools;
	The next step is to implant the intraocular lens.

Training

Uncontrolled hypertension represents an increased risk of intraocular bleeding after injection of local anesthesia and postoperative suprachoroidal bleeding. Another factor in the occurrence of undesirable consequences will be a pulse rate of more than 85 beats / min, so special attention is paid to people with hypertrophied feelings of anxiety (medical sedation is indicated) or with poorly controlled atrial fibrillation.

Laser phacoemulsification

This technology requires maximum concentration and professional actions from the operating ophthalmic surgeon. Laser phacoemulsification is prescribed for opacities in the eye media that are insensitive to ultrasonic waves. Cataract removal and lens replacement are performed on special expensive equipment and can be prescribed in the most complex medical cases.

Anesthetic drops are pre-buried. The healthy area is temporarily covered with a sterile drape. And around the affected area, everything is treated with an antiseptic. The ophthalmic surgeon then performs a micro incision on the cornea. The laser beam crushes the affected tissue into tiny particles. At the same time, it focuses only in the thickness and never damages the cornea. In moments of destruction, bright flashes are visible.

Then a pre-prepared artificial prosthesis is introduced into the capsule apparatus. Sealing is done in an atraumatic, seamless way.

The positive point is that no microsurgical instruments are inserted into the wound, which significantly reduces the risk of complications. After the manipulation, the patient spends several hours in a medical clinic under observation, and then goes home. Visual perception is restored gradually.

Ophthalmic surgeons advise not to overwork for two months, to minimize reading literature, watching TV, using a computer, and not driving a car if possible.

Ultrasonic phacoemulsification

This is the "gold standard" of operative ophthalmology, it is recognized as the most highly effective and safe. An anesthetic eye drops and an intravenous sedative are used for pain relief. Widely prescribed drugs such as Alkain, Tetracaine, Proparacaine. Maybe.

FEC uses high-tech equipment to obtain a liquid emulsion, it is aspirated through a probe with two lumens. This can be done with a microscopic puncture - about 3 mm, but recent developments allow removal through a 2 mm micro-puncture. There is less change in the cornea (which accounts for two-thirds of the focus), resulting in better recovery. Emulsification is carried out in a closed environment with less fluctuations in IOP.

In place of the affected tissue, a flexible IOL (multifocal, toric and accommodating) is inserted in a collapsed state.

In FEC, a viscoelastic substance is injected into the anterior chamber to conserve space and protect the corneal endothelium. A small tear is formed in the capsule - about 5 or 6 mm in diameter. This allows access to the contents of the natural lens, which is removed by the ultra-fine tip. After that, an additional viscoelastic fluid is injected into the empty space to preserve the space in which the compact implant is placed. Once the viscoelastic material has been removed, the surgeon carefully checks the tightness of the micro-incision to ensure that it is watertight. A seam is not needed. The administration of a bolus of cefuroxime minimizes the incidence of postoperative endophthalmitis.

After prosthetics, it is better to avoid physical exertion and critical temperatures. Ophthalmologists categorically forbid visiting swimming pools, baths and saunas, as well as washing with soap. Specialists do not allow sleeping on the side where the implantation was. So that the infectious agent does not get inside the body, for some time it is necessary to abandon the use of decorative cosmetics. It is better not to expose the optical apparatus to aggressive sunlight, so doctors recommend wearing dark glasses with an ultraviolet filter.

Extracapsular extraction

It belongs to traditional methods and can be performed without the use of cutting-edge equipment. An opaque substance is removed through a micro incision on the cornea. With “manual microsurgery”, the lens capsule is preserved, it serves as a natural barrier between adjacent segments. The core is taken out in a single block, and therefore relatively large access is required.

However, the main disadvantage of EEC is that it requires postoperative sutures, which further negatively affects visual function - farsightedness and astigmatism develop. The rehabilitation period after prosthetics lasts an average of 4 months.

Despite the great advantages of cutting-edge techniques, doctors sometimes perform extracapsular cataract removal.

Intracapsular extraction

This is an outdated technology in which the lens substance is completely removed along with the bag, leaving no implant support behind the pupil. In this procedure, intraocular lenses are either attached to the iris or placed in front of the iris. IEC is carried out with a highly specialized tool - a cryoextractor. It gently freezes the tissue, making it firmer and easier to suck out.

Complications

An artificial analogue is installed for life, it does not wear out and does not become cloudy. This means that it does not require subsequent replacement.

But sometimes a secondary closure of the posterior area with connective tissue fibers develops. This is a pathological situation in which the person sees again poorly months or years after high-tech assistance, because the area of ​​the capsular sac becomes cloudy. Secondary pathological transformations are successfully treated with a laser.

Cataract removal is the most demanded and widespread surgical intervention in modern ophthalmology. According to the World Health Organization, 285 million people in the world suffer from visual impairment, 33% of which are caused by cataracts. Removal and replacement of the clouded lens with an artificial analogue (intraocular lens) during a microsurgical operation is the only way to combat this progressive disease.

Cataract is an irreversible pathology of the organ of the visual system associated with a number of destabilizing factors. Causes of disease include:

• natural aging of the main structures of the lens (age-related cataract);
• congenital pathologies;
• negative external influences (radiation of various nature);
• eye injury;
• smoking;
• various systemic diseases (diabetes mellitus);
• taking certain medications.

In 90% of human cases. The first signs of a decrease in the transparency of the lens are detected in patients older than 60 years. After the age of 80, symptoms are observed in almost all older people.

The result of the development of cataracts is a gradually progressive loss of visual acuity and blindness. Without appropriate treatment, against the background of clouding of the lens, the patient may constantly increase intraocular pressure, develop secondary glaucoma. An overripe cataract is accompanied by the disintegration of the lens fibers, inflammation and severe pain. Ignoring these symptoms can lead to loss of the eye.

Modern methods of removing and replacing the lens are the only method of treating the disease. The operation allows you to fully restore the functions of the organ at almost any stage, however, experts recommend seeking help as early as possible to minimize the possibility of complications.

Cataract symptoms for which you should seek medical attention:

• veil, cloudiness before the eyes;
• myopia;
• blurring of contours, fuzziness of surrounding objects;
• increased or decreased painless photosensitivity;
• double vision;
• deterioration in color perception;
• complete or partial change in the color of the pupil;
• sudden improvement in vision at dusk or in cloudy weather;
• intolerance to bright light.

Which specialists treat cataracts? Surgery is performed by ophthalmologists.

Preoperative period

Cataract surgery is considered the safest surgical procedure. Every year, millions of lens replacement procedures performed around the world end with consistent success and give people a second chance to see without interference.

Clouding of the lens is a long process, so regular examination by an ophthalmologist plays an important role in the timely diagnosis of the disease. Progressive age-related cataract can be seen with the naked eye: the lens changes color from black to gray-white or yellowish. The initial stages of the disease, especially if the turbidity begins to develop on the periphery of the transparent body, are often asymptomatic and are found precisely during preventive examinations.

And the preoperative period includes the following types of necessary examinations:

• examination of the eye through a slit lamp with a preliminary instillation of the drug to expand the pupil (allows you to identify the degree of maturity of clouding of the lens);
• measurement of intraocular pressure;
• determination of visual acuity and field of view;
• ultrasound examination of the condition of the eye (the retina and optic nerve are subject to examination).

Cataract surgery is performed after making an accurate diagnosis and conducting the necessary studies that characterize the patient's health status. What tests should be done before surgery for the disease:

• general blood analysis;
• blood sugar test;
• blood test for prothrombin index;
• blood test for syphilis, hepatitis B, C;
• general urine analysis.

Additionally, an ECG and fluorography are prescribed. In the presence of chronic diseases, consultations with an ENT doctor, gynecologist, urologist, dentist and endocrinologist may be necessary.

Surgery is the only way to eliminate cataracts

After agreeing with the doctor on the type of intraocular lens (IOL) and the date of the operation, it is recommended:

• a week before the procedure, stop taking blood-thinning drugs;
• on the day of the intervention, take a shower, paying special attention to the face (brow ridges and the area around the eyes);
• put on clothes and underwear that do not require removal over the head;
• take a sedative drug (agreed in advance with the surgeon and anesthetist).

The preoperative period does not require a specific diet, however, you should not overeat on the eve of the operation.

Intervention Information

Only replacing a clouded lens with a clear artificial lens (IOL) will help defeat cataracts. The final date of surgical treatment is set depending on the degree of spread and density of opacification, as well as the impact of the disease on the patient's daily life.

Thanks to new technologies, in most cases, cataract surgery does not require hospitalization and can be performed on an outpatient basis. Within a few hours after the procedure, patients are able to leave the clinic on their own.

If the ailment has affected both eyes, first the 1 lens is operated on, they wait for complete healing and restoration of the functions of the organ, and only then they change the transparent body in the 2nd eye.

In individual cases, cataract surgery may be contraindicated in:

• hypertension;
• acute inflammatory processes;
• heart disease;
• diabetes mellitus;
• malignant tumors.

Today there is no need to wait for the maturation of pathology. The earlier cataract surgery is performed, the better and more predictable the result will be. With timely treatment, postoperative recovery is much easier and painless.

Many are interested in the question, how much does cataract surgery cost? Depending on the chosen method of surgical intervention and the type of artificial lens, the procedure may require payment in the amount of 20 to 150 thousand rubles. The cost of treatment is also affected by the type of anesthetic support, the list of certified medicines and the number of examinations required in the postoperative period, the pricing policy of the clinic.

Classical techniques

Operative cataract removal, including the removal of the clouded lens and its replacement with an artificial analogue, has been successfully carried out since the 1950s. last century. And if a few years ago it was believed that in order to obtain a good result from the procedure, it is necessary to wait for the full maturation of the disease, today this is not necessary.

Despite the rapid development of surgical ophthalmology, some medical institutions still use methods of cataract removal that are considered outdated.

These include:

The advantage of these methods is the affordable price.

Ultrasonic and laser phacoemulsification

Ultrasonic phacoemulsification is one of the advanced methods of treating lens opacity, which has practically no contraindications and age restrictions.

In the case of cataract therapy with this method, how is the operation performed? The technique of the procedure includes the following steps:

• drip anesthesia (without injection);
• microsection of the lens capsule (no more than 2 mm long);
• introduction of a special instrument into the incision, which is connected to an ultrasound machine;
• liquefaction of the hard nucleus of the lens with the help of ultrasonic waves and its removal (suction) together with the cortical substance;
• implantation (in the folded state) of a soft or hard artificial IOL lens;
• centering the lens with the help of special temples and placing it in the lens bag;
• gauze bandage.

The micro-incision closes and seals itself, eliminating the need for sutures. The whole procedure takes 15-20 minutes, and the patient can go home the same day. Vision improvement is observed immediately after the intervention.

Laser phacoemulsification is a cataract surgical treatment in which the corneal incision, the formation of a round micro-hole in the capsular bag and the fragmentation of the lens nucleus are performed using a femtosecond laser. This is the safest and most accurate method in modern cataract surgery, allowing:

• crush the lens without violating the integrity of the cornea;
• make a perfect, physically stable cut;
• minimize the risk of postoperative infectious complications;
• accelerate the natural sealing of the incision.

- an operation, the cost of which is quite large. However, it is this procedure that allows to obtain the highest quality of postoperative vision.

Implants: Choice of Intraocular Lenses

Cataract surgery involves the obligatory implantation of an intraocular lens (IOL) in place of the removed lens nucleus. IOLs are transparent acrylic or silicone lenses that have some kind of refractive (corrective) power. The average size of the optical part is 5-6 mm. Each lens has elastic temples with which it is fixed in the lens bag.

IOLs can be:

• rigid (require a wide incision and postoperative sutures);
• soft (flexible).

Soft lenses are safer, do not require extensive trauma to the cornea, facilitate and accelerate the healing process.

Depending on the type of refractive capabilities, the following models of intraocular lenses are distinguished:

• monofocal - lenses with 1 focus point (IOL for distance);
• monofocal with astigmatism correction;
• multifocal - lenses with several focus points (provide a full spectrum of vision: for near, far, intermediate vision);
• multifocal with astigmatism correction.

High-quality IOLs do not wear out and have ideal biocompatibility with eye tissues, which allows them to be used without replacement until the end of a person's life. The calculation of lens refraction depends on the results of preoperative examinations and the patient's wishes for improved vision after the intervention.

Postoperative period and possible complications

After surgery, the operated patient goes home. However, even with uncomplicated recovery, he may require postoperative examinations: the next day after the procedure, 3 days, a week and a month after the operation.

This is necessary to prevent rare complications that cataract removal can cause. These include:

• the development of an infectious process (inflammation);
• damage (rupture) of the capsular bag of the lens;
• astigmatism;
• clouding of the cornea;
• increased intraocular pressure;
• retinal detachment.

To reduce the risk of complications, after surgery, patients are recommended a gentle lifestyle. It is forbidden to scratch, touch, exert mechanical pressure on the operated organ. Within 1-2 months it is desirable to give up physical activity, smoking, visiting baths and saunas.

After cataract removal in the elderly, if glasses are required, the lens strength should be adjusted 2-3 weeks after the intervention. During this period, patients are not recommended to read a lot and watch TV.

If you experience pain, deterioration of visual acuity, redness of the eyes, you should immediately seek medical help.

Video

A disease such as a cataract of the eye leads to irreversible clouding of the lens and causes a decrease in visual acuity. This pathology can be cured only with the help of surgical intervention, which involves the radical removal of cataracts by various methods.

Causes, symptoms and types of cataracts

There is a cataract with damage to only one eye or both at once. It may vary in maturity:

• mature cataract;
• overripe cataract;
• initial cataract;
• immature cataract.

There are also congenital and secondary cataracts. As a result of age-related changes, nuclear cataracts can occur. A nuclear cataract forms in the center of the lens and leads to severe visual impairment, nearsightedness, and color vision problems. The lens becomes yellowish and strongly compacted. Nuclear cataract belongs to the varieties of senile pathology of vision, the causes of which lie in the natural aging of the body.

Symptoms of a nuclear cataract:

• myopia;
• bifurcation of objects;
• problem with color recognition;
• blurry image.

Congenital cataract occurs in newborns in quite rare cases and is accompanied by clouding of the lens. It is possible to diagnose such a pathology in children immediately after birth. A cataract affects one or both eyes at once. The causes of this pathology are the development of intrauterine infection and genetic disorders.

Symptoms of congenital eye disease in children:

• clouding in the pupil;
• lack of focus on objects;
• strabismus.

Secondary cataracts and clouding of the lens of the eye sometimes occur as a complication of vision restoration surgery. The appearance of secondary pathology can be expected approximately two years after the operation. It is believed that the causes of secondary pathology of the eye are the active reproduction of the remaining cells of the lens epithelium.

Symptoms of a secondary cataract:

• deterioration of visual perception;
• veil or "fog" before the eyes;
• double vision of objects.

Immature cataract is a type of senile visual impairment and occurs in many older people. The causes of this disease are the action of external factors and heredity.

Symptoms of an immature cataract of the eye:

• lens changes;
• cloudiness;
• blurred vision;
• vagueness.

Advice: surgical treatment of cataracts is selected depending on the cause of the disease. A complete medical examination will help identify all symptoms and make an accurate diagnosis.

Cataract surgery: types

Conservative methods of treating cataracts can only eliminate the symptoms of this disease for a certain time, but blindness may occur in the future. There are several surgical techniques to eliminate cataracts: intracapsular extraction; phacoemulsification; extracapsular extraction; femtosecond laser.

Intracapsular extraction involves the removal of the cloudy lens along with the entire capsule. Such an operation is shown to replace the lens of the eye in the presence of post-traumatic cataract. All manipulations are performed using a cryoextractor, which freezes the eye lens and removes it. An artificial lens is securely installed in its place. This cataract surgery in most cases does not have any side effects, but has certain contraindications. It is forbidden to carry out this surgical intervention in children, as well as adolescents, which is associated with the peculiarity of the anatomical structure of the eye in childhood.

Phacoemulsification is a painless and effective cataract surgery during which an artificial lens is implanted into the patient's eye. The essence of the technique lies in the fact that an ultrasonic probe is inserted through a micro-incision into the lens chamber and destroys it, and the remnants are carefully removed to the outside. The advantages of this method include the absence of sutures and the low likelihood of infection during surgery. Since there are no age restrictions, the operation can be performed even in children. Contraindications to such treatment: diabetes mellitus, corneal dystrophy, conjunctivitis.

Extracapsular extraction is performed with preservation of the lens capsule and removal of the nucleus. This cataract surgery involves the complete removal of the lens and cutting the membrane of the eye. At the end of all manipulations, it is necessary to suture, which may affect vision. Also, the disadvantages of this method of treatment include a long rehabilitation period, because the seam may disperse if some rules are not followed. Contraindications to surgery: childhood, inflammatory processes, infections, oncological diseases.

Femtosecond laser

Treatment of cataracts with a laser practically does not differ from the method of ultrasonic phacoemulsification. In this case, the femtosecond laser beam destroys the lens. The femtosecond laser can be used at different stages of cataract with the same effectiveness, no matter what symptoms are present.

The femtosecond laser helps to carry out the operation without damaging the cornea and does not destroy the lens. Therefore, the risk of complications after such treatment is always the lowest. This laser operation is performed for glaucoma and even in the presence of diabetes mellitus, which in many cases is a contraindication to surgical intervention. Contraindications: clouding of the cornea of ​​the eye, overripe cataract, anatomical features of the structure of the eyes.

Advice: the type of surgical intervention should be selected taking into account the individual pathology and age of the patient, since many types of eye operations have different indications and contraindications.

rehabilitation period

Half the success of how the postoperative period will pass after cataract removal, largely depends on the correct preparation and behavior of the patient himself. After surgical treatment, the doctor should advise the patient about further treatment and examinations.

Regardless of which type of surgery was chosen, there is always a risk of developing negative consequences. Possible complications after this operation include an infectious process that occurs when the rules of asepsis and hygiene are not followed. In addition, hemorrhage, corneal edema, retinal detachment or secondary cataract may begin.

Therefore, if such symptoms appear in the period after the operation, it is urgent to consult a doctor. The duration of the recovery process is a total of about two months. Almost immediately after cataract removal, the patient can go home, but at the same time he must follow all the recommendations of the ophthalmologist.

It is forbidden after the operation to eat too hot and hard food, drink carbonated drinks and make sudden movements. Sleeping is recommended only on the back or on the side of the healthy eye. Avoid getting water into the operated eye to avoid infection.

You can not watch TV, use a laptop or read in the first days after the operation. To protect your eyes, you must use glasses and eye drops, which will be prescribed by a doctor.

Gradually, many restrictions are removed, but for the entire period of rehabilitation, strong physical activity remains prohibited. Periodic ophthalmological examinations are required.

Prevention

Prevention can help prevent the recurrence of cataracts. In diabetic patients, cataract prophylaxis is to reduce the risk of lens clouding. To do this, you need to achieve compensation of carbohydrate metabolism. Traumatic cataracts can be prevented by avoiding injuries to the head, falls and bruises.

Regular visits to an ophthalmologist at least once a year will help diagnose the disease at an early stage of development and provide assistance in time. Modern technologies and methods of treatment make it possible to diagnose and remove cataracts in a timely manner, as well as cure other eye diseases. With the help of a surgical operation, it is possible to successfully replace the lens with an artificial lens and restore impaired vision.

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Attention! The information on the site is presented by specialists, but is for informational purposes only and cannot be used for self-treatment. Be sure to consult a doctor!