Inflammation of the eye after lens replacement surgery. Rehabilitation, complications and limitations after lens replacement surgery. Reasons for the development of negative phenomena

Consequences and complications after cataract surgery

Surgical removal of a cataract is a highly effective, but rather complex and jewelry operation, the risk of complications after which is relatively high. Complications after cataract surgery occur, as a rule, in those patients who have concomitant diseases or do not comply with the rehabilitation regimen. In addition, the development of complications may be the result of a medical error.

Common complications are described below.

Watery eye

Excessive lacrimation may be the result of infection. Infection in the eye during the operation is practically excluded due to the observance of sterility. However, non-compliance with the recommendations of the doctor in the postoperative period (washing with running water, constant rubbing of the eye, etc.) can lead to infection. In this case, antibacterial drugs are used.

Eye redness

Redness of the eye can be both a sign of infection and a symptom of a more formidable complication - hemorrhage. Hemorrhage into the eye cavity can occur during traumatic cataract surgery and requires immediate specialist attention.

Corneal edema

The consequences of cataract surgery may include swelling of the cornea. A mild degree of swelling is quite common and most often manifests itself 2-3 hours after the operation. Most often, mild swelling resolves on its own, however, in order to speed up the process, the doctor may prescribe eye drops. During the period of swelling, vision may be blurry.

Pain in the eye

In some cases, intraocular pressure increases after cataract removal. Most often this occurs due to the use of a solution during the operation, which cannot normally pass through the drainage system of the eye. An increase in pressure is manifested by pain in the eye or headache. As a rule, increased intraocular pressure is stopped by medication.

Retinal disinsertion

The consequences after cataract removal include such a serious complication as retinal detachment. At risk are patients with myopia (nearsightedness). According to studies, the incidence of retinal detachment is about 3-4%.

Intraocular lens displacement

A rather rare complication is displacement of the implanted intraocular lens. Often this complication is associated with a rupture of the posterior capsule, which holds the lens in the correct position. The displacement can manifest itself as flashes of light before the eyes or, on the contrary, by darkening in the eyes. The most striking manifestation is “double vision” in the eyes. With a strong displacement, the patient can even see the edge of the lens. If these symptoms appear, you should consult a doctor as soon as possible. The displacement is eliminated by “suturing” the lens to the capsule holding it. In the case of prolonged displacement (more than 3 months), the lens may heal, which subsequently complicates its removal.

Endophthalmitis

A rather serious complication of cataract surgery is endophthalmitis - an extensive inflammation of the tissues of the eyeball. Launched endophthalmitis can cause loss of vision, so it is impossible to postpone its treatment in any case. The average incidence of endophthalmitis after cataract removal is about 0.1%. Patients with thyroid diseases and weakened immune systems are at risk.

Opacification of the lens capsule

Among the complications after cataract removal is clouding of the posterior lens capsule. The reason for the development of this complication is the "growth" of epithelial cells on the posterior capsule. This complication can lead to a deterioration in vision and a decrease in its acuity. Opacification of the posterior capsule occurs quite often - in 20-25% of patients undergoing cataract removal. The treatment of opacification of the posterior capsule is surgical, and is carried out using a YAG laser, which “burns out” the growths of epithelial cells on the capsule. The procedure is painless for the patient, does not require anesthesia, after which it is recommended to instill anti-inflammatory drops. The patient after laser therapy can immediately return to the normal rhythm of life. Sometimes after the procedure, blurred vision is noted, which quickly disappear.

This is a rather serious complication, as it may be accompanied by loss of the vitreous body, migration of the lens masses posteriorly, and less often, expulsive bleeding. With inappropriate treatment, long-term effects of vitreous loss include a retracted pupil, uveitis, vitreous opacities, wick syndrome, secondary glaucoma, posterior dislocation of the artificial lens, retinal detachment, and chronic cystic macular edema.

Signs of posterior capsule rupture

Sudden deepening of the anterior chamber and sudden dilation of the pupil.
The failure of the core, the impossibility of pulling it to the tip of the probe.
Possibility of vitreous aspiration.
A ruptured capsule or vitreous body is clearly visible.

Tactics depends on the stage of the operation at which the rupture occurred, its size and the presence or absence of vitreous prolapse. The main rules include:

the introduction of viscoelastic for nuclear masses in order to bring them into the anterior chamber and prevent vitreous hernia;
the introduction of a special tonsil behind the lens masses to close the defect in the capsule;
removal of lens fragments by the introduction of viscoelastic or their removal using phaco;
complete removal of the vitreous body from the anterior chamber and the incision area with a vitreotomy;
The decision to implant an artificial lens should be made taking into account the following criteria:

If large amounts of lens masses have entered the vitreous cavity, an artificial lens should not be implanted, as it may interfere with fundus imaging and successful pars plana vitrectomy. The implantation of an artificial lens can be combined with vitrectomy.

With a small rupture of the posterior capsule, careful implantation of the SC-IOL into the capsular bag is possible.

With a large gap, and especially with intact anterior capsulorhexis, it is possible to fix the SC-IOL in the ciliary sulcus with the placement of the optical part in the capsular bag.

Insufficient capsule support may necessitate sulcular suturing of the IOL or implantation of a PC-IOL using a glide. However, PC-IOLs cause more complications, including bullous keratopathy, hyphema, iris folds, and pupillary irregularity.

Dislocation of lens fragments

Dislocation of lens fragments into the vitreous body after rupture of the zonular fibers or the posterior capsule is a rare but dangerous phenomenon, as it can lead to glaucoma, chronic uveitis, retinal detachment, and chronic racemose macular edema. These complications are more often associated with phaco than with EEC. Uveitis and glaucoma should be treated first, then the patient should be referred to a vitreoretinal surgeon for vitrectomy and lens fragment removal.

NB: There may be cases where it is impossible to achieve the correct position even for the PC-IOL. Then it is more reliable to refuse implantation and decide on the correction of aphakia with a contact lens or secondary implantation of an intraocular lens at a later date.

The timing of the operation is controversial. Some suggest removing residues within 1 week, since later removal affects the restoration of visual functions. Others recommend postponing surgery for 2-3 weeks and treating uveitis and elevated intraocular pressure. Hydration and softening of the lens masses during the treatment facilitates their removal with a vitreotome.

The surgical technique includes pars plana vitrectomy and removal of soft fragments with a vitreotomy. More dense fragments of the nucleus are connected by the introduction of viscous fluids (for example, perfluorocarbon) and further emulsification with a phragmatome in the center of the vitreous cavity or by removal through a corneal incision or scleral pocket. An alternative method for removing dense nuclear masses is their crushing followed by aspiration,

Dislocation of the SC-IOL into the vitreous cavity

Dislocation of the SC-IOL into the vitreous cavity is a rare and complex phenomenon, indicating improper implantation. Leaving the IOL can lead to vitreal hemorrhage, retinal detachment, uveitis, and chronic cystic macular edema. Treatment is vitrectomy with removal, reposition or replacement of the intraocular lens.

With adequate capsular support, repositioning of the same intraocular lens into the ciliary sulcus is possible. With inadequate capsular support, the following options are possible: removal of the intraocular lens and aphakia, removal of the intraocular lens and its replacement with a PC-IOL, scleral fixation of the same intraocular lens with a non-absorbable suture, implantation of an iris clip lens.

Hemorrhage into the suprachoroidal space

Hemorrhage into the suprachoroidal space may be the result of expulsive bleeding, sometimes accompanied by prolapse of the contents of the eyeball. This is a formidable but rare complication, unlikely with phacoemulsification. The source of hemorrhage is the rupture of long or short posterior ciliary arteries. Contributing factors include advanced age, glaucoma, anterior-posterior segment enlargement, cardiovascular disease, and vitreous loss, although the exact cause of the bleeding is not known.

Signs of suprachoroidal hemorrhage

Increasing grinding of the anterior chamber, increased intraocular pressure, iris prolapse.
Leakage of the vitreous body, the disappearance of the reflex and the appearance of a dark tubercle in the pupil area.
In acute cases, the entire contents of the eyeball may leak out through the incision area.

Immediate actions include closing the incision. Posterior sclerotomy, although recommended, can increase bleeding and lead to loss of the eye. After the operation, the patient is prescribed local and systemic steroids to stop intraocular inflammation.

Subsequent tactics

ultrasound is used to assess the severity of the changes that have occurred;
the operation is indicated 7-14 days after the liquefaction of blood clots. Blood is drained, vitrectomy is performed with air/fluid exchange. Despite an unfavorable prognosis for vision, residual vision may be preserved in some cases.

Edema

Edema is usually reversible and is most often caused by the operation itself and trauma to the endothelium in contact with instruments and the intraocular lens. Patients with Fuchs endothelial dystrophy present an increased risk. Other causes of edema are the use of excessive power during phacoemulsification, complicated or prolonged surgery, and postoperative hypertension.

Iris prolapse

Iris prolapse is a rare complication of small incision surgery, but may occur with EEC.

Causes of iris prolapse

The incision during phacoemulsification is closer to the periphery.
Moisture seepage through the incision.
Poor suturing after EEK.
Patient-related factors (cough or other tension).

Iris prolapse symptoms

On the surface of the eyeball in the area of the incision, the fallen out tissue of the iris is determined.
The anterior chamber in the incision area may be shallow.

Complications: uneven scarring of the wound, severe astigmatism, epithelial ingrowth, chronic anterior uveitis, racemose macular edema, and endophthalmitis.

Treatment depends on the interval between surgery and the detection of prolapse. If the iris falls out during the first 2 days and there is no infection, its reposition with repeated suturing is indicated. If the prolapse occurred a long time ago, the area of the prolapsed iris is excised due to the high risk of infection.

Intraocular lens displacement

Displacement of the intraocular lens is rare, but can be accompanied by both optical defects and disorders of the structures of the eye. When the edge of the intraocular lens is shifted into the pupil area, patients are disturbed by visual aberrations, glare and monocular diplopia.

The reasons

The displacement of the intraocular lens mainly occurs during surgery. It can be due to dialysis of the zonium ligament, rupture of the capsule, and can also occur after conventional phacoemulsification, when one haptic part is placed in the capsular bag, and the second in the ciliary sulcus.
Postoperative causes are trauma, irritation of the eyeball and shrinkage of the capsule.

Treatment with miotics is beneficial with little displacement. Significant displacement of the intraocular lens may require its replacement.

Cataract of the eye is a complex ophthalmic pathology characterized by clouding of the lens. Lack of timely treatment threatens with loss of vision. The disease usually progresses slowly into adulthood. However, certain types of cataracts are characterized by rapid development and can lead to blindness in the shortest possible time.

At risk are people after fifty years. Age-related changes and disruption of metabolic processes in the eye structures often lead to a loss of transparency of the lens. The cause of cataracts can also be eye injuries, toxic poisoning, existing ophthalmic pathologies, diabetes mellitus, and much more.

All patients with cataracts have a progressive decrease in visual acuity. The first symptom is fog in the eyes. Cataracts can cause double vision, dizziness, photophobia, and difficulty reading or working with fine details. As the pathology progresses, patients even cease to recognize their acquaintances on the street.

Conservative treatment is advisable only at the initial stage of cataract. It should be understood that drug therapy protects against the rapid progression of the disease, but it is not able to save a person from the disease and restore transparency to the lens. If the clouding of the lens further increases, cataract surgery is required.

General information about cataract surgery

At the first stages of clouding of the lens, dynamic observation by an ophthalmologist is indicated. The operation can be performed from the moment the patient's vision begins to decrease significantly.

A direct indication for an operation to replace the lens is visual impairment, which causes discomfort in everyday life and limits work. The selection of an intraocular lens is done by a specialist. The procedure is performed under local anesthesia. An anesthetic drops are instilled into the conjunctival sac before the operation. Usually the removal of the lens lasts half an hour. On the same day, the patient can be at home.

ATTENTION! In case of complete blindness, cataract surgery will not bring any results.

Modern medicine does not stand still, so the replacement of the lens of the eye with cataracts can be done in various ways. The essence of the procedure is to remove the natural lens. It is emulsified and removed. An artificial implant is placed in place of the deformed lens.

Surgery may be used in the following cases:

overripe stage of cataract;
swelling form;
dislocation of the lens;
secondary glaucoma;
abnormal forms of clouding of the lens.

There are not only medical, but also professional and household indications for the operation. For workers in some professions, there are high requirements for vision. This applies to drivers, pilots, operators. The doctor may also recommend a lens replacement if the person is unable to perform normal household chores due to decreased vision, or if the visual field is severely narrowed.

Contraindications

Any eye surgery has a number of limitations, and lens replacement is no exception. Cataract removal with lens replacement is prohibited in the following cases:

infectious diseases;
exacerbation of a chronic process;
ophthalmic disorders of an inflammatory nature;
recent stroke or heart attack;
period of pregnancy or lactation;
mental disorders accompanied by inadequacy of the patient;
oncological processes in the eye area.

The ban on the operation of pregnant women and nursing mothers is explained by the fact that during surgery, medical support for the patient is necessary. Doctors prescribe antibacterial, sedative, analgesic drugs, which may not have the best effect on the condition of a woman and a child.

Age up to eighteen years is a relative contraindication to the operation. In each case, the doctor makes an individual decision. It largely depends on the condition of the patient.

It is dangerous to perform surgery for decompensated glaucoma. This can lead to bleeding and loss of vision. Surgical intervention should be carried out after the normalization of intraocular pressure.

If the patient has no light perception, surgical treatment is not performed. This indicates that irreversible processes have begun to develop in the retina and surgical intervention will no longer help here. If during the study it turns out that vision can be partially restored, an operation is prescribed.

Complicating factors during surgery include:

diabetes;
hypertension;
chronic pathologies;
under the age of eighteen.

Most often, cataracts occur in old age. Elderly people often have serious illnesses. In some of them, anesthesia is a big health risk. Many modern techniques involve the use of local anesthesia, which does not put an increased burden on the cardiovascular system.

The operation to replace the lens can not be done in case of infectious diseases

Techniques

Let's talk about four modern techniques that help to completely get rid of the clouding of the lens.

Laser phacoemulsification

The operation requires the surgeon to be extremely precise and focused. It is prescribed when hardening is detected in the eye environments, which is absolutely not sensitive to ultrasonic exposure. Laser phacoemulsification is not available to many patients, as it involves the use of special expensive equipment.

The operation can be performed in extremely difficult cases:

with glaucoma;
diabetes mellitus;
subluxation of the lens;
dystrophic changes in the cornea;
various injuries;
loss of endothelial cells.

Before the procedure, the patient is given anesthetic drops. A healthy eye is covered with a medical napkin, and the area around the affected eye is treated with an antiseptic.

Next, the surgeon makes a small incision through the cornea. The laser beam crushes the clouded lens. It focuses in the thickness of the lens, while not damaging the cornea. After that, the clouded lens is split into tiny particles. During surgery, patients may see small flashes of light.

Then the capsule is prepared for the implantation of an artificial lens (about the rules for choosing an artificial lens). A pre-selected intraocular lens is placed. The incision is sealed using a sutureless method.

IMPORTANT! During the operation, the surgeon does not insert instruments into the eye, thereby reducing the risk of postoperative complications.

Complications appear quite rarely, yet they are possible. Among the negative consequences are the appearance of bleeding, displacement of the artificial lens, retinal detachment. Following all the doctor's recommendations and observing the rules of hygiene is the best way to avoid the development of dangerous complications!

Laser phacoemulsification does not imply mandatory hospitalization. A few hours after the procedure, a person can return home. Recovery of visual function occurs within a few days.

However, some restrictions will have to be taken into account for some time. During the first two months, try not to overwork your eyes. Better to stop driving. To minimize the risk of complications, you will have to take medications and vitamins prescribed by your doctor.

Ultrasonic phacoemulsification

This technique is recognized as one of the most effective and safe in the treatment of cataracts. If already at the first stage a person experiences discomfort, then, at his request, a replacement of the lens can be carried out.

Surgical treatment is absolutely painless, the patient does not experience any discomfort during the procedure. Anesthetize and immobilize the eyeball with topical agents. Drops with an anesthetic effect can be used: Alkain, Tetracain, Proparacaine. Also, for anesthesia, injections are carried out in the area around the eyes.

With the help of ultrasound, the damaged lens is crushed into small particles, turning into an emulsion. The removed lens is replaced by an intraocular lens. It is made individually, taking into account the characteristics of the eye of each patient.

ATTENTION! Concomitant eye pathologies reduce the effectiveness of surgical interventions.

During the procedure, the surgeon makes a small incision. This became possible due to the high flexibility of the IOL. They are introduced in a folded state, and already inside the capsule they are straightened and take the desired shape.

During the recovery period, intense physical activity and high temperatures should be avoided. Doctors categorically forbid visiting saunas and baths. It is not recommended to sleep on the side on which the eye was operated on. In order to avoid infection, it is temporarily better to stop using decorative cosmetics. Your eyes should not be exposed to the harsh rays of the sun, so don't forget to wear glasses with an ultraviolet filter.

Extracapsular extraction

This is a simple traditional technique without the use of expensive equipment. A large incision is made in the shell of the eye, through which the clouded lens is completely removed. A characteristic feature of EEC is the preservation of the lens capsule, which serves as a natural barrier between the vitreous tolium and the artificial lens.

Extensive wounds require suturing, and this affects visual function after surgery. Patients develop astigmatism and farsightedness. The recovery period takes up to four months. Extracapsular extraction is carried out with mature cataracts and a hardened lens.

When extracting a cataract, the surgeon has to make a large incision, followed by suturing

The most commonly used tunnel technique. During the operation, the lens is divided into two parts and removed. In this case, the risk of postoperative complications is reduced.

Removal of sutures does not require anesthesia. About a month later, glasses are selected. A postoperative scar can cause astigmatism. Therefore, in order to avoid its discrepancy, injuries and excessive physical exertion should be avoided.

Despite the high efficiency of modern techniques, in some cases, specialists prefer traditional surgery. EEC is prescribed for weakness of the ligamentous apparatus of the lens, overripe cataracts, corneal dystrophy. Also, the traditional operation is indicated for narrow pupils that do not expand, as well as for the detection of secondary cataracts with IOL disintegration.

IMPORTANT! Vision begins to recover already during the operation, but it takes time to fully stabilize.

Intracapsular extraction

It is carried out using a special tool - a cryoextractor. It instantly freezes the lens and makes it hard. This facilitates its subsequent removal. The lens is removed along with the capsule. There is a risk that particles of the lens will remain in the eye. This is fraught with the development of pathological changes in visual structures. Unremoved particles grow and fill the free space, which increases the risk of developing a secondary cataract.

Among the advantages of IEC, one can single out the affordable cost, since it eliminates the need to use expensive equipment.

Training

What tests should be done before the operation? The visual apparatus and the whole organism are checked to exclude contraindications for surgical intervention. If any inflammatory processes were detected during the diagnosis, the pathological foci are sanitized and anti-inflammatory therapy is carried out before the operation.

The following studies are mandatory:

general analysis of blood and urine;
coagulogram;
hematological biochemistry;
blood glucose test;
analysis for HIV infection, syphilis and viral hepatitis.

Disinfecting and pupil dilating drops are injected into the operated eye. For anesthesia, eye drops or injections into the area around the eye can be used.

The selection of an artificial lens is a complex and time-consuming process. This is perhaps one of the most crucial stages of preparation, since the patient's vision after surgery depends on the quality of the chosen lens.

Recovery period

The operation is well tolerated by patients in most cases. In rare cases, experts complain about the appearance of discomfort, including:

photophobia,
discomfort,
fast fatiguability.

After the operation, the patient goes home. A sterile bandage is applied to the person's eye. During the day, he must observe complete rest. Approximately two hours later, food is allowed.

IMPORTANT! In the first time after surgery, patients should avoid sudden movements, not lift weights, and refrain from alcohol.

For a speedy recovery, you must follow medical recommendations:

follow the rules of eye hygiene;
within three weeks after the operation, do not go out without sunglasses;
do not touch the operated eye and do not rub it;
refuse to visit swimming pools, baths or saunas;
reduce the time spent in front of the TV and computer, as well as reading;
do not drive a car for the first two weeks;
dietary compliance.

Learn more about rehabilitation after surgery.

People who have had to deal with such an ophthalmic problem as clouding of the lens know that the only way to get rid of it is cataract surgery, that is, IOL implantation. In the US, more than 3 million such operations are performed per year, and 98% of them are successful. In principle, this operation is simple, fast and safe, but it does not exclude the development of complications. What complications after cataract surgery can appear and how to correct them, we will find out by reading this article.

All complications that accompany IOL implantation can be divided into those occurring directly during surgery or postoperative. Postoperative complications include:

rise in intraocular pressure; uevitis, iridocyclitis - inflammatory eye reactions; retinal detachment; hemorrhage in the anterior chamber; displacement of the artificial lens; secondary cataract.

Inflammatory eye reactions

Inflammatory responses almost always accompany cataract surgery. That is why, immediately after the completion of the intervention, steroid drugs or broad-spectrum antibiotics are injected under the conjunctiva of the patient's eye. In most cases, after about 2-3 days, the symptoms of the response completely disappear.

Hemorrhage into the anterior chamber

This is a fairly rare complication that is associated with trauma or damage to the iris during surgery. The blood usually resolves on its own within a few days. If this does not happen, doctors wash the anterior chamber, and, if necessary, additionally fix the lens of the eye.

Rise in intraocular pressure

This complication may appear due to clogging of the drainage system with highly elastic viscous preparations that are used during surgery to protect the cornea of the eye and other intraocular structures. Usually, instillation of drops that reduce intraocular pressure solves this problem. In exceptional cases, it becomes necessary to puncture the anterior chamber and thoroughly wash it.

Retinal detachment

Such a complication is considered severe, and it occurs in case of eye injury after surgery. In addition, retinal detachment is most common in people with myopia. In this case, ophthalmologists most often decide on an operation, which consists in sealing the sclera - vitrectomy. In the case of a small area of detachment, restrictive laser coagulation of the rupture of the eye retina can be performed. Among other things, retinal detachment leads to another problem, namely lens displacement. Patients at the same time begin to complain of rapid eye fatigue, pain, as well as double vision that appears when looking into the distance. The symptoms are intermittent and usually disappear after a short rest. When there is a significant displacement (1 mm or more), the patient feels constant visual discomfort. This problem requires re-intervention.

Full lens shift

Dislocation of the implanted lens is considered the most severe complication that requires unconditional surgical intervention. The operation consists in lifting the lens and then fixing it in the correct position.

Secondary cataract

Another complication after cataract surgery is the formation of a secondary cataract. It occurs due to the reproduction of the remaining epithelial cells from the damaged lens, which spread to the region of the posterior capsule. The patient at the same time feels a deterioration in vision. To correct such a problem, it is necessary to undergo a procedure of laser or surgical capsulotomy. Take care of your eyes!

Rupture of the posterior capsule

Signs of posterior capsule rupture

Sudden deepening of the anterior chamber and sudden dilation of the pupil. The failure of the core, the impossibility of pulling it to the tip of the probe. Possibility of vitreous aspiration. A ruptured capsule or vitreous body is clearly visible.

Tactics depends on the stage of the operation at which the rupture occurred, its size and the presence or absence of vitreous prolapse. The main rules include:

the introduction of viscoelastic for nuclear masses in order to bring them into the anterior chamber and prevent vitreous hernia; the introduction of a special tonsil behind the lens masses to close the defect in the capsule; removal of lens fragments by the introduction of viscoelastic or their removal using phaco; complete removal of the vitreous body from the anterior chamber and the incision area with a vitreotomy; The decision to implant an artificial lens should be made taking into account the following criteria:

With a small rupture of the posterior capsule, careful implantation of the SC-IOL into the capsular bag is possible.

With a large gap, and especially with intact anterior capsulorhexis, it is possible to fix the SC-IOL in the ciliary sulcus with the placement of the optical part in the capsular bag.

Dislocation of lens fragments

NB: There may be cases where it is impossible to achieve the correct position even for the PC-IOL. Then it is more reliable to refuse implantation and decide on the correction of aphakia with a contact lens or secondary implantation of an intraocular lens at a later date.

Dislocation of the SC-IOL into the vitreous cavity

Hemorrhage into the suprachoroidal space

Signs of suprachoroidal hemorrhage

Increasing grinding of the anterior chamber, increased intraocular pressure, iris prolapse. Leakage of the vitreous body, the disappearance of the reflex and the appearance of a dark tubercle in the pupil area. In acute cases, the entire contents of the eyeball may leak out through the incision area.

Subsequent tactics

ultrasound is used to assess the severity of the changes that have occurred; the operation is indicated 7-14 days after the liquefaction of blood clots. Blood is drained, vitrectomy is performed with air/fluid exchange. Despite an unfavorable prognosis for vision, residual vision may be preserved in some cases.

Edema

Iris prolapse

Iris prolapse is a rare complication of small incision surgery, but may occur with EEC.

Causes of iris prolapse

The incision during phacoemulsification is closer to the periphery. Moisture seepage through the incision. Poor suturing after EEK. Patient-related factors (cough or other tension).

Iris prolapse symptoms

On the surface of the eyeball in the area of the incision, the fallen out tissue of the iris is determined. The anterior chamber in the incision area may be shallow.

Complications: uneven scarring of the wound, severe astigmatism, epithelial ingrowth, chronic anterior uveitis, racemose macular edema, and endophthalmitis.

Intraocular lens displacement

The displacement of the intraocular lens mainly occurs during surgery. It can be due to dialysis of the zonium ligament, rupture of the capsule, and can also occur after conventional phacoemulsification, when one haptic part is placed in the capsular bag, and the second in the ciliary sulcus. Postoperative causes are trauma, irritation of the eyeball and shrinkage of the capsule.

Treatment with miotics is beneficial with little displacement. Significant displacement of the intraocular lens may require its replacement.

Rheumatogenous retinal detachment

Rheumatogenous retinal detachment, although rare after EEC or phacoemulsification, may be associated with the following risk factors.

Before surgery

"Retinal" retinal degeneration or tears require prior treatment before cataract extraction or laser capsulotomy if ophthalmoscopy is possible (or as soon as it becomes possible). High myopia.

During the operation

Vitreous loss, especially if subsequent management was wrong, and the risk of detachment is about 7%. In the presence of myopia >6 diopters, the risk increases to 1.5%.

After operation

Carrying out YAG-laser capsulotomy in the early stages (within a year after the operation).

Cystic retinal edema

Most often, it develops after a complicated operation, which was accompanied by a rupture of the posterior capsule and prolapse, and sometimes infringement of the vitreous body, although it can also be observed with a successfully performed operation. Usually appears 2-6 months after surgery.

The lens capsule is elastic. During cataract surgery, an artificial lens is placed in the eye to replace the real one. In this case, the posterior capsule serves as a support for the new one. It happens that the capsule begins to become cloudy, which causes a phenomenon such as a secondary cataract after replacing the lens. Treatment, reviews of which are the most positive, is carried out in accordance with medical indications. The latest methods and high quality equipment are used.

Causes of the phenomenon

Where does secondary cataract appear after lens replacement? Reviews of doctors about this complication indicate that the exact causes of its appearance are not disclosed.

The development of a secondary complication is explained by the growth of the epithelium localized on the surface of the posterior capsule. There is a violation of its transparency, which causes a decrease in vision. Such a process can in no way be associated with a surgeon's mistake during the operation. Secondary cataract after lens replacement, the causes of which lie in the reaction of the body at the cellular level, is a fairly common phenomenon. The cells of the lens epithelium turn into fibers that are functionally defective, have an irregular shape and are opaque. When they move to the central part of the optical zone, turbidity occurs. Vision loss can be caused by capsular fibrosis.

Risk factors

Ophthalmologists have established a number of factors that explain why secondary cataracts appear after lens replacement. Among them are the following:

Patient's age. In childhood, cataracts after surgery occur more often. This is due to the fact that tissues in a young organism have a high level of regeneration ability, which causes the migration of epithelial cells and their division in the posterior capsule.
IOL form. A square-shaped intraocular lens allows the patient to significantly reduce the risk of injury.
IOL material. Doctors have found that after the introduction of an acrylic-based IOL, secondary lens opacification occurs less frequently. Silicone structures provoke the development of complications more often.
The presence of diabetes mellitus, as well as some general or ophthalmic diseases.

Preventive measures

To prevent the appearance of secondary cataracts, doctors use special methods:

The lens capsules are polished to remove as many cells as possible.
Produce a selection of specially designed designs.
Used medications for cataracts. They are instilled into the eyes strictly for the intended purpose.

Signs of the appearance of a secondary cataract

In the early stages, secondary cataract after lens replacement may not manifest itself at all. The duration of the initial stage of the development of the disease can be from 2 to 10 years. Then obvious symptoms begin to appear, and there is also a loss of objective vision. Depending on the area in which the deformation of the lens occurred, the clinical picture of the disease can vary significantly.

If a secondary complication has manifested itself on the periphery of the lens, then it may not cause visual impairment. As a rule, pathology is detected during a routine examination by an ophthalmologist.

How does such a pathological process as a secondary cataract manifest itself after lens replacement? Treatment (symptoms and appropriate examinations should confirm the diagnosis) is prescribed for a persistent drop in visual acuity, even if it was completely restored during surgery. Other manifestations include the presence of a veil, the appearance of light from the sun's rays or artificial light sources.

In addition to the symptoms described above, monocular bifurcation of objects may occur. The closer to the center of the lens is the opacification, the worse the patient's vision. Secondary cataract can develop in one eye or both. There is a distortion of color perception, myopia develops. External signs are usually not observed.

Treatment

Secondary cataract after lens replacement, which is successfully treated in modern ophthalmological clinics, is removed by capsulotomy. This manipulation helps to free the central zone of the optics from cloudiness, allows light rays to enter the eye, and significantly improves the quality of vision.

Capsulotomy is performed both mechanically (tools are used) and laser methods. The latter method has great advantages, since it does not require the introduction of a surgical instrument into the eye cavity.

Surgical intervention

How is a secondary cataract of the lens eliminated? Treatment involves surgery. Such surgery involves dissection or excision of the clouded film with a surgical knife. Manipulation is indicated in the case when the secondary cataract after the change of the lens has caused great complications, and there is a possibility that the patient will become blind.

During the operation, cross-shaped notches are performed. The first is done in the projection of the visual axis. As a rule, the hole has a diameter of 3 mm. It may have a higher indicator if an examination of the bottom of the eye is needed or photocoagulation is required.

Cons of surgery

The surgical method is applied to both adult patients and children. However, a fairly simple operation has a number of significant drawbacks, which include:

infection in the eye;
getting injured;
corneal edema;
the formation of a hernia as a result of a violation of the integrity of the membrane.

Features of laser treatment

What innovative methods are used to eliminate such a problem as a secondary cataract of the lens? The treatment is carried out using laser beams. This method has a high degree of reliability. It assumes the presence of precise focusing and the expenditure of a small amount of energy. As a rule, the energy of the laser beam is 1 mJ/pulse, but if necessary, the value can be increased.

Laser intervention is called discission. It has a high level of efficiency. With this treatment, a hole is made in the back wall of the capsule by burning. The cloudy capsule is removed through it. For this method, a YAG laser is used. In modern medicine, this method is preferred.

Patient reviews indicate that such an intervention does not require a stay in the hospital, the operation is very fast and does not cause pain or discomfort. Manipulations are performed using local anesthesia.

How is secondary cataract eliminated after lens replacement? Treatment of complications with a laser involves the following steps:

Pupil dilation with medication. Eye drops are applied to the cornea to help dilate the pupils. For example, tropicamide 1.0%, phenylephrine 2.5%, or cyclopentolate 1-2% are used.
To prevent a sharp increase in pressure inside the eye after surgery, apraclonidine 0.5% is used.
The implementation of several laser shots using a special device mounted on a slit lamp causes the appearance of a transparent window in the cloudy capsule.

How does a person feel after laser removal of such a phenomenon as a secondary cataract after lens replacement? Patients' testimonials indicate that after the operation they went home within a few hours. Seams and bandages are not required for this intervention. Patients are prescribed hormonal eye drops. Their use in the period after the operation will be the last step on the way to the restoration of vision.

A week later, the survivor will have a scheduled check-up with an ophthalmologist to make sure everything is going right.

Another examination is shown a month later. It is not considered planned, but its passage is desirable. In this way, possible complications can be identified and eliminated in a timely manner. It should be noted that the vast majority of complications occur within a week. Later they occur very rarely.

For the most part, secondary cataracts are eliminated in one operation with a laser. Secondary intervention is extremely rare. The probability of complications from this kind of treatment is very small and amounts to about 2%.

In what cases is a dispensation given?

Secondary cataract discission is applied if:

a damaged posterior stack of the capsule causes a sharp drop in vision;
poor vision hinders the social adaptation of the patient;
there are problems with the vision of objects in excessive or poor lighting.

Strict contraindications

Is it always possible to eliminate such a complication as a secondary cataract after lens replacement? There are undoubtedly contraindications. Moreover, they can be absolute, excluding the possibility of any manipulations. These include:

the presence of puffiness or scar tissue in the cornea, which prevents the ophthalmologist from clearly seeing intraocular structures during surgery;
the occurrence of an inflammatory process in the iris of the eye;
the presence of a retina;
clouding in the cornea;
pupil membrane thickness exceeding 1.0 mm.

Relative contraindications

Relative contraindications include conditions in which the risk of secondary complications is increased:

the period of surgical intervention to remove cataracts for pseudophakia is less than six months, and for aphakia less than 3 months;
complete contact of the posterior capsule with the IOL;
a pronounced process of neovascularization of the pupil membrane;
the presence of uncompensated glaucoma;
the presence of inflammatory processes in the anterior segment of the eye.

The operation is carried out with great care if the patient has previously experienced retinal detachment or rupture.

The laser method of treatment has its drawbacks. Laser radiation can damage the optical part of the artificial lens.

Complications

What is the effect of the laser method in the treatment of such an ailment as a secondary cataract after lens replacement? The consequences may be undesirable.

After replacing the lens with a secondary cataract, the appearance of black flies may be noted, which is caused by damage to the structure of the lens during the operation. This defect has no effect on vision. Damage of this kind is caused by poor focusing of the laser beam.
A dangerous complication is racemose retinal edema. In order not to provoke its appearance, surgical intervention should be carried out only six months after the previous operation.
eyes. This phenomenon is extremely rare and is caused by myopia.
Increasing the level of IOP. Usually this is a quickly passing phenomenon and does not pose any threat to health. If it continues for a long time, then this indicates the presence of glaucoma in the patient.
Subluxation or dislocation of the IOL is observed in rare cases. This process is usually caused by IOLs with a silicone or hydrogel base with disc-shaped haptics.
The chronic form of endophthalmitis is also rare. It is caused by the release of isolated bacteria into the vitreous area.
Fibrosis (subcapsular opacity) is rare. Sometimes such a process develops within a month after the intervention. An early form of complication can provoke contraction of the anterior capsule and the formation of capsulophymosis. Development is influenced by the model and material from which the IOL is made. Often this deviation is caused by silicone models with haptics in the form of discs and less often by IOLs, which consist of three parts. The basis of their optics is acrylic, and the haptics are made from PMMA.

To prevent complications after surgery, doctors are advised to regularly use eye drops that prevent the development of cataracts.

Conclusion

From all of the above, we can conclude that after cataract surgery, a complication such as a secondary cataract of the lens often occurs. Treatment of the disease with the use of modern methods gives good results, but adverse reactions are also possible.