Secondary cataract after lens replacement treatment reviews. Secondary cataract after lens replacement. Video: Do's and Don'ts for Cataracts

Secondary cataract is a separate disease, has practically nothing to do with the primary manifestations of the disease of the same name. For various reasons, epithelial tissue begins to grow on the lens, due to which a veil forms in front of the eyes and vision is greatly reduced.

Secondary cataract after lens replacement is not repeated after primary cataract, however, in such patients, the risk of developing the problem is significantly increased and accounts for about 30% of all clinical cases.

The main methods of getting rid of the disease are surgery and laser correction of pathology. Surgery is the most effective way to restore vision, but it has some contraindications and side effects.

Causes

There are many predisposing factors for the development of secondary cataracts. Their effect on the organs of vision has not been fully studied, however, statistics confirm a stable pattern - patients at risk more often go to the doctor again with symptoms of a veil before their eyes.

The main reason for the occurrence of a secondary cataract after a previous replacement of the eye lens is the incorrect actions of a specialist during the operation, as well as non-compliance by the patient with medical recommendations during the rehabilitation period.

What else affects the development of such a complication:

More precisely, no specialist can predict the causes of the pathology. The disease is not fully understood, so a failure in the genetic code is considered one of the main causes of secondary cataracts.

Risk factors

The main and most important risk factor for the occurrence of such a pathology is a previous operation on the eyes. Much depends on the type of previous surgical treatment, as well as the age of the patient and the presence of aggravating diseases in his anamnesis. The combination of several predisposing causes increases the risk of proliferation of epithelial tissue on the pupil.

In what clinical cases does the risk factor increase:

• patients suffering from systemic and metabolic disorders (eg, diabetes mellitus, thyroid pathology, human immunodeficiency virus);
• retirement age;
• myopia, hypermetropia (nearsightedness and farsightedness);
• work in hazardous industries (contact with radiation, bright light, construction dust, as well as strong physical exertion, the likelihood of eye damage);
• other aggravating chronic diseases of the organs of vision;
• congenital eye diseases.

Secondary cataract most often develops six months after surgery, but can occur even after several years. Sometimes an inflammatory process becomes the triggering mechanism, due to which the epithelial cells on the lens begin to grow uncontrollably. Thus, an immune response to external stimuli occurs.

Various inflammatory pathologies of the eyes during the rehabilitation period increase the risk of complications by 3-5 times.

Another reason for the occurrence of pathology, experts call the adaptation of the lens to the setting of an intraocular lens during the first surgical intervention. The body tries to take root with a foreign body, because of which the epithelial tissue grows greatly. Often this complication is the result of incorrect actions of the specialist during the operation.

Symptoms and clinical picture of lens disease

It is almost impossible to ignore the development of a secondary cataract, since the pathology is accompanied by quite pronounced symptoms. Such signs should alert if an operation was performed on the eyes a short time ago.

Symptoms of the disease are as follows:

If several of these symptoms are present at once, and surgery was performed on the eyes three or more months ago, the development of a secondary cataract can be assumed. With the initial appearance of pathology on the organs of vision, no physical changes will visually form. In the future, the color of the eye may become cloudy.

Treatment

To treat cataracts and eliminate the overgrown epithelium, a second operation will be required. However, initially it is necessary to diagnose the pathology using specialized equipment. For this purpose, the specialist uses isometry, eye biomicroscopy, ultrasound research method and optical coherence tomography.

Also, if necessary, you will need to pass some laboratory tests. Based on all the results obtained, the ophthalmologist confirms the diagnosis, and then selects the type of surgical intervention.

Surgical intervention

The surgical operation is a mechanical dissection of the formed connective tissue on the surface of the lens. It is carried out in a hospital, after which the patient is under observation for some time. The procedure is performed under local anesthesia and lasts about 20-30 minutes.

After the operation, you should walk in a special gauze bandage for several days, treat the eye with antibacterial drops and perform regular dressings. Physical activity is also prohibited for some time.

Cons of surgery

One of the main advantages of a standard operation is its price. It can be minimal or completely free, depending on the region of residence.

However, such an aggressive impact has a number of disadvantages:

• duration of the rehabilitation period;
• the likelihood of complications;
• the need for dressings after surgery;
• deterioration of vision due to improper dissection of the film.

Soreness, duration of preparation, high risk of possible complications - all this is a reason to abandon surgical intervention in favor of an equally effective laser one.

Each technique has its own contraindications, so it is better to choose the type of surgical intervention together with an ophthalmologist.

Features of laser treatment

Laser treatment is a safer and more effective technique. In other words, the operation is called a capsulotomy or discission. The intervention is carried out on an outpatient basis, after some time after the procedure, the patient can go home.

This technique has a minimum of complications, and subsequent rehabilitation does not require any additional manipulations.

Advantages of laser therapy:

• ambulatory treatment;
• the procedure does not take much time;
• long preliminary diagnostics is not required;
• minimum contraindications;
• restrictions in the recovery period are also minimal.

The main disadvantage of such an operation is the cost. In various regions of Russia, it ranges from 30-60 thousand rubles for the correction of one eye.

Treatment of secondary cataracts is carried out under local anesthesia with the help of special drops that further expand the pupil and open access to the back wall.

During the procedure, a small incision is made along the back of the lens using a specially designed laser. In the future, this allows light to properly penetrate the retina, due to which vision is restored.

Contraindications

Despite the fact that laser treatment has a minimum of contraindications and side effects, there are still prohibitions on the operation. Previously, the ophthalmologist determines the general health of the patient, as well as directly the organs of vision.

Under what conditions is it forbidden to carry out the procedure:

Laser treatment is also not carried out until 6 months after the lens replacement surgery. There are also relative contraindications, in which any intervention in the body is not recommended.

Among them:

• HIV, as well as other viral and bacterial infections;
• problems with the cardiovascular system;
• complicated diabetes mellitus;
• the presence of inflammatory processes in the eye area.

If there are such conditions, the ophthalmologist will advise you to be examined by specialized specialists to confirm the safety of future eye surgery.

Possible complications in the postoperative period

Even the simplest intervention in the body can sometimes lead to complications. Often this happens due to the wrong actions of a specialist during the procedure, as well as due to the individual characteristics of the body, which are sometimes impossible to predict.

Possible complications:

The risk of possible complications can be minimized. To do this, it is necessary to conduct a full diagnosis of the state of health before the operation, as well as follow all the recommendations of the doctor.

It is especially necessary to follow the doctor's instructions after surgical treatment, since most complications are observed in this case. The consequences after the laser are much less common, and their absence directly depends only on the qualifications of the doctor.

What happens if a secondary cataract is not treated

The most unpleasant complication of secondary cataract is partial or complete loss of vision. This is possible if the therapy has not been used for a long time.

Also, patients with the disease note:

• the appearance of "flies" when looking at an object;
• dizziness;
• headache;
• inability to carry out any labor activity (read, write).

After some time, the eye begins to become covered with a transparent or white veil, due to which not only functional disorders appear, but also the aesthetics of the appearance deteriorate, and the affected eye has a more faded pupil and iris color.

Preventive measures

After the operation to replace the lens and the setting of corrective lenses, it is necessary to carry out the prevention of secondary cataracts. This complication occurs in 15-30% of all clinical cases, so it is necessary to take measures to prevent the development of the disease.

What needs to be done for prevention:

• regularly visit an ophthalmologist for preventive examinations;
• give up bad habits, such as drinking alcohol, smoking;
• pay attention to even minor signs of a secondary cataract;
• limit heavy physical activity;
• take timely measures to combat infectious diseases, as well as support the body in chronic pathologies;
• do not choose glasses or lenses for vision correction on your own;
• take a responsible approach to the choice of an ophthalmologist and subsequently follow all the recommendations of a specialist after the operation to replace the lens;
• protect eyes from strong sunlight or artificial light.

It is with the condition of an attentive attitude to one's health, as well as with trust in the attending physician, that one can prevent the occurrence of a secondary cataract or detect it in a timely manner. Also, for prevention, you can use special drops that are prescribed after surgery to prevent various complications.

Vision is one of the main ways for a person to know the world, as well as to achieve any of his goals. That is why the eyes must be protected and if a symptom of a serious illness appears, immediately contact a specialist.

Secondary cataract develops as a complication after the main operation. Causes of occurrence - the epithelium is compacted with the implant.

There is a sharp decrease in visual activity. After lens replacement, almost 20% of patients develop the presented pathology.

Treatment

Secondary cataract after lens replacement significantly complicates the life and activities of a person. The disease requires urgent surgical treatment.

It consists in the use of laser or other surgical technology.

Laser removal

An available method for the treatment of secondary cataracts are YAG lasers. The posterior compartment of the lens capsule is burned by the beam. Turbidity is eliminated. The procedure is painless and complications are minimal.

Surgical technology

Removal of a secondary cataract after lens replacement is carried out by a microsurgical technique - phacoemulsification. Ultrasonic equipment is used, the nucleus is grown. The procedure is effective and safe.

The wall barrier of the capsule is incised, a phacoemulsifier (a mechanism that expands the nucleus) is introduced, and damaged fragments are removed.

Cloudiness is eliminated by ultrasound, a lens with a similar optical effect is installed. Operation is permissible on one or two eyes, even at different stages of secondary cataract.

Advantages of the technique:

• carried out in laboratory conditions, duration 30 minutes;
• local anesthesia is applied;
• lack of pain and stitches;
• rapid regeneration of the skin;
• return to usual activity after 7 days;
• restoration of visual functions in 5-6 hours after the operation.

Phacoemulsification is indicated for patients of all age categories.

Medical treatment

After surgery, the patient needs to stabilize the metabolism. To restore the functionality of the lens of the eye, eye drops are prescribed, which contain magnesium and potassium salts. At the initial stage of secondary cataract, hormonal preparations are indicated in combination with vitamins.

Secondary cataract after lens replacement on video:

laser dissection

One of the effective methods of dealing with the development of secondary cataracts is laser dissection. 30 years have passed since the first operation.

Since that time, laser treatment of the eye organs has become quite popular. Advantage: the minimum percentage of side effects and complications.

The operation is indicated for patients with:

• a sharp decrease in visual function;
• clouding of the lens capsule;
• decrease in visual activity in the presence of bright light or poor lighting.

The discission does not apply to patients with:

• inflammatory reactions of the iris of the eyes;
• the presence of scar tissue compounds in the cornea;
• swelling of the mucosa;
• molecular hematoma of the retina.

Treatment is prescribed after a diagnostic examination.

The operation is performed under local analgesics. The patient does not feel pain or discomfort.

Removal of a repeated cataract:

1. Drops are applied to the eyeball area to help dilate the pupils. Used Phenylephrine, Tropicamide, Cyclopentolate. With the help of drugs, the visibility of the posterior capsule improves.
2. Laser pulses are directed to the posterior part of the lens capsule;
3. Epithelial growths are burned out;
4. The walls become transparent. Visual function is restored.

To prevent intraocular pressure, the patient is prescribed Apraclonidine.

Contraindications

Surgery is not indicated for all patients. In the presence of certain pathologies, the operation is not performed.

These include:

• infectious lesions;
• congenital pathologies of the eye organ, infectious diseases;
• oncological formations in the eye area.

Contraindications to surgical measures:

• high pressure;
• epilepsy;
• congenital heart disease;
• kidney failure;
• brain injury;
• cancerous tumors of different localization.

Removal of repeated cataracts is prohibited in diabetes mellitus, children under 18 years of age. The doctor conducts diagnostics, considers the results, makes a decision on the operation individually for each patient.

Repeated membranous cataract

Secondary membranous cataract is a seal located on the back wall of the lens capsule. Indicators lead to a sharp deterioration in visual function. The capsule is a fragile bag compartment where the natural or artificial lens is located.

The reasons for the formation of a secondary cataract: spontaneous resorption of the lens as a result of trauma or the surgical process. In its place remains the anterior or posterior wall with a wide, cloudy film.

Repeated membranous pathology is removed surgically. The central section is dissected using a laser or a special knife. An artificial lens is inserted into the hole.

Complications

Secondary cataract is characterized as a complication after primary cataract surgery. The presented ophthalmological pathology is treated with a surgical or laser method. The cloudy lens is removed and an artificial lens or lens is implanted.

In some cases, surgical measures are accompanied by complications:

1. Injury to the artificial lens. This is usually the result of poor calibration of the laser equipment or incorrect beam focusing.
2. Swelling of the molecular retina. The consequences are caused by a significant load on the visual organ. In order to avoid the presented consequences, it is recommended to perform the operation no earlier than one year after the operation of the first cataract.
3. Retinal detachment. Complication occurs in rare cases. Causes: medical errors or restrictive laser coagulation.
4. Displacement of the implant. With laser treatment, the likelihood of this complication is negligible. Violation occurs during surgery.
5. An increase in intraocular pressure. Reasons: clogging of the drainage of the eye organ. To eliminate the complication, drops are prescribed that stabilize the pressure. In rare cases, the anterior chamber compartment is washed or pierced.

There have been cases when a secondary cataract is complicated by astigmatism (nearsightedness). An intraocular lens is implanted. Contact optics purposefully combats the manifestation of cataracts and astigmatism.

Why does it occur - reasons

The lens is covered by a transparent shell, similar to a sac. From there, fluid is removed and the implant is inserted. After some time (4-5 months) after surgery, the epithelium grows on the posterior part of the capsule.

There is a decrease in transparency, which leads to a loss of visual activity. Reasons for the development of secondary cataracts: insufficient functioning of cellular structures.

Why does the disease occur, what contributes to its development:

• age-related changes (aging);
• genetics;
• eye injuries;
• comorbidities (glaucoma, astigmatism);
• exposure;
• frequent exposure to sunlight;
• poisoning;
• nicotine, alcohol.

• use of disinfectants;
• it is forbidden to sleep on the stomach and side (where the operated organ is located);
• exclude the ingress (into the eyeball area) of an aqueous substance and detergents;
• reduce physical activity;
• stop driving.

Secondary cataract is treatable. Don't put off going to the doctor.

Symptoms

Repeated pathology develops over months, in some cases - several years. The time cycle depends on the age criteria and the installed implant (its quality).

When using acrylic lenses, re-disease progresses less frequently than when using silicone lenses. Often the first symptomatic manifestations occur in the elderly or children.

There is a sharp decrease in visual activity, the sharpness of the susceptibility of color gamuts disappears.

If there is a sharp improvement, and after a few days a decrease in visual activity, it is recommended to consult your doctor. The symptom indicates the development of repeated pathology.

The main symptomatic manifestations include:

• split image;
• visibility of circular pictures;
• surrounding objects appear in yellow shades;
• vagueness of letters and numbers.

Pathology is characterized by gray or yellow tones of the pupil. Increased sensitivity to bright or dim light. In the presence of these symptoms, it is recommended to seek advice from an ophthalmologist.

Diagnostics

Instrumental and laboratory diagnostics are used for examination. The doctor performs an ophthalmic examination using a slit lamp. The transparency of the posterior capsule is visible. Stimulants are introduced for better visibility of the veil.

In addition, it is appointed:

1. Visometry. The level of visual acuity is determined.
2. Biomicroscopy. Turbidity of the optical compartments, abnormal modifications of the anterior eye area are visualized.
3. Ultrasound A and B modes. The physiological feature of the visual organ, the position of the IOL is assessed.
4. coherence tomography. Additionally, the topography of the eyeball, intraorbital structures are diagnosed. Pathological transformations of the posterior chamber barriers are revealed (connective tissue film coating, concentration of rings, cellular structures).

The instrumental diagnostic method is effective in severe modifications of the lens capsule. Laboratory research is assigned at the initial stage of pathology formation. Diagnostics will allow predicting the risk of developing nosology.

Therefore, an additional laboratory study is assigned:

1. Measuring level of cytokines. The methodical move is characterized by hybridization and immunofluorescence. The level of cytokines in the blood is determined, which provoke inflammation at the time of the postoperative stage.
2. Antibody testing. If there is an excess of antibodies in the circulatory system, then there is a risk of recurrent cataracts.
3. Film diagnostics. Cells are detected 90 days after surgery. They indicate a long-term progression of secondary cataract.

Diagnostic measures allow timely detection of the development of secondary cataracts. Timely diagnosis and competent treatment contributes to a quick recovery. Their absence leads to frequent relapses, complete or partial blindness.

Prognosis and preventive actions

If repeated surgical intervention is carried out correctly, the prognosis is positive. The patient notices a noticeable improvement in the quality of vision within a week. However, no one canceled the complications.

Most often, the following may occur:

• damage to the lens by a laser beam, which occurs due to insufficient qualifications of the doctor and incorrect equipment settings;
• the development of panophthalmitis, which is associated with the entry of microbes into the eye;
• intraocular hemorrhage that occurs against the background of vascular damage.

The doctor should warn that glaucoma, retinal detachment or retinal edema may occur. However, such serious complications occur only in the absence of timely treatment.

The main preventive measure, which is always effective, is a timely consultation with an ophthalmologist. The patient should, with any alarming symptom, contact a specialist for competent advice.

This article is for informational purposes only, and only an ophthalmologist can prevent the development of a secondary cataract in time.

Among the preventive measures is called the competent use of drops. Drugs such as Oftan Katahrom and Quinax minimize the risk of cataracts. Within 1-2 weeks after the operation, it is necessary to resort to the use of protective measures. Thus, the patient should not read from electronic devices, spend a lot of time at the computer and look at bright light sources without suitable protection.

Ophthalmologists recommend having a consultation and examination at least once every 2 months during the year after the operation. Then the probability of timely detection of the disease will be higher. The use of preventive measures, coupled with timely consultation with an ophthalmologist, reduces the risk of cataract progression to zero.

The re-development of the disease after removal of the lens is not excluded, however, this problem will not arise if the doctor and the patient make every effort to combat it in a timely manner.

What happens if the disease is not treated

Since the lens has a very delicate epithelium, the first blow will fall on the inner shell.

Lack of timely treatment can lead to the following consequences:

• partial or complete loss of vision;
• pathologies of the retina caused by inflammation of the epithelium;
• diplopia caused by a deterioration in the elasticity of the capsule.

Secondary cataract after lens replacement will not return if you follow these recommendations:

1. You should not visit the pool or swim in the river for a month.
2. In the summer season, avoid sharp sunlight on the iris and do not sunbathe in open areas.
3. Periodically change the load on the eyes: your main task is not to overstrain the optic nerves.
4. Women are advised to avoid cosmetics after the operation. Wash your face with baby soap.

After the operation, the patient undergoes a rehabilitation course, which includes eye exercises, medication and regular visits to the doctor. The main thing in the life of every person is a healthy view of the world!

Rehabilitation

Treatment of secondary cataract after lens replacement also includes a rehabilitation period. At this time, a person should use the prescribed drops and follow all the doctor's recommendations.

To avoid the development of anterior uveitis (a common complication of laser discission), the patient is prescribed antibacterial and anti-inflammatory drugs. A person should instill them into the operated eye daily, 3-4 times a day. Medicines help relieve inflammation, which often occurs after the intervention.

A frequent complication of laser discission is an increase in intraocular pressure (IOP). In order to identify and eliminate the problem in time, the patient is given tonometry 30 and 60 minutes after the manipulation. For all patients with concomitant glaucoma or a tendency to ocular hypertension, doctors prescribe antihypertensive drops.

How long is the disease treated?

With a timely visit to the doctor, it is treated quite simply and in a short time. In the case of using a laser, the patient returns home the same day. With phacoemulsification, when to send the patient home, the doctor decides, but more often this is a period of 7-10 days. Treatment of secondary cataract in the early stages will allow the patient to quickly return to their usual way of life and not experience discomfort.

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Any clouding of the lens of the eye is called. Secondary cataract is fibrosis of the capsule located behind the intraocular lens.

Secondary cataract is a complication of surgical treatment. This pathology develops only in a pseudophakic eye, that is, after (removing) the cataract and replacing its own lens with an artificial lens.

The causes of turbidity can be:

1. expansion of the capsule. During the operation, the anterior capsule is dissected and partially removed. After that, the lens itself is removed. The posterior capsule remains intact and an intraocular lens is placed on it. With some common diseases (diabetes mellitus) or chronic inflammation of the middle shell of the eye (), after installing the lens, the structure of the posterior capsule changes and becomes cloudy.
2. Incorrect installation of the intraocular lens. With an incorrectly selected size or an error in the implantation of the lens, a repeated cataract occurs.
3. The formation of cell clusters. According to this theory, after dissection of the anterior lens capsule, epitheliocytes (cells that provide the growth of connective tissue) migrate to the region of the posterior capsule and seek to restore its structure. The intraocular lens is perceived as a foreign body. Cellular elements forming a membrane are deposited on its surface. As a result, turbidity occurs. This reason is most common among young people, since their epithelial cells are more active.

Disease classification

Eye with secondary cataract

Depending on the pathogenetic mechanisms of development and the causes of opacities, fibrous and proliferative secondary cataracts are isolated. The fibrous form occurs shortly after the installation of an intraocular lens. Fibrosis (overgrowth of connective tissue) affects only the posterior capsule.

In the proliferative form of the disease, clouding is caused by cellular elements migrating to the intraocular lens. This type of secondary cataract develops after a longer time (a year or more).

Signs of the development of pathology

After removal of the clouded lens, the patient's vision in most cases (in the absence of other pathology) is completely restored. But after a while, if a repeated cataract is formed, the patient again complains of a decrease in distance and near vision, there is a sensation of a foreign body in the eye. The eye becomes sensitive to bright light, color perception changes. Glasses do not help improve vision, cause dizziness and headache. Sometimes there is double vision, distortion of objects, a change in their shape, blurred vision, iridescent circles when looking at a bright light.

Diagnosis of the disease

The diagnosis of secondary cataract is made by an ophthalmologist. The appearance of the above symptoms a few months after the cataract extraction performed suggests the formation of a secondary cataract. If these signs appear earlier than after 3 months, it is worth looking for another reason for the development of symptoms.

At the appointment, the ophthalmologist conducts a vision test with a trial selection of glasses, measures intraocular pressure to rule out glaucoma. After that, a study of the organ of vision (biomicroscopy) is carried out on a special apparatus - a slit lamp. Biomicroscopy reveals fibrosis of the posterior capsule, which appears as a gray background of the pupil. Additionally, ultrasound of the eye and optical coherence tomography are performed. These research methods allow visualization of fibrosis of the posterior capsule.

Methods of treatment of secondary cataract

The safest method of treating the disease is laser discission (dissection) of the capsule. In some cases, surgery is performed.

Treatment of secondary cataract with medications is ineffective, since the drops do not penetrate to the posterior lens capsule and cannot act on it. The choice of method of treatment of pathology does not depend on the causes of cataracts.

Dissection of the posterior capsule

Laser treatment is carried out on an outpatient basis in a polyclinic, preoperative preparation is not carried out. An hour before the discission, the doctor instills the patient with a drug in the form of drops that dilate the pupil. In the reviews, patients note the painlessness of the procedure, so most often the use of anesthetic drops is not required.

The incision is made with a laser. The patient sets his head on the apparatus and looks at one point. The surgeon dissections the capsule under a microscope and forms a “window” in the center of the field of view.

The operation is non-penetrating and non-contact, the intraocular lens does not change its position. There is no recurrence of secondary cataract.

Surgical treatment

In some cases, for example, with significant fibrosis of the posterior capsule or the patient refuses laser treatment, surgical intervention is performed. The operation is performed in a hospital setting. On the operating table, after installing eyelid dilators on the eye, the patient is punctured with a thin needle at two points in the cornea. After that, the surgeon injects a special solution under the intraocular lens to separate it from the posterior capsule.

A microsurgical aspirator removes the posterior lens capsule, and a special retaining ring is placed on the intraocular lens. After that, the solution is removed from the eye and the lid dilators are removed. The puncture sites are not sutured.

Contraindications to treatment

A contraindication to laser cataract dissection can only be an extremely severe general condition of the patient. Surgical intervention is not performed for severe cardiovascular diseases, respiratory failure.

Before the operation, the patient must obtain the conclusion of a therapist, a cardiologist, pass a clinical and biochemical blood test, a coagulogram.

Postoperative period

After laser treatment, the patient is prescribed anti-inflammatory drops for 3 days. Drug therapy after surgical treatment involves the appointment of anti-inflammatory and antibacterial drops, regenerating ointments for up to 3 weeks.

Vision after laser capsulotomy is restored to its previous level within a few hours.

Poor vision may persist for up to 10 days after surgical removal of the posterior capsule.

Complications of the disease and the postoperative period

Secondary cataract does not lead to the development of complications. The loss of vision is completely reversible. Changes in the position of the intraocular lens (in the absence of other eye diseases) do not occur.

Secondary cataract- symptoms and treatment

What is a secondary cataract? We will analyze the causes of occurrence, diagnosis and methods of treatment in the article of Dr. Orlova Olga Mikhailovna, an ophthalmologist with an experience of 7 years.

Publication date August 12, 2019Updated October 04, 2019

Definition of illness. Causes of the disease

Secondary cataract is a clouding of the posterior capsule of the lens of the eye. Clouding can occur after a cataract is removed and the native lens is replaced with an artificial one, also known as an artificial or intraocular lens (IOL).

This is one of the most common pathologies that occur after cataract removal. Before we start discussing the causes and treatment of secondary cataracts, it is important to note that in most cases this pathology does not develop due to negligence or unprofessionalism of the surgeon. As a rule, this is an individual feature of the organism, the result of cellular reactions and metabolic processes in the lens capsule.

The average time for the development of a secondary cataract is from two months to four years after surgical treatment. Many patients mistakenly consider a secondary cataract as a type of clouding of the native lens. In fact, this is a clouding of its posterior capsule, which occurs after the replacement of the native lens with an artificial one.

The main reason for the development of secondary cataract is the proliferation of epithelial cells on the posterior lens capsule after surgical treatment.

Also, the following factors influence the formation and rate of development of secondary cataract:

• age - the older a person becomes, the more changes occur in the metabolic processes of the body, including at the cellular level;
• the presence of concomitant diseases in the body, such as diabetes mellitus, rheumatism and other diseases associated primarily with impaired metabolic processes;
• eyeball injury;
• inflammatory processes that occur in the eye after lens replacement, for example, iridocyclitis and uveitis.

Sometimes the technique of cataract removal can serve as a risk factor for the development of a secondary cataract and the rate of its progression. For example, when extracapsular cataract extraction when the affected lens is removed through a small incision (10-12 mm) on the cornea, the risk of secondary cataract is higher than with phacoemulsification(the incision is only 2-3 mm). However, now the extraction method is practically not used due to the emergence of new, more modern technologies.

There is also an assumption that the development of secondary cataracts is affected by exposure to ultraviolet rays and various drugs. However, this information has not been confirmed.

Thus, the probability and rate of development of a secondary cataract is individual and depends on many factors.

If you experience similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!

Symptoms of a secondary cataract

The main complaint of patients is a gradual decrease in visual acuity after lens replacement. Vision may deteriorate both at a distance and near, a violation of the focus of the gaze is possible. Contrast sensitivity and/or color perception (image brightness) may decrease.

Some patients have complaints about dark adaptation disorder, the appearance of glare and halos, especially at night when looking at a bright light source (lantern, headlights).

Increased fatigue during reading and normal visual stress. There is double vision and a feeling of a veil or fog in front of the operated eye.

The pathogenesis of secondary cataract

To understand how a secondary cataract is formed and develops, you need to understand the structure of the eye, or rather the lens.

The lens is a transparent, biconvex biological lens, one of the main components of which is protein. That is, it is a protein structure. Unlike other structures of the eye, there is very little water in it (about 50-60%). With age, the amount of water decreases, the cells of the lens become cloudy and thicken. Normally, the biological lens of an adult is yellowish in color, and when a cataract occurs, it acquires a more intense yellow or red hue. The lens in the eye is in a special capsule bag (capsular bag, capsule). The part of the capsule that covers the lens from the front is called the "anterior capsule", the capsule bag that covers the lens from the back is called the "posterior capsule".

From the inside, the anterior lens capsule is covered with epithelial cells, and the posterior part of the capsular bag does not have such cells, so it is almost twice as thin. The epithelium of the anterior capsule actively reproduces throughout life and participates in the metabolic processes of the lens, selectively passing nutrients to it through the anterior capsule.

When the native lens becomes cloudy and a cataract forms, the question arises of surgical treatment.

There are several types of cataract surgery. To date, the most effective and fastest way to treat opacification is phacoemulsification with the replacement of the clouded lens with intraocular lens. The technique of the operation is quite simple and does not require long-term rehabilitation. First, the surgeon makes micro-incisions on the cornea 1 mm and 2-3 mm. Next, a round hole is formed in the anterior capsule, and with the help of ultrasound, the cloudy lens is removed through this hole. The posterior lens capsule remains intact. After the lens masses are removed, an artificial lens (IOL) is implanted into the capsular bag through the same opening.

According to its structure, the intraocular lens is much thinner than the biological one, therefore, in the capsular bag, at first it is in a free position. Within a period of one week to a month, the capsular bag tightly envelops the artificial lens.

Sometimes single epithelial cells may remain on the anterior lens capsule. Depending on the metabolic processes and the individual characteristics of the organism, these cells can grow and move to the posterior lens capsule. When a large number of these cells accumulate on it, the capsule becomes cloudy and visual acuity gradually decreases. This clouding of the posterior capsule is called a secondary cataract. That is, the pathology is the result of the growth of epithelial cells on the posterior lens capsule.

Classification and stages of development of secondary cataract

There are several classifications of secondary cataracts. In this section, we will look at the most common ones.

Complications of secondary cataract

Considering that the main symptoms of secondary cataract are associated with a deterioration in visual functions after lens replacement, the main complication is a decrease in the patient's quality of life. Without treatment, the symptoms will progress, gradually increasing visual discomfort.

Secondary cataract can lead to disability and disability. But this, as a rule, does not come to this, since patients go to the doctor much earlier, at the stage of visual impairment.

Diagnosis of secondary cataract

Usually, a standard ophthalmological examination is required to detect a secondary cataract - biomicroscopy(visual acuity test and slit lamp examination with dilated pupil).

In some cases, the density of opacities on the posterior capsule (posterior capsule thickness) is determined using a device pentacam(used for computer topography of the cornea and complex examination of the anterior segment of the eyeball). This type of diagnosis is most often carried out for the purpose of clinical research or to determine the feasibility of removing the capsule, as well as to determine the power of the laser during the operation.

Differential diagnosis of the disease is not carried out, since the clinical and laboratory signs of the disease are obvious.

If, in the presence of clouding of the capsule, the doctor sees that the degree of clouding does not correspond to the degree of decrease in visual acuity, then further additional examination is carried out. The specialist must identify another disease that is the cause of visual impairment, and determine the further tactics of treating the patient.

Treatment of secondary cataract

The main task of secondary cataract treatment is to form a round hole in the clouded posterior lens capsule in order to improve visual functions.

There are two main ways to make such a hole:

1. Surgical treatment (invasive method, penetrating operation).
2. Laser treatment (non-invasive, non-penetrating operation).

In the first case, the surgeon makes incisions in the operating room, penetrates the eyeball and mechanically removes the clouded capsule, forming a round hole in it. This is a rather traumatic method, therefore it is used extremely rarely, usually in the presence of absolute contraindications to laser treatment.

Currently, in the treatment of patients with secondary cataract, mainly used laser photodestruction (LPD). LPD is a laser discission of a secondary cataract (otherwise it is called YAG laser dissection of the lens capsule or laser capsulotomy), that is, the dissection of the clouded posterior lens capsule using a laser beam.

Precise and dosed exposure of the laser beam has little trauma to the structures of the eye and allows you to achieve high visual functions immediately after surgery.

This type of operation does not require hospitalization. The procedure itself is painless, done without anesthesia and lasts no more than 5-10 minutes. Only in some cases, it may be necessary to instill painkillers.

Operation technique

30 minutes before the start of the procedure, the patient is instilled with a mydriatic (drops that dilate the pupil) in the eye. Depending on the type of opacities in the posterior capsule and other factors, the surgeon determines the optimal tactics of laser treatment and the power of laser radiation. The doctor focuses the laser beam on the posterior capsule, when exposed to it, the posterior capsule is dissected in several places and a round hole is formed.

Indication for YAG laser discission:

• secondary cataract (clouding of the posterior lens capsule).

Possible contraindications:

• low predicted result after the procedure (as a rule, this is due to concomitant diseases in this eye);
• inflammatory processes of the eye in the acute period;
• cloudy environments of the eye, which make it difficult for the surgeon to see the posterior capsule and may affect the quality of the operation.

Postoperative period

The rehabilitation period after removal of a secondary cataract is not required. The patient can lead a normal life immediately after the operation. In some cases, the doctor prescribes anti-inflammatory and / or antihypertensive eye drops for several days after surgery and / or restriction of physical activity and activity for a certain period.

Any therapy must be prescribed by the attending physician. You need to understand that each case is individual, and in order to correctly determine the tactics of treatment, it is important to know the overall picture of concomitant diseases.

Complications during laser treatment and postoperative period

Until recently, the appearance of laser equipment in ophthalmic practice was perceived only optimistically. However, with the accumulation of clinical experience, information began to appear about the risk of developing various complications.

The most important advantage of laser surgery is the formation of a stable optical hole in the posterior lens capsule. Precise dosed exposure of the laser beam provides high postoperative results. However, despite the simplicity of the operation technique, the possibility of developing these complications requires a thorough examination of patients and taking into account all possible risk factors. This approach allows you to carry out the procedure safely and get a good postoperative result.

Forecast. Prevention

Secondary cataract does not recur. The cause of the disease is clouding of the lens capsule, which is dissected by a laser during the operation and removed. In its place, an empty hole ("window") is formed, and the cells that caused the decrease in vision have nowhere else to grow. Some surgeons address the issue of secondary cataract prophylaxis simultaneously with cataract removal. This is especially true for patients at risk of developing macular edema or retinal detachment and in young children. This technique avoids the development of secondary cataracts and, as a result, laser intervention.

However, to date it has been proven that removal of the posterior lens capsule simultaneously with cataract removal in order to prevent secondary cataract is not advisable, since it can lead to a number of complications.

Above, we said that one of the factors in the development of secondary cataracts is inflammatory processes in the eye after surgical treatment. Therefore, anti-inflammatory therapy in the early postoperative period reduces the likelihood of opacities on the posterior lens capsule.

As a preventive measure, photodynamic therapy (photochemical effect on newly formed vessels) can be carried out before surgical treatment of cataracts. However, there are many contraindications to it, and the effectiveness of such therapy is not always justified.

Of no small importance is the material from which the artificial lens is made. To date, preference is given to IOLs made of acrylic. In addition to many advantages, such lenses are laser-resistant. That is, if it becomes necessary to remove a secondary cataract, there is practically no chance that the laser beam will damage the optics of the lens and affect the quality of vision after the operation.

It must be remembered that for the purpose of prevention, it is recommended to undergo an examination by an ophthalmologist 1-2 times a year and immediately consult a doctor if there is a sharp deterioration in vision.

Opacification of the lens substance is a dangerous disease, and its cure is often associated with certain difficulties. Despite high-precision equipment and advanced technologies, the result of the intervention largely depends on the individual characteristics of the patient. Sometimes a secondary cataract develops after lens replacement. Laser treatment can solve the problem.

Recurrent cataract after lens replacement, causes

In the primary pathology, the transparent body becomes cloudy, which is replaced with an artificial lens. With a "relapse" - there is a seal on the back of the capsule. This is due to the growth of the epithelium along the capsular surface, due to which there is a sharp decrease in transparency, a characteristic veil appears, a person sees the surrounding objects in a blurry and fuzzy form.

Where does a repeated cataract come from after a surgical replacement of the lens? The reason lies not in the professionalism of the ophthalmic surgeon. The cellular response of the body is to blame, which is unique for everyone. Fibrous deposits are more common in young and mature people. Usually, the doctor in this situation recommends laser discission of the secondary membranous cataract.

Other risk factors:

• traumatic brain injury;
• Unhealthy Lifestyle;
• metabolic disorders;
• belonging to the age category over 60 (weakening of immunity, deterioration of blood flow, concomitant diabetes mellitus affect);
• prolonged hypovitaminosis;
• background ophthalmopathologies;
• inflammatory processes, infections.

Secondary cataract of the lens after its replacement - laser treatment

YAG laser dissection is a painless, effective and high-tech way to restore vision to the patient in the shortest possible time. The surgeon dissects the structurally changed area with a laser beam, the installed intraocular implant (artificial lens) and other areas of the visual apparatus are not affected. The impact falls on a small volume of the posterior capsule of the lens, a hole is formed through which light will enter the retina. The whole manipulation takes a little more than ten minutes and is performed under local anesthesia. Beforehand, special drops are instilled to expand the pupil and facilitate examination of the organ.

After capsulotomy, no additional procedures are required. To exclude complications, it is necessary to follow all the recommendations of the attending doctor during the rehabilitation period, and if discomfort occurs, contact the clinic.

The operation cannot be performed when:

• macular edema;
• bulk fibrosis;
• swelling of the cornea;
• inflammation of the iris;
• immediately after phacoemulsification (you need to wait at least six months).

The right choice of strategy, the use of metabolic drugs at the stage of recovery, constant dispensary observation by an ophthalmologist are an excellent means of preventing this disease.