Cataract is a pathology, the crust of the lens or its capsule is observed. This pathology leads to a decrease in visual acuity due to reduction of the transparency of the lens. The disease usually slowly progresses in adulthood. However, certain types of cataracts can break rapidly and in a short time lead to loss of vision.

About Cataract was known in ancient times, from the time of the great ancient Greek doctor of the Hippocrat. Cataract translated from greek means "waterfall". The ancient Greeks explained this by the fact that when a disease appears, a person begins to see the surrounding items, as if through the falling flow of water, which prevents the penetration of light rays inside the eye. That's just differentiate cataract from other eye diseaseFor example, glaucoma, the doctors of that time were very difficult, and there was no speech about correct treatment.

Some tried to treat cataract compresses from antimony, milk, honey, vinegar and, even blood and animal indoors. Other - diet, massage, healing baths, castor Oil and a variety of herbs. To a significant improvement in vision, none of these treatment methods contained. Over time, the cataract has become a serious problem leading to shopful deterioration vision. Therefore, many thousand years ago, it began to be treated with the help of surgical intervention, which is evidenced by the descriptions in the treatises of ancient Greece, Rome and Egypt. But, unfortunately, even such methods did not lead to an improvement of vision, since the principle of this operation was only in the extraction of a magnificent lens, which allowed the patients to distinguish the light that came to the eyeball and shadows.

Cataract At this point in time is considered one of the most common ophthalmological diseases found in people in old age. Thus, approximately 17 million people aged 60 years and older suffer from cataract. According to the World Health Organization for 1000 people aged from 70 to 80, cataracts are found in 460 women and 260 men, and after 80 years is an illness of almost everyone. Currently, there are more than 40 million blind people in the world, half of them lost sight due to cataracts. In developed countries, people over 50 of the cataract occur in 15%, and in developing countries it reaches 40%.

Anatomy and Phrase Physiology

Crystalik is a bone lens, located directly for the pupil. It is one of the most important light-conducting parts in the light-timing system of the eye.

The lens consists of a capsule, which is filled with crystal transparent, normal, crystal substance. Capsule is thin, puffy on the gap. Crustal masses have a layered structure and with age tend to become more dense and change the color closer to yellow.

All necessary for exchange processes The substances of the lens receive from the so-called watery moisture of the rear eye chamber.

Inside eyeball He takes a place between the iris and the vitreous body, sharing the eye on the front and rear cameras. In the young age, the human eye lens is transparent and has high elasticity, which allows it to easily change his form. Like a camera, a healthy lens instantly "enters the focus", which ensures the human eye the impeccable vision of objects both away and close. A healthy lens 60 - 65% consists of water, 35 - 40% are proteins, 2% of fats and various enzymes and no more than 1% are of mineral substances.

In the human eye, the lens is performed by very important functions: lighting, lightwriting, is a separation barrier of the eye to the front and rear chambers, as well as a protective barrier (prevents penetration of microbes into the vitreous body from the front chamber of the eye).

Causes of cataracts

To date, numerous reasons that contribute to the occurrence of cataracts are known. Depending on the root cause, which caused the disease, all cataracts are divided into two large groups: congenital and acquired.

Cataract Risk Risk Factors

1. Unbalanced nutrition
2. Lack of timely and adequate treatment chronic diseases (arterial hypertension, diabetes, hepatitis, cholecystitis, stomach ulcer)
3. Injuries or inflammatory eye diseases moved in the past
4. The presence of cataracts of relatives of the first degree of kinship
5. Long use Some drugs

Cataract Development Mechanism

The normal functioning of the lens is maintained as much time as the percentage equilibrium is maintained in the structure of the lens. The cataractogenic process is characterized by numerous biochemical factors: a change in the amount of water included with the composition of the lens, the loss of potassium, an increase in calcium content, reducing the amount of oxygen and ascorbic acid, as well as glutathione and hexose. The transparency of the optical lens eye provides water-soluble proteins included in its structure. With age, the processes of chemical oxidation of membrane substances begin to prevail in the eye lens, which in turn leads to self-dissemination of proteins. Consequently, from water-soluble proteins gradually turn into water-insulapable.

This chain of pathological processes leads to the loss of transparency of the lens, that is, to the emergence of its cloudy. The closet of the lens is a response from the crustacean substance to the impact of various adverse factors or the modification of components that are part of intraocular fluidwhich is a medium surrounding a lens.

Symptoms of Cataract

Clinical picture Cataracts varies depending on the localization, forms, as well as the stages of clouding lens. All patients with cataract are inherent gradual progressive reduction in vision. Most of them complain about the presence of a pelleh or fog in front of the eyes, the presence of black points of those who are felt in the field of view that moves simultaneously with the movements of the eye and remain fixed when the patient's eye moves.

Also, patients may have two-ways, haloes around objects with bright lighting, optical distortion, light-free, dizziness, discomfort, visual impairment, which are intensified at night, when managing vehicles, letter, reading, sewing, when working with small details. Over time, as cataracts ripening, the vision worsens, the possibility of reading is lost, patients cease to recognize persons surrounding and objects. In the future, there is only the ability to distinguish light and shadows. The totality of these symptoms leads to the development of professional and social disadaptation of a person. With absence timely treatment Cataract most often leads to full blindness.

Stages of ripening cataracts

Initial cataract - It is characterized by the appearance of turbidity along the periphery of the lens, without damaging the optical zone.

Unripe Cataract - It is peculiar to the spread of closet of lens to the center of the optical zone. The acuity of vision at this stage is significantly reduced.

Mature Cataract - clouding the entire area of \u200b\u200bthe lens. Progressive impaired view, subjectness loss, patients are able to recognize only light and shadow.

Persered Cataract - Further development of the process, which is accompanied by the complete destruction of the lens fibers and the dissolution of the cortical substance. As a result, the lens becomes milky and white and homogeneous in consistency. Overripe Cataract is quite rare. This is the most dangerous stage for which the development of heavy complications is characterized, for example, the gap of the capsule with the output of its contents into the cavity of the eye, which also entails adverse effects.

Diagnosis of cataracts

To detect the cataract on the eye in the patient does not constitute a special difficulty, difficulties arise when the task is to determine the stage, localization, etiology of clouding and, most importantly, to establish the necessary volume and tactics of operational intervention. The difficult diagnosis of cataracts is due to the fact that pronounced turbidity in the lens is greatly hampered, and sometimes it is not possible to study the study of the state directly behind the lens, fiscame body and retina.

All methods of examining a patient with a cataract can be divided into four large groups:

1. Standard (routine) Methods required for each patient

• Visometry - Determination of visual acuity
• Definition binocular vision - Evaluation of volumetric, stereoscopic vision with both eyes at the same time
• Perimetry - Study of fields of view
• Tonometry - Measure intraocular pressure
• Biomicroscopy. - Method of microscopic examination of eye tissues, allowing a detailed study of the front and rear departments of the eyeball, regardless of the illumination of the room. Biomicroscopy is the most responsible stage of the patient examination with the cataract, with which the ophthalmosyrurg is choosing the most effective method Cataract removal. For biomicroscopy, a special device is applied, called a slit lamp. The study is carried out under the conditions of medication mydriasis (expanding the pupil with drug drugs), the following indicators are estimated: the size and density of the kernel, the stage of dystrophic changes in the capsule, the position of the lens, the presence of a pronounced or hidden sliding lens caused by dystrophic changes, the destruction of the ligament fibers supporting the lens
• Ophthalmoscopy. - method of retinal research, spectator nerve, vascular shell in the rays of light, which are reflected from the eye bottom. Sometimes due to strong closet of lens, the execution of this method of research is hampered. At the same time, ophthalmoscopy is very informative when studying eyes in patients with diabetes, uveit, myopia, pigment retinitis.
• Gonoscopy - Studying the angle of the anterior chamber of the eye. This research method is of fundamentally important in determining the tactics of surgical treatment of patients with lens pathology in combination with glaucoma

1. Additional methodsare also mandatory for each patient.

• Refractometry - Determination of eye refraction (refracting power of the optical system of the eye). The method is necessary to determine the degree of hypotherness, myopia and astigmatism.
• Ophthalmometry - Represents eye research using a special device - ophthalmometer. With this device, an ophthalmologist can measure the radii of curvature of surfaces, both cornea and lens itself
• Definition of the front - rear size of the eyeball
• Skiaskopia - Method Defraction of the refraction of the eye, consisting in observing the movement of shadows in the pupil area, with the beam of light aimed at the eye, reflected from the mirror
• Electrophysiological examination of the eye - Used to determine the lability and threshold of the sensitivity of the optic nerve

Holding all methods of research included in this group is necessary to calculate the necessary parameters of the eye, allowing to accurately calculate optical power. artificial lenswhich will be implanted during the operation (intraocular lens). All data obtained is processed using a computer, which makes it possible to instant the correction of hyperopia and myopia.

1. Additional methods applied to the destination of the doctor

• Densitometry
• Ultrasonic biomicroscopy
• Endothelial biomicroscopy

1. Laboratory research methods.

Appointed patients before hospitalization for surgery or directly in the hospital. Mandatory for all patients are: a general analysis of blood and urine, glycemia, a coagulogram, a study of blood for HIV, hepatitis B and C, syphilis. Biochemical analysis The blood is carried out by appointing a doctor if the patient has concomitant diseases. In the case of congenital cataracts to clarify its etiology, the blood serum and the crust of the mother and the child must be tested to determine the markers of the hepatitis V. virus

Cataract treatment

Medicia treatment

Conservative treatment It is advisable only in the initial stage of cataract development, which provides for the prevention of rapid progression of crustaging. Patients are prescribed to instill drugs that have a positive effect on the metabolism flowing in the structures of the eye. Such preparations contain ascorbic acid, glutamine, cysteine, as well as a complex of vitamins and microelements, for example, Quenaks, Offanta Catane, Taufon. Offanta Katahro - eye drops Finnish production, for more than 10 years, one of the most famous in Russia, well-proven in the treatment of cataracts of the initial stage. The preparation contains in its composition cytochrome C, which plays the role of antioxidant, adenosine, acting as a source of energy and nicotinamide, is important vitamin In the human body, due to which it has a clinical action regarding the slowdown in the development of the catiarca. The drug does not require breeding, it is well tolerated, rarely causes unwanted side effectsIt is widely available in the pharmacy network and ease of use, which is often assigned to patients with cataracts that are currently not ready to operate. The results of such treatment do not always justify the patient's expectations. In sharp cases of clouding lens in some forms of primary cataracts, they can dwell or explain in case timely and rational therapy primary diseasewhich caused the development of cataracts.

We must not forget that cataract is the process of progressing and irreversible. Drug treatment methods can only suspend the development of the process for some time, but it will never be able to return its initial transparency to the lens.

It is very important to know that if the closet of the lens continues to enhance, it is necessary to produce operational interference with the removal of cataracts.

Surgery Cataract

A direct indication of the operation is to reduce visual acuity, provoking the restriction of the patient's working capacity and the emergence of discomfort in everyday life. When determining the testimony to remove the cataract, its maturity has no value. A completely unpromising operation to remove cataracts is considered only in the case of full blindness. This is possible when there are other pathologies in the eye with cataracts that led to blindness.

Preparation for the operation

Before the operation, each patient needs to make a thorough study of both eyes using the methods specified earlier in the "Diagnostics of Cataract", as well as a full assessment. general status Whole organism. This is necessary for the proper prediction of the results of the operation, relative to the prevention of all sorts of complications, both from the operated eye and the organism itself, as well as to determine the functional ability of the eye after the operation.

If in the survey process is detected inflammatory processes In the eye, or in the organs and tissues, located in the vicinity of the eye, it is obligatory to the operation to the operation of foci of inflammation plus the conduct of anti-inflammatory therapy. Directly on the operating table, the patient's preparation consists in instilcing in the operated eye of disinfecting droplets, as well as drops that expand the pupil. The anesthesia depends on the type of the upcoming operation, may be local or general ( intravenous administration anesthetics).

Selection of intraocular lenses

The selection of an intraocular lens is a rather complicated and labor-intensive process, and the mainly responsible factor of a successful operation, since the quality of the patient's vision is depends on the correctly selected lenses. An individual selection of lenses is carried out by a specialist with the help of specialized equipment (the methods are listed in the "Diagnostics of Cataract"). The choice also depends on the desire of the patient to see well without glasses near either the distance. Careful selection of intraocular lenses is so important due to the fact that all the lenses are different, so it is necessary to make the only right choice It is for your eye.

Types of intraocular lenses

• Monophocal intraocular lisen - the most commonly used form of artificial lens. Provides top quality of videos, regardless of the degree of illuminance of terrain or premises. But at the same time vision near (letter, reading, sewing) needs a minor correction with glasses.
• Accommodating monophocal intraocular lisen - has a property to easily change its position in the eye, which contributes to the focus of the image precisely on the retina, regardless of whether the patient looks near either the distance. Accommodation such a lens is similar to the natural accommodation of a healthy lens. After the operation, the patient can easily do without glasses.
• Multifocal intraocular Lisa - Due to the features of manufacture, they have ultra-optical optical characteristics, imitating the work of a healthy eye lens, which allows the patient after surgery to see without glasses is equally good at any distance.
• Toric intraocular lisa - due to its cylindrical form, they are able to change the refractive force in certain areas, which is very important in the correction of corneal astigmatism, which is often complicated by the cataract.
• Aspherical intraocular lisen - has all the properties of a healthy lens, except for high visual acuity implantation of this type of lenses provide high sharpness and contrasting sensitivity of vision.

Types of Cataract Operations

Surgery Cataracts is to remove the speeded lens and replacing it with an artificial intraocular lens. There are several cataract removal operations:

• Intrakapsular cataract extraction - It is removed from the lens along with the capsule carried out through a large incision using a special device - a cryoxtractor. This technique is quite traumatic for the eye, so it is currently practically not applied. Usually, the testimony for such an operation is traumatic cataractsWhen it is not possible to maintain the integrity of the lens capsule or the lens, when hanging his threads (chords) are damaged.
• Extracapsular cataract extraction - The crystal is removed, but at the same time the rear capsule is preserved, which gives the method of advantage compared to the first. The barrier is preserved between the front and rear cameras eyes. But nonetheless, this method It is also very traumatic due to the performance of a large cut and, needs the imposition of seams on a postoperative wound. It is widely applied at present, but intensively displaces the modern small-scale method - facoemulsification.
• Facoemulsification - Removal of lens with ultrasound. The advantages are that the operation is performed through a microgeneration from 2.2 to 5.5 mm, depending on the selected intraocular lens. The operation is performed under local anesthesia, it allows the surgeon to be in contact with the patient throughout the operation. No postoperative seams do not need. Duration does not take more than 15 minutes, absolutely painless and safe, risk of occurrence postoperative complications Minimized. The patient is rapidly rehabilitated, fully recovered after 10 days.
• Laser Surgery Cataracts - It is based on the use of laser radiation for crushing the kernel of the lens, which has the maximum degree of hardness in a short period of time, and is absolutely safe, almost without damaging the rear epithelium of the cornea.

After operation

After the operation is completed on the operated eye, a sterile bandage is superimposed. After a few hours after the operation, the patient sees well enough by the operated eye, and during the week he is finally adjusted with visual functions.

If the patient has no complications in the early postoperative period during the operation and in the early postoperative period, then the next day it is discharged home. It should be saved from excessive overvoltage of the eyes, do not lift gravity, avoid sharp movements, observe eye hygiene, eliminate sharp temperature differences, refrain from alcohol for at least 3-4 weeks after surgery.

Immediately after returning home, the patient returns to the former lifestyle. It is allowed to read, write, watch TV, etc. In an individual, the Doctor prescribes eye drops to reduce the reducing period, and also informs the patient about the need for prophylactic examinations.

Cataract prevention

In order to prevent cataracts, some substances, such as antioxidants, are recommended to fill in the body. These include: glutathione, lutein, vitamin E. Balanced diet, abstinence from smoking and alcohol, physical activity can prevent the development of cataracts. Regular examination of the ophthalmologist of persons over 50 years old.

Cataract is the most common ophthalmic disease. This is pathology eye leakWhen the development of which, it observes its cloudy. In order to understand his mechanism, it is necessary to know that the lens of the eye is a border lens, which is inside the eye directly for the pupil.

It provides a setup of view on different distances, which is called focusing or accommodation in accordance with medical terminology. It is thanks to the lens that a person can be equally well to see how near and away.

Cataract Classification - Operation

With age or under the influence of any adverse external or internal factors, cloues may be observed in the lens. It is worth noting that cataracts in most cases is an age-related disease and often requires a cataract operation.

As a rule, it develops in older people from 55 years. Moreover, it is diagnosed equally often both in men and women. But due to the fact that the life expectancy of women is more, they more often turn to those skilled in the art.

Currently, two types of cataracts are classified - age or primary and complicated, which develops with other internal diseases, such as diabetes, rheumatic pathologies, or with traumatic eye damage.

Therefore, this disease is developing individually, and to allocate some risk factors for the occurrence of primary pathology at the moment is not possible. In the case of complicated cataracts, the main risk factor is diabetes, which can be a starting mechanism for the development of crust blur.

Genetic predisposition to this disease has not been detected. It is worth noting that there is a congenital cataract, which arises due to intrauterine infections of the fetus at different times of pregnancy, affecting the organs of vision. In the case of a traumatic cataract, its causes can be bruised eyes or penetrating injuries. The crystal retains transparency only under the condition of the integrity of its capsule. When damaged it hesitates.

Cataract can also provoke some medications, such as antimetabolites used in the treatment of oncological diseases. It may also occur in radiotherapy, which can cause radiation cataracts arising from the effects of ionizing radiation on the structure of the lens of the eye, as a result of which its structural changes occur.

Cataract treatment

It is worth noting that at present ophthalmologists leave the classical cataract gradation, which implies four stages of this disease - the initial, immature, mature and overripe. Such a classification was relevant in the past when it was necessary to determine the possibility of surgical intervention.

Previously, the surgery for removing the lens provided for an extensive corneroskleral cut of the eyeball and the removal of the lens kernel. If it was not formed and was not dense enough, it was very difficult to remove the soft lens, so it was necessary to wait for cataracts and it would become dense.

In this case, it was possible to remove a crystal with one block. With the development of technologies and the use of fameemulsification methods, it is not important at what stage of development is Cataract.

Operate and treat the cataract in the immature stage is even easier, because the soft crusting masses are easier aspiring and less ultrasound is used to fragmentation. It is worth noting that cataract implies only operational treatment, since all other conservative techniques will not lead to the desired result. Cataract prices can be found in

As a lens is one of the main components visual organThe violation of its functions significantly reduces the quality and clarity of the perception by the people of the surrounding world. It represents a two-way lens located under the iris. In the process of view, the lens is responsible for the ability to focus and clearly see both distant objects and those that are located near. This process is called accommodation, and it is carried out by reducing the ciliary muscle. Due to the fact that the lens is elastic, the muscles either seal it, or stretch it a bit, thereby changing the refractive force and ensuring the correct ingress of the light beam on the retina.

One of the main and serious irregularities in the work of the lens is the cataract -Utrate their abilities to accommodation and the loss of transparency. It is established that this happens for several reasons, depending on the type of cataracts. So, for example, the old cataract is characterized by a violation chemical composition Lens, the unbalancement of amino acids, ions occurs. Violates the allocation of necessary for proper nutrition Enzymes, reduced the absorption of oxygen. With other types of cataracts, similar disorders occur, but under the influence of external destructive factors. The progression of cataracts takes place in several stages that can proceed individually for each person and range from month to decades.

Stages and symptoms of the disease

A total of four stages of development of cataracts of the eye is made.

• Initial. The first stage, during which you can already make a diagnosis. As a rule, at this stage, a crystal begins to a curm, and in most cases - from the periphery. Gradually begin to develop dark stripes that stretch into the center of the eye. The formation of such strips or small "flakes" is noticeably patient. Moreover, the vision is still sufficiently sharp (since there is a clouding if there is, it is too weak), however, protein seal begin to interfere, as it is partially covered by an overview. In rare cases, cataract develops from the center - the kernel of the lens. At the same time, the loss of vision goes much faster. On average, the initial stage is developing from month to ten years. At the same time there is a loss of sight to 0.5.
• Immature cataract. The following stage, which is characterized by a noticeable closet of a lens and a decrease in the clarity of vision. In detail to consider the objects of the patient only near, there are already no glasses or contact lenses. This stage wears the second name - "swelling", because It is at this stage that the cataract is somewhat increasing in size, which creates an additional risk of glaucoma, since intraocular pressure is growing.
• Mature cataract. It is characterized by a complete closet of a lens to such an extent that the patient near is able to distinguish only the movement, but not details of objects. The pupil is observed dairy.
• Overripe cataract. At this stage, the lens is already killed, it becomes smaller in size and gives a characteristic yellow shade of his nucleus. Due to the sharp decrease in size, it begins to move in its chamber during head slopes. Vision either remains at the same level, or is slightly improving, but only if there is a long period.

In addition to these basic stages, there are even additional stages of cataracts of the eye: traumatic, when the seal seals are formed by external eye injury, and electric - under the influence electric current, gamma rays, infrared or ultraviolet rays violates the correct work of the lens.

- Pathology of the light-strain structure of the eye - lens, characterized by its turbidity and loss of natural transparency. Cataract is manifested by the "blurred" view, worsening night vision, weakening color perception, sensitivity to bright light, diplopy. Ophthalmological examination in cataract includes visometry, perimetry, ophthalmoscopy, biomicroscopy, tonometry, refractometry, ophthalmometry, ultrasound scanning eyes, electrophysiological studies. To slow down the progression of cataracts is carried out conservative therapy; Removal of cataracts is made by microsurgical intervention with a crystal replacement for an intraocular lens.

General

Cataract (from Greek. Katarrhaktes is a waterfall) - clouding or a change in the color of the part or the entire lens, leading to a decrease in its light engineering and a decrease in visual acuity. According to WHO, half of the cases of blindness around the world due to the cataract. In the age group of 50-60 years, the cataract is detected from 15% of the population, 70-80 years - in 26% -46%, over 80 years old - almost everyone. Among the congenital diseases of the cataract also takes the leading positions. The greater prevalence and social consequences of the disease make the cataract of one of the most actual problems modern ophthalmology.

The lens is part of the dioptric (light-conducting and light-strain) apparatus of the eye, located the steepler from the iris, opposite the pupil. Structurally lens is formed by a capsule (bag), capsular epithelium and crustal substance. The lens surface (front and rear) have a spherical shape with different radius of curvature. The diameter of the lens is 9-10 mm. Crystal - widnish epithelial education; The nutrients in it come by diffusion from the surroundary fluid.

According to its optical properties, the lens represents a biological bicon-like transparent lens, the function of which consists in the refraction of the rays included in it and focusing them on the retina of the eye. The refractive strength of the lens is inhomogeneous in thickness and depends on the state of accommodation (at rest - 19.11 DPTR; in a voltage state - 33.06 DPTR).

Any change in shape, magnitude, the position of the lens leads to significant violations of its functions. Among the anomalies and the pathology of the lens occasionally occur (lack of lens), microfakia (decrease in dimensions), koloboma (lack of a part of the lens and its deformation), lentikus (protrusion of the surface in the form of a cone), cataract. Cataract formation can occur in any of the lens of the lens.

Catakti reasons

The etiology and mechanisms of cataractogenesis - the development of cataracts are explained from the standpoint of several theories, but none of them gives an exhaustive response to the question of the causes of the disease.

In ophthalmology, the theory of free-radical oxidation was most common, which explains the cataracting mechanism from the point of view of the formation of free radicals - unstable organic molecules with a unpaired electron, easily entering chemical reactions and causes the strongest oxidative stress. It is believed that lipid peroxidation - the interaction of free radicals with lipids, especially unsaturated fatty acids, leads to the destruction of cell membranes, which causes the development of senile and diabetic cataracts, glaucoma, microcirculation disorders in brain tissues, hepatitis. The formation of free radicals in the body, first of all, the smoking and ultraviolet radiation contribute.

An important role in the mechanism of development of cataracts plays an age reduction in antioxidant protection and a shortage of natural antioxidants (vitamins A, E, glutathione, etc.). In addition, with age, the physico-chemical properties of lens protein fibers, which constitute over 50% in its structure. Violation of the metabolism of the lens and the development of clouds can be associated with a change in the composition of intraocular fluid in recurrent inflammatory diseases of the eye (iridocyclite, chorioretinate), as well as ciliary body dysfunction and iris (fuchs syndrome), terminal glaucoma, pigment degeneration and retinal detachment.

In addition to the age involution, the development of cataracts predispose deep overall exhaustion after severe infectious diseases (typhus, malaria, smallpox, etc.), starvation, anemia, excessive insolation, exposure to radiation, toxic poisoning (mercury, tallium, naphthalene, ardines). Cataract Risk factors are endocrinopathy (sugar diabetes, tetania, muscle dystrophy, adiposogenital syndrome), Daun disease, skin disease (sclerodermia, eczema, neurodermatitis, pyachilodermia Jacobi). Complicated cataracts may occur in mechanical and contusion injuries, eye burns, transferred eye operations, dysfunctional heredity of cataract in the family, myopia high degree, uveitis.

Congenital cataract in most cases is caused by toxic effects on the embryo during the lens bookmark. Among the causes of congenital cataracts, pregnant infections are distinguished (flu, rubella, herpes, cortex, cortexcoplasmosis), hypoparathyroidism, taking corticosteroids, etc. Congenital cataract may occur during hereditary syndromes and combined with the definitions of the development of other bodies.

Cataract classification

In ophthalmology, cataracts are divided into two large groups: congenital and acquired. Congenital cataracts are usually limited in areas and stationary (not progress); For acquired cataracts, changes in the lens progress.

Among the acquired cataracts, depending on the etiology, elder (seenile, age-related - about 70%), complicated (with eye diseases - about 20%), traumatic (when eye wounds), radiation (when damaged lens X-ray, radiation, infrared radiation ), Toxic (with chemical and medicinal intoxications), cataracts associated with general diseases.

On localization of turbidity in the lens differ:

• front polar cataract - located under the capsule in the front pole area of \u200b\u200bthe lens; Lounge has the kind of round spots of whitish and grayish color;
• the rear polar cataract - is located under the crystal rear pole capsule; in color and form similar to the front polar cataract;
• the verte-like cataract - is located on the front of the axis of the crystal; It has the form of spindle, it resembles a thin gray ribbon;
• nuclear cataract - located in the center of the lens;
• a layered (zonular) cataract - is located around the kernel of the lens, and the turbid and transparent layers alternate;
• cortical (cortical) cataract - located along the outer edge of the lens shell; has the type of whitish wedge-shaped inclusions;
• rear subcapsular - located under the slope behind the lens;
• the total (total) cataract is always a bilateral, characterized by the clouding of the entire substance and the crystal capsules.

The overripe of cataract may be complicated by a trunk (faly medium) glaucoma associated with clogging of natural paths of outflow of VGG macrophages and protein molecules. In some cases, the lens capsule can occur and the exit to the cavity of the Eye of the Protein Detriton, which entails the development of faulation of the iridocyclitis.

Cataract ripening can be fast-moving, slowly progressive and moderately progressive. At the first embodiment from the initial stage to extensive clouds, the lens passes 4-6 years. Figrogressing cataract develops approximately 12% of observations. Slow ripening cataract occurs within 10-15 years and occurs in 15% of patients. Moderate cataract progression in 70% of cases occurs over a period of 6-10 years.

Symptoms of Cataract

Indimacy clinical manifestations Depends on the stage of cataracts. Acidness of sight initial Cataract may not suffer. Early signs of the disease can be the boss of items (diplopia), the flashes of "flies" before the eyes, a blurredness of vision ("as in the fog"), painting visible items in a yellowish tint. Cataract patients note difficulties with letters, reading, working with small details.

For the cataract clinic, the high sensitivity of the eyes towards the light, the worsening of the night vision, the weakening of color perception, the need to use bright lighting when reading, the appearance of "haloe" when looking at any light sources. Vision during cataract changes towards myopia, so patients with pronounced hyperopia sometimes suddenly discover that they are beautifully seen near without glasses. The visible image breaks down in front of the eyes, but adjust it with glasses or contact lenses It fails, despite the change of diopter level.

In the stage of immature and especially mature cataracts of visual acuity decrease sharply, the substantive vision is lost, only light is maintained. In the process of ripening cataract, the color of the pupil becomes milky white instead of black.

Diagnosis of cataracts

Cataract detection is carried out by an ophthalmologist based on a number of standard and additional surveys.

The routine ophthalmological examination in suspected cataract includes a visometrium (test of visual acuity), perimetry (definition of fields of vision), color testing, tonometry (measurement of intraocular pressure), biomicroscopy (research of the eyeball with a slit lamp), ophthalmoscopy (study of the eye dN). In the aggregate, standard ophthalmological examination allows you to identify such signs of cataracts as a decrease in visual acuity, violation of color perception; Explore the structure of the lens, evaluate the localization and magnitude of the clouding, to detect the dislocation of the lens, etc. With the impossibility of inspection of the ophopic bottom, with a pronounced closet of lens, resort to the study of entopic phenomena (mechanophosphane and autoophthalmoscopy phenomenon), which make it possible to judge the state of the neuroreceptor retinal state.

Cataract methods include refractometry, ophthalmometry, ultrasonic biomicroscopy, etc., ultrasound biomicroscopy, etc. Additional methods allow a surgeon-ophthalmologist to calculate the force of an intraocular lens (artificial lens), to determine the optimal operating technique.

For rate functional state retina, optic nerve and central departments visual analyzer Cataracts are carried out electrophysiological studies: electrocoooography (EOG), electricoretinography (erg), registration of visual caused potentials (ZVP).

Cataract treatment

In the initial stages senile cataract Conservative therapy applies, including instillations eye drops (Azaptainaparta, Pyrenexin, combined drugs With cytochrome C, Taurine, etc.). Such measures do not lead to the resorption of lens of the lens, but only slow down the progression of cataracts.

The meaning of the so-called substantive therapy is to introduce substances, the lack of which leads to the development of cataracts. Therefore, the composition of the eye drops includes amino acids, vitamins (riboflavin, a nicotinic acid, ascorbic acid), antioxidants, iodide potassium, ATP, etc. substances. The preparation of amazeparents has a different mechanism of action - due to the activation of proteolytic enzymes, it contributes to some extent contributes to the resorption of opaque protein structures of the lens.

Conservative cataract treatment is ineffective, so the only method of eliminating pathology and reduction of vision is a microsurgical operation - removal of the altered lens and replacing it intraocular lens. The possibilities of modern microsurgery of the eyes are eliminated from the need to wait for the full ripening of cataracts to remove it.

Medical readings K. operational treatment Include: swelling cataract, overruming cataract, sublux or lens, detecting secondary glaucoma, accompanying the pathology of the operal bottom, requiring treatment (diabetic retinopathy, retinal detachment, etc.). Additional readings Surgical treatment of cataracts are determined by professional and household needs in improving the quality of vision. With double-sided cataract, first operate an eye having a lower visual sharpness.

In modern cataract surgery, several ways to remove the speeding lens are used: extracapsular and intracapsular cataract extraction, ultrasonic and laser facoemulsification.

The most serious forecast for the visual function is associated with congenital cataract, since in this case, as a rule, there is a change in the neuro-receptor apparatus of the eye. Surgical treatment of the acquired cataracts, in most cases leads to the achievement of an acceptable visual acuity, and often to restore the patient's ability to work.

Prevention congenital cataracts Requires warning viral diseases During pregnancy, excluding radiation impacts. To prevent the development of acquired cataracts, especially at the young age, the antioxidant protection of the body requires the treatment of related overall and ophthalmic pathology, prevention of eye injuries, annual profuse of an ophthalmologist.

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