Loss of vision after cataract removal. Cataract worse after surgery

12.03.2020 -

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. Apply latest methods and high quality equipment.

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 irregular shape and 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 cataract after surgical intervention occurs more frequently. This is due to the fact that the tissues young body have a high level of ability to regenerate, 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.
Availability diabetes, 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.
Apply medications against cataracts. They are instilled into the eyes strictly for the intended purpose.

Signs of the appearance of a secondary cataract

On the early stages secondary cataract after lens replacement may not manifest itself at all. Duration initial stage 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 found on scheduled inspection at the 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 sun 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 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. Usually the energy laser beam equal to 1 mJ/pulse, but the value can be increased if necessary.

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. applied to the cornea eye drops that promote pupil dilation. 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;
occurrence 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 there is an increased risk of secondary complications:

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.
dangerous complication considered to be 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.
Chronic form endophthalmitis is also rare. It is caused by the release of isolated bacteria into the area vitreous body.
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 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.

Secondary cataract after lens replacement - requires treatment. It develops in every third person who has undergone an operation to replace the lens. It occurs in all age groups, more often in people over 50-60 years old.

- defeat optical system eyes when the lens becomes cloudy. When usually retain the posterior capsule, which serves as a support for a new intraocular artificial lens. It is subject to repeated turbidity, wrinkling due to thinning of the walls, pathological growth epithelial tissue.

Secondary cataract is divided into 3 forms:

Fibrous cataract, when there is an overgrowth of connective tissue elements.
Proliferative cataract, when specific cells are determined, indicating a long course of the process.
Thickening of the capsule, not accompanied by turbidity.

Unpleasant symptoms cause the first two forms of secondary cataract.

Causes

The secondary form of the disease does not have a specific cause. There are predisposing factors:

Leaving destroyed fragments due to carelessness or inexperience of the surgeon.
IOL materials. Acrylic square-edged lenses are less likely than silicone rounded-edged lenses to develop secondary cataracts after surgery.
Elderly age.
Somatic diseases (autoimmune diseases of the connective tissue, arterial hypertension, dysfunction thyroid gland).
Ophthalmic diseases (uveitis, high myopia, glaucoma, retinal detachment, dystrophic changes organ of vision).
Complications after.
Hypovitaminosis, avitaminosis.
Factors that irritate the visual organ: frequent exposure to bright sun, welding, caustic fumes, smoke.

The development of a secondary cataract after lens replacement has no clear cause. No specialist can guarantee that you will not experience repeated changes in the lens during the recovery period or after a few years. The exclusion of predisposing factors will only reduce the risk of occurrence.

Symptoms

After eyeball surgery, a person may notice a progressive decline in the quality of vision. This is how the first symptoms of a secondary cataract begin after lens replacement. What other manifestations does the secondary form of the disease cause?

Flickering flashes, sparks.
, blurred vision.
Double vision.
Blurred vision.
Violation of color perception.
Fuzzy image, blurring of contours.
Focus disturbances.
Decreased visual acuity. Spectacle correction is unsuccessful.

The clinical picture develops in different ways. For some, the secondary form occurs abruptly and suddenly, while for others it slowly progresses over the years. Usually the first symptoms occur no earlier than 3 months after phacoemulsification.

Video: Secondary cataract after lens replacement

Diagnostics

Repeated cataract is treated by an ophthalmologist. First, a series of examinations is assigned. The doctor measures IOP. Uses Sivtsev-Golovin tables to assess visual acuity (visometry). Conducts perimetry: determines the boundaries and areas of loss of visual fields.

Examination with a slit lamp (biomicroscopy) evaluates the structures of the eye, allows you to see the localization of the pathological focus, its size, characteristics. If macular edema is suspected, fluorescein angiography and OCT (optical coherence tomography) are performed.

If a person has a disease internal organs, then he is sent for examination to the doctors of the appropriate profile. It requires treatment of the underlying pathology, normalization of laboratory parameters. Otherwise, a repeated cataract after treatment will recur.

Video: Secondary cataract after lens replacement and treatment

Treatment

Increasing visual impairment requires treatment of secondary cataracts. If left untreated, partial or complete blindness will develop over time. What methods of removal are used to treat a repeated cataract?

The best treatment for recurrent cataract after lens replacement is laser dissection of the secondary cataract. Laser discission is widespread, ophthalmic surgeons have a lot of experience. It is considered the gold standard of treatment, it is carried out quickly, does not require hospitalization.

Before the operation, mydriatics are instilled to dilate the pupil. Then a small hole is created with a laser. Next, photodestruction of altered tissues is carried out, i.e., dissection and destruction with a laser.

Treatment of secondary cataract is a complex task. This is due to the frequent need for surgery and the inability to perform it due to concomitant diseases. In this case, conservative methods of treatment help to slow down the development of pathology, improve the quality of life. Patients are prescribed drops that have a positive effect on the state of the lens, improve metabolic processes in it, contributing to the normal regeneration of damaged tissues. For example, a doctor may recommend Oftan Katahrom, a clinically proven Finnish eye drop that contains the antioxidant cytochrome C, the vitamin nicotinamide, and the energy source adenosine.

Removal of a secondary cataract with a laser is less traumatic; it is not necessary to introduce surgical instruments into the eye cavity. 98% of people notice a significant improvement in vision. Contraindications to the treatment of secondary cataracts with a laser: scars, clouding, swelling of the cornea, pathological changes in the fundus, inflammatory eye diseases.

The surgical method of removing a secondary cataract is outdated and rarely performed. It's called a capsulotomy. The essence of the method is the dissection of the clouded lens capsule with surgical instruments. Surgical capsulotomy is dangerous due to the risk of traumatic damage to the structures of the visual organ. Has a long recovery period. Associated with an increased risk of infectious complications.

In the postoperative period, symptoms may occur: redness of the eyes, swelling of the eyelids, lacrimation. This is the result of an intervention visual organ. To improve a person's condition, an ophthalmologist prescribes eye drops, ointments.

The goal is to prevent infectious complications, reduce inflammatory manifestations, and stabilize IOP. Well local therapy- up to 1 week. At follow-up examinations after surgery, the doctor evaluates the condition of the visual organ and decides whether to reduce or extend the course of therapy.

Forecast and prevention

Laser discission proceeds, as a rule, without complications. Secondary cataract requires re-intervention in only 2% of people. Most often, IOP rises within 3 hours after surgery. To reduce prescribe pressure drops. A follow-up examination is required the next day.

Anterior uveitis is the second most common complication after surgery. For its prevention, antibacterial and anti-inflammatory drugs are prescribed. local funds. It is extremely rare that the macula or iris swells, the retina exfoliates, the IOL is damaged, and hemorrhage occurs. The reasons lie in the defects of the operation.

Almost all people with the secondary form have a favorable prognosis. At the beginning of the recovery period, the quality of visual functions returns. In the first month, people complain about floating points, the appearance of flashes before their eyes. Complaints will pass when the organ of vision is fully restored. In general, a person begins to see clearly already in the first days after laser treatment.

Wear sunglasses when you go outside.
Skip eye makeup for 2-3 weeks.
Bury prescribed drops 3-4 r / d, duration 1 week.
Go for a scheduled check-up the next day, a week and a month after the operation.
At the first suspicious symptoms, contact an ophthalmologist immediately.

Video: Do's and Don'ts for Cataracts

After the end of the recovery period, it is recommended to be observed by an ophthalmologist at least 1 r / year. See a doctor even if you don't have symptoms. Secondary cataract may recur. There is a risk, but it is minimal.

Replacement of the lens is necessary for such pathologies as cataracts, astigmatism, myopia, eye injuries, which resulted in violations of the integrity of the lens. The most common indication for surgery is cataract. Most often, the disease manifests itself in old age after 75-80 years, but there may be cases of congenital pathology or the development of the disease at a younger age.

A new artificial lens helps restore the patient's full vision. The lens replacement surgery lasts about 15 minutes, does not require a long recovery period and is well tolerated by patients. But in some cases, there may be complaints that after replacing the lens, the eye sees cloudy. Consider what could be the causes of this phenomenon and methods of restoring vision.

Causes of cloudiness

If after replacing the lens the eye sees cloudy, we are talking about postoperative complications. It should be distinguished from the natural reaction of the body on the first day after surgery, when vision remains at the same level as before surgery. Blurred vision is a consequence of corneal edema, which inevitably occurs during surgical procedures. This condition resolves on its own 2-3 days after surgery and does not require treatment.

If in the future the symptoms of the disease (veil and flies before the eyes, double vision, blurred vision) persist, we are talking about a secondary cataract. This complication occurs in 15-20% of the operations performed.

Pathology can also develop some time after the operation, regardless of how successful it was. Secondary cataract cannot be considered as a result of the low qualification of the doctor who performed the operation.

The reasons that cloudy eyes persist after lens replacement may be:
a strong degree of myopia;
endocrine diseases (for example, diabetes mellitus);
retinal disinsertion;
inflammation of the choroid of the visual organ;
low immunity;
negative impact on the patient of toxic substances;
hereditary predisposition.

In the development of clouding of the lens after its replacement, the age of the patient plays an important role. Over the years, the level of regeneration decreases, increasing the risk re-development pathology.

Symptoms of the disease

On the initial stage clouding of the lens pathology may not cause negative sensations. Sometimes it is found only on examination by an ophthalmologist. The disease progresses over 2-10 years, eventually causing the following symptoms:
doubling of objects;
pain and tearing of the eye;
decreased visual acuity;
the appearance of flies, dots, yellow spots in front of the eyes.

Treatment

The very name "secondary cataract" is conditional, since clouding in the eyes is not caused by disorders of the lens, but by pathological changes in the posterior wall of the capsular bag, which remains intact during the operation to replace the lens with an artificial one.

To diagnose a secondary cataract, the doctor conducts an examination of the fundus, measures intraocular pressure, and determines the extent of opacification of the posterior capsule. During the examination, it is necessary to exclude swelling and inflammation of the anterior part. eyeball.

For the treatment of pathology, an operation to excise the film of the capsular bag is indicated. Manipulation is carried out mechanically or by laser treatment.

Laser capsulotomy is a painless, non-invasive treatment that rarely causes complications and restores visual acuity to most patients. Contraindications to laser capsulotomy are corneal edema, inflammation of the eyeballs, cystic macular edema, and retinal tears.

It should be noted that it is impossible to cure cloudy eyes with drops, various medicines and home remedies. With a decrease in visual acuity and the appearance of other negative signs, you should immediately contact an ophthalmologist.

Forecast

The earlier the patient applied for medical care when he noticed that after replacing the lens, the eye sees cloudy, the more favorable the treatment prognosis. Surgical or laser treatment returns up to 90% of visual acuity. Postponing treatment increases the risk of developing other eye diseases, in particular glaucoma.

There are no preventive measures to eliminate the risk of clouding of the eye after the corresponding operation. The main thing for the patient is to regularly visit an ophthalmologist in order to control the condition of the eye and early treatment in case of violations. Visits to the doctor should become mandatory if the patient notices a deterioration in visual acuity.

Through vision, we receive 80% of information about the world around us. But often visual impairment in a person does not cause concern, it is believed that this is due to age-related changes.

However, visual impairment is almost always a symptom of some disease. Causes of visual impairment - diseases of the lens, retina, cornea, or common diseases, leading to damage to the vessels of the eyeball, or violations of the tissues surrounding the eye - adipose tissue and eye muscles.

Visual impairment can be of a different nature.

Violation of visual acuity is associated with pathologies of the retina. A healthy eye has a visual acuity of -1.0. Sharp deterioration vision can cause obstructions in the path of light to the retina, which occurs with changes in the cornea and lens. With disorders of the nervous system, vision is also impaired. This is facilitated by chronic lack of sleep, constant overwork and stress, prolonged visual strain. Often, to eliminate visual impairment in this situation, it is enough to rest and perform gymnastics for the eyes. And yet visit an ophthalmologist, so as not to miss the disease.

Retinal detachment

The retina is the part of the eye in which the nerve endings perceive light rays and translate them into an image. The retina is in close contact with the choroid. If they separate from each other, visual impairment develops. Symptoms of retinal detachment are very typical:

First, vision deteriorates in one eye.
A veil appears before the eyes.
Flashes, sparks are periodically felt before the eyes.

The process captures different parts of the retina, depending on what these or other visual impairments occur. Recovery normal state retinal treatment is carried out surgically.

Macular degeneration

Macular degeneration is the cause of visual impairment in age group after 55 years. In this disease, the place on the retina is affected, where the largest number of light-sensitive nerve receptors is located ( corpus luteum). The causes of the disease are still not entirely clear.

Scientists are inclined to believe that it is caused by a lack of vitamins and minerals in the body.

Treatment for this disease is of two types - laser therapy and photodynamic therapy; drug therapy in the form of tablets or injections.

Retinal tear and vitreous detachment

The vitreous body is a substance that fills the inside of the eyeball, and is firmly attached to the retina in several places. In youth, it is dense and elastic, and with age it begins to liquefy and separates from the retina, which leads to its ruptures and detachment. Treatment is carried out surgically, and two identical cases of this disease do not exist.

diabetic retinopathy

Diabetic retinopathy - with diabetes, vision almost always deteriorates, in the later stages it occurs in 90% of patients, especially in type 1 diabetes.

Diabetic retinopathy is caused by damage to the capillaries and small vessels of the retina, which leaves entire areas of it without the necessary blood supply. If visual acuity decreases or one eye stops seeing, it means that irreversible changes in vision have developed. Therefore, patients with diabetes should regularly undergo examinations by an ophthalmologist.

Cataract

Cataract is the most common pathology of the lens. It develops in old age, it is very rarely congenital. It is believed that it is caused by metabolic disorders, trauma, exposure free radicals. This reduces visual acuity, up to blindness in one eye. In the initial stages, visual impairment can be treated with eye drops, a radical method of treatment is surgical intervention.

Myopia

Myopia - the most common pathology, may be due to a hereditary factor; elongated shape of the eyeball; violation of the shape of the cornea (keratoconus); violation of the shape of the lens; weakness of the muscles that are responsible for the movement of the eyeballs. Glasses are used for treatment laser correction and other microsurgical interventions.

farsightedness

Farsightedness is a pathology in which visual impairment is caused by: a small diameter of the eyeball; a decrease in the ability of the lens to change shape, starting at age 25 and continuing until age 65. As people age, they become farsighted. and visual impairments are corrected with contact lenses and glasses. Exist surgical methods treatment with special lasers.

Eye injury

Eye injuries are accompanied by a sharp deterioration in vision. The most common types of injuries are: foreign body; eye burns; contusion of the eyeball; retinal hemorrhage; eye injury (the most dangerous injury); hemorrhage in the eye. In all cases, the ophthalmologist should examine, determine the extent of damage and prescribe appropriate treatment.

Clouding of the cornea (thorn)

Clouding of the cornea (thorn) is a process in which a cloudy infiltrate forms on the surface of the cornea, which disrupts normal vision. To restore it, special drops can be used, as well as surgical intervention - keratoplasty.

Keratitis

Keratitis is a group of diseases that is characterized by the presence of an inflammatory process in the cornea. Inflammation of the cornea is caused by: bacterial and viral infections; keratitis fungal, autoimmune and allergic origin; toxic keratitis. In any case, visual impairment occurs, which disappears after the disease is cured. Sometimes a thorn is formed, which is accompanied by a persistent visual impairment.

Corneal ulcer

A corneal ulcer is a defect caused by trauma, infection and inflammation, accompanied by visual impairment. As a treatment, drops with antibiotics and hormonal anti-inflammatory drugs are prescribed.

Thyroid diseases

Thyroid disease - diffuse toxic goiter (Basedow's disease), one of the symptoms of which is bulging eyes associated with double vision and blurred vision. Treatment is conservative, in severe cases surgical intervention is performed.

Spinal disorders

Spinal disorders - vision is subject to brain activity with the participation of the spinal cord passing through the spine. Injuries, damage to the vertebrae, unsuccessful childbirth can cause visual impairment.

Diseases

Diseases of an infectious and venereal nature affect the nervous system of the body, and vision is steadily falling.

Bad habits

Bad habits - alcohol, smoking, drugs affect the condition of the eye muscles and blood vessels of the retina. Violation of the blood supply to the eyes sooner or later leads to a drop in vision.

Postoperative complications of cataract removal

Each eye reacts differently to the artificial lens. Some patients have no reaction at all, others have an inflammatory reaction that requires special attention. drug treatment, in the third, this reaction is expressed to a large extent. After surgery, some patients may experience an increase in intraocular pressure, a fog appears before their eyes, vision deteriorates, and sometimes pain in the eye and temple appears. With this complication, the doctor prescribes various drops and tablets to reduce intraocular pressure.

Postoperative complications also include retinal detachment, which is treated only surgically, hemorrhages in the retina and vitreous body. Therefore, a patient with an artificial lens should be attentive to himself, if the slightest change in vision occurs, consult a doctor in order to maintain the vision obtained after the operation.

In old age, metabolic processes worsen not only in the lens, but often in the retina, which leads to the development of retinal dystrophy and a decrease in central vision. In such cases, after cataract removal after surgery, it is rarely possible to obtain good vision due to changes in the retina in its central section. In order to help such patients, a special model of an artificial lens was developed, in which the image of objects is slightly shifted from the center of the retina to the paracentral, unaffected zone. Vision in patients with such a lens is somewhat better than in patients with a conventional lens.

O. Chentsova, E. Chentsova

Question: cataract?

My mother was diagnosed with cataracts. The deterioration of vision due to cataracts has occurred over the past half a year. She is 79 years old, 2 years ago she had an operation for glaucoma. I heard from many that the improvement in vision after cataract surgery does not occur for a long time. After a certain number of months, worsening occurs again. Question: 1. Is it due to secondary cataract or are there other reasons as well? 2. Mom also has hypertension. Should cataract surgery be done anyway? Thanks in advance for the answer.

To restore vision, it is necessary to remove the cloudy lens (cataract) without fail.

Form for supplementing a question or feedback:

#6018: Poor vision after cataract removal.

Causes

There is an opinion that the cause of secondary cataract is the inexperience or lack of skill of the surgeon who performed the operation. However, this assumption is not entirely correct. In fact, the pathology develops due to the active growth of the epithelium that covers the posterior lens capsule. The exact reason for this phenomenon is still unknown.

The likelihood of developing a secondary cataract depends to some extent on the quality of the intraocular lens that is implanted in a person. For example, silicone IOLs are more likely to cause complications than acrylic IOLs. The shape of the lens used is also important. Artificial lenses with square edges are best tolerated by patients.

In some cases, cataracts develop due to incomplete extraction of the lens masses during surgery. The reason for this is in fact the inattention or lack of experience of the surgeon.

Secondary cataracts can develop against the background of the following diseases:

diabetes;
hyper- or hypothyroidism;
scleroderma;
neurodermatitis;
lupus erythematosus;
systemic vasculitis;
myopia high degree;
uveitis and iridocyclitis;
retinal detachments.

Opacification of the lens may be the result of contusions and penetrating wounds of the eyeball. The impetus for the development of pathology in this case is the violation of the integrity of the lens capsule, followed by the penetration of intraocular fluid into its cavity. All this leads to the rapid formation of turbidity.

The growth of epithelial tissue on the surface of the capsule causes a decrease in transparency and clouding of the lens. To some extent, the likelihood of pathology depends on the quality of the implanted lens.

The presence of silicone material is more likely to cause complications. In terms of shape, lenses with square edges are best tolerated by patients.

Sometimes a cataract develops against the background of incomplete extraction of the masses of the lens during the operation. This is due to the carelessness of the surgeon.

Complications can be caused by trauma to the eyeball and contusion.

There are other reasons for the development of secondary cataracts:

UV irradiation;
age-related changes;
heredity;
bad habits;
poisoning with poisons or chemicals;
high radiation;
frequent exposure to the sun without glasses;
poor metabolism;
inflammatory processes of internal organs.

Elderly men and women, children are prone to developing complications. In a young organism, the level of the ability to regenerate cells is increased, which causes their migration and division in the posterior capsule.

Despite the fact that the true causes are still being studied by specialists, the provocative causes of this complication have been established:

burdened heredity;
age-related changes;
mechanical damage;
inflammatory processes;
ultraviolet radiation;
metabolic disorder;
eye diseases - myopia, glaucoma;
metabolic disorder;
radiation;
metabolic disease;
taking drugs with steroids;
bad habits (smoking, alcoholism);
intoxication.

Experts note the role of a poorly performed operation and medical error in the occurrence of complications. It is possible that the whole problem lies in the reaction of the cells of the lens capsule to the artificial material.

The specific causes of secondary cataracts are still not fully understood. This phenomenon is caused by natural processes in the body and most often manifests itself with age. The described disease occurs due to excessive growth of the epithelium on the walls of the lens bag, but this phenomenon cannot be considered medical negligence. The occurrence of this disease due to an incorrectly performed operation on the lens occurs in rather rare cases. In addition, this ailment can be congenital.

Age changes.
Internal inflammation.
Mechanical damage.
Wrong metabolism.
Eye diseases.
UV and microwave radiation.
High radiation background.
Toxic poisoning.
Having bad habits.

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.

Age changes.
genetic predisposition.
Internal inflammation.
Mechanical damage.
Wrong metabolism.
eye diseases.
UV and microwave radiation.
Long exposure to the sun without protective glasses.
High radiation background.
Toxic poisoning.
Having bad habits.

Types of complications

Rupture of the posterior lens capsule. This complication It is considered one of the most serious, as it is associated with damage to the vitreous body, displacement of the lens, less often, expulsive bleeding. If the treatment time for this complication is missed, the following consequences are possible: a pupil pulled up, the formation of vitreous opacities, the occurrence of secondary glaucoma, posterior displacement of the intraocular lens, retinal detachment. its volume. Basic rules include:

Removal of the lens masses into the anterior chamber by introducing viscoelastic behind the nuclear masses, which will prevent vitreous hernia;
Elimination of a defect in the capsule by introducing a special tonsil behind the lens masses;
Removal of the vitreous body with a vitreotomy.

The resulting complication can cause the impossibility of implanting an intraocular lens, since the residual masses of the lens substance can interfere with the visualization of the patient's fundus. IOL implantation can be combined with vitrectomy.

Posterior prolapse of the lens substance. In the process of rupture of the lens capsule, dislocation of lens fragments into the vitreous body area may occur. This complication is quite rare, but can cause the development of secondary glaucoma, retinal detachment, chronic uveitis, macular edema. To eliminate the consequences of the complication, the first stage is the treatment of glaucoma and the resulting uveitis, then a vitrectomy operation is prescribed to eliminate the lens substance.

Concerning terms of elimination of consequences of a complication experts differ in opinions. Some believe that the removal of the remnants of the lens should be carried out within a week, others hold the point of view according to which, first, normalization of intraocular pressure and treatment of uveitis are necessary, and vitrectomy to clear the space from the lens masses can be performed after three weeks.

Posterior dislocation of the intraocular lens. With the displacement of the posterior capsular IOLs towards the vitreous body, it may indicate, first of all, incorrect implantation of the lens. Such a complication can cause retinal detachment, vitreal hemorrhage, cystic macular edema. The treatment is vitrectomy to remove, reposition, or replace the IOL.

Suprachoroidal hemorrhage. This formidable, but very rare complication may be due to expulsive bleeding due to rupture of the ciliary arteries. The factors contributing to its occurrence are: the advanced age of the patient, the large size of the anterior-posterior segment, glaucoma, cardiovascular diseases, although its exact cause is still not clear.

Signs of suprachoroidal hemorrhage are considered to be:

Dynamic shredding of the anterior chamber, increased IOP, iris prolapse.
The expiration of the vitreous body, the appearance of a dark tubercle in the pupil, the disappearance of the reflex.
IN difficult cases, the contents of the eyeball can flow out completely through the incision area.

The condition requires immediate action, including closing the incision and performing a posterior sclerotomy. Although the recommended surgery may increase bleeding, leading to loss of the eye. In the postoperative period, the patient is prescribed steroids to stop inflammation (locally and systemically).

Edema of the cornea. Reversible complication associated with surgical trauma to the endothelium. Patients with endothelial dystrophy have an increased risk of its occurrence. Other factors of its occurrence can be considered prolonged operation time and postoperative increase in IOP.

Iris prolapse. This rather rare complication may accompany small incision cataract surgery. The main signs of iris prolapse are uneven scarring of the wound, racemose macular edema, astigmatism, epithelial ingrowth, and endophthalmitis.

In this case, the tactics of treatment depends on the timing of the operation. If the prolapse is detected immediately (within 2 days after the intervention), then in the absence of infection, the iris is repositioned and sutures are applied. If the operation was performed a long time ago, the prolapsed area of the iris is excised due to high risk infection development.

Cystic retinal edema. This complication is associated with rupture of the lens capsule and prolapse or infringement of the vitreous body. It can manifest itself after several months even in the absence of surgical complications.

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.

Symptoms

Secondary cataract after lens replacement is manifested by a gradual deterioration in vision. At first, the patient may complain of difficulty in reading, flickering flies before the eyes, and the appearance of halos around light sources. Later, a dense veil forms in front of one or both eyes. As a result, it becomes difficult for him to navigate in space and lead a familiar lifestyle.

Other symptoms of secondary cataract:

irreversible reduction in visual acuity;
double vision;
violation of color perception;
difficulty focusing on small objects
the appearance of dots and colored spots in the field of view;
blurring and fuzziness of the image.

With a secondary cataract caused by other diseases, the patient has similar symptoms. In different cases, the disease progresses at different rates. It can develop slowly over many years or it can occur spontaneously over a few days. The latter is characteristic of diabetic cataract, hitting people with high blood sugar.

Initially, the patient complains of difficulty in writing and reading, a veil forms in front of one or both eyes.

It becomes difficult for a person to navigate in space, his quality of life deteriorates. He complains of increased fatigue after visual work.

The use of glasses or lenses does not help relieve these symptoms. Visual changes in the eyes and pain are not observed.

The first signs of secondary cataract develop 3 months after surgery. In each individual case, the pathology progresses at a different rate. It can take years to develop or occur in a few days. Last case often seen in people with diabetes.

The long course of the disease leads to loss of vision, which is not amenable to classical methods of correction. Often secondary cataract provokes disperse syndrome and pigmentary glaucoma, scleritis, uveitis, endophthalmitis, increased intraocular pressure.

Surgical complication is a rather lengthy process. The first signs of a secondary cataract appear months or even years later. If after the operation your vision deteriorated and color sensitivity decreased, contact a specialist immediately. Most often, the complication occurs in young children and the elderly.

As the secondary cataract progresses, the following symptoms appear:

spots before the eyes;
diplopia - doubling;
vagueness of the boundaries of objects;
grayish spot on the pupil;
yellowness of objects;
a feeling of "fog" or "haze";
image distortion;
lenses and glasses do not correct visual dysfunction;
unilateral or bilateral lesion.

On the early stages visual function may not suffer. The initial stage can last up to ten years. The clinical picture largely depends on which part of the lens has clouded. Opacification in the peripheral part practically does not affect the quality of vision. If the cataract approaches the center of the lens, then vision begins to deteriorate.

Complication develops in the form of two forms:

Fibrosis of the posterior capsule. Compaction and clouding of the posterior capsule causes a decrease in vision.
Pearly dystrophy. The epithelial cells of the lens grow slowly. As a result, visual acuity is significantly reduced.

In the membranous form, a certain area of the lens tissue is absorbed, and the capsules grow together. A membranous cataract is dissected with a laser beam or a special knife. An artificial lens is placed in the resulting hole.

Opacities of the capsule are primary and secondary. In the first case, the complication occurs immediately after the operation or after a short time. Turbidity has a different shape and size. As a rule, this kind of clouding does not affect the quality of vision, therefore, it does not require mandatory treatment. Secondary opacities often occur due to cellular reactions and can worsen the results of the operation.

The development of a secondary cataract is a rather lengthy process. The first noticeable symptoms may appear months, and sometimes even years, after the replacement of the lens with a lens. If, after surgery, visual acuity begins to fall and the susceptibility of the eyes to color disappears, then this clear sign contact an optometrist.

Most often, these symptoms occur in the elderly or children.

Also, the appearance of a secondary cataract after lens replacement largely depends on the type of lenses installed - acrylic implants cause the described disease much less often than their silicone counterparts. If after the operation the patient's vision improves dramatically, and then worsens again, then this is also a considerable cause for concern. At this stage, any significant changes can be detected even with a routine ophthalmological examination.

At the initial stage of cataract development, visual acuity practically does not change. Depending on the characteristics of the organism, the formation of epithelial growths can take from 1 to 15 years. During the development of the disease, symptoms such as:

Spots before eyes.
Double vision.
Visible yellowness of objects.
Blurry letters when reading.

Recurrent cataract is divided into two forms: primary and secondary. Primary opacities occur immediately after surgery. Opacities can have a different shape and size. Vision does not deteriorate, so no special treatment is required. Secondary opacities develop slowly and appear late. They worsen the results achieved after treatment.

The symptoms of a secondary cataract do not differ from clinical manifestations primary pathological process. The disease develops slowly. The main symptom is blurred vision. The lens loses its transparency and causes blindness. Depending on the location of the opacities, the symptoms may vary. Ophthalmologists distinguish several stages of the development of the disease:

initial;
immature;
mature;
overripe.

An early symptom is the occurrence of double vision. Some patients complain of the appearance of "flies" before their eyes. As the disease progresses, this symptom disappears. The duration of the initial stage can be from 2 to 7 years. At the second stage, the lens noticeably becomes cloudy and the picture becomes blurry, blurry, which cannot be corrected by glasses and contact lenses. The stage is also referred to as the "swelling stage". As the lens enlarges, intraocular pressure increases. Without treatment, secondary glaucoma can develop.

The mature stage is characterized by complete clouding of the lens. The patient begins to see poorly near and far objects. At the overripe stage, flashes or glare before the eyes may appear at night. Increased light sensitivity. All bright light sources irritate the eyes. When reviewing light sources, the patient sees halos. There are no external changes in cataract.

Diagnostics

For diagnostic purposes, the patient performs visiometry. In people with secondary cataracts, the doctor usually detects a decrease in visual acuity that is not amenable to optical correction. During perimetry, the patient may detect a narrowing of the visual fields or the appearance of cattle - a variety of spots in front of the eyes.

The most informative and valuable method for diagnosing pathology is biomicroscopy. During the examination in the slit lamp, an experienced ophthalmologist can not only identify opacities, but also assess their size and location.

To identify the cause of the disease, the patient may require additional examination and consultations of other specialists. For example, with diabetic cataract, the patient needs to measure the level of glucose and glycosylated hemoglobin, with hypoparathyroid - the determination of hormones in the blood.

Methods of treatment and further prevention

Diagnosis and treatment of cataracts is carried out by a highly specialized ophthalmologist. Manipulations aimed at removing opacification are entitled to be performed by ophthalmic surgeons and laser ophthalmologists.

If a secondary cataract did not occur after surgery, but as a result of other diseases, the patient may need the help of an endocrinologist, immunologist, neuropathologist or other highly specialized doctor. An experienced specialist will conduct an examination and find out what led to the development of cataracts in the patient. Making the correct diagnosis will greatly facilitate the fight against the disease.

Secondary cataract after lens replacement is usually treated with a laser. The procedure allows you to quickly and painlessly remove opacities from the posterior capsule without damaging the intraocular lens. In 90% of cases, after laser discission, a person immediately begins to see well.

With a secondary cataract that has arisen against the background of another disease, a person is prescribed complex treatment. The patient takes the drugs necessary to combat the underlying pathology. The clouded lens in this case is removed by phacoemulsification, extracapsular or intracapsular extraction. More about cataract surgery →

Surgical

Nowadays, the clouded lens is most often removed by phacoemulsification (PEK). The surgeon enters the eye through small incisions in the cornea. With the help of ultrasound, it crushes the lens into pieces. He extracts the resulting lens masses, and implants an intraocular lens into the capsule. FEC is considered the least traumatic and most safe operation.

If there are contraindications to phacoemulsification, the patient can perform another operation. Intra- and extracapsular extractions are more traumatic and require a long recovery period. Fortunately, they are rarely made these days.

laser

Laser cataract treatment is performed on an outpatient basis. In modern ophthalmology, YAG-type lasers are used for these purposes. Anesthetic drops and pupil dilating agents are instilled into the patient's eyes. Then, using a special device, the doctor removes the cloudiness from the posterior lens capsule.

Today, laser discission of a secondary cataract is considered the most modern, safe and effective method of treating the disease. Unfortunately, it can not be used in all cases. If there are contraindications to the treatment of secondary cataract with a laser, the patient undergoes a mechanical capsulotomy.

Capsulotomy

To carry out the manipulation, the doctor uses special surgical instruments. With their help, the ophthalmologist removes the film that has formed on the posterior lens capsule. The disadvantages of such an operation include the need to introduce instruments into the eye cavity, which is associated with the risk of infection and the development of infectious complications.

Eye drops in the postoperative period are an integral aspect of rehabilitation. This treatment is necessary for the fastest healing postoperative wound, as well as for the prevention of infectious complications. The purpose and dosage regimen of eye drops is individual for each patient. All this is determined by the surgeon immediately after the operation, and then at each visit. As a rule, the following groups of drugs are used:

Antibacterial agents (drops containing ciprofloxacin, tobramycin).
anti-inflammatory drugs ( nonsteroidal drugs- diclofenac, indomethacin).
Combined preparations containing hormonal and antibacterial agents).

As healing progresses, the frequency of use of the drops decreases. However, all issues of dosing and the occurrence of adverse reactions should be discussed with your doctor. In order not to injure the eye during instillation, as well as to prevent infection, simple rules must be followed.

First of all, before using eye drops, wash your hands thoroughly with soap and water. Then tilt your head back or lie down on a horizontal surface. The lower eyelid must be pulled down with a finger, turn the bottle of drops over and press the bottle or pipette. After instillation, close the eyes, you can attach a sterile gauze pad. If there are several drugs, a five-minute interval is considered the minimum. After use, eye drops must be tightly closed. To save medicinal properties the drug is recommended to observe the temperature regime of storage.

Recovery after lens replacement is not a very long process. Patients usually do not experience significant discomfort, and the restrictions are always temporary. Compliance with all medical recommendations and the regimen guarantees the maximum possible restoration of visual acuity for each individual patient. All questions and ambiguities that arise during the rehabilitation period are best discussed with the attending physician.

A sharp deterioration in vision after surgery can be detected even during a routine examination.

The following procedures are usually used as diagnostic methods:

Ultrasound of the eye. Evaluates anatomical and physiological features structure of the eye, the location of the lens.
OCT. Optical coherence tomography is used to further study the topography of the apple.
biomicroscopy. Applied to visualize the clouding of the eye.
Visometry. Allows you to determine the stage of visual acuity reduction.

Additionally, the doctor may prescribe a study of the titer of antibodies to the lens, cytology of the film, and measurement of the level of cytokines.

To eliminate the pathology, a procedure called laser discission is used. It is carried out under local anesthesia. In the process, eye drops are applied to the cornea to dilate the pupil. A hole is burned in the back wall of the capsule, through which the turbidity is removed. Seams are not required for this intervention.

The patient goes home about 2 hours after the operation. He is prescribed anti-inflammatory drops, and after 7 days he must be examined by an ophthalmologist.

Usually a secondary cataract can be removed during one operation.

With caution, operations are performed in case of detachment or rupture of the retina. It is one of the most effective and safest treatments.

There are other ways to eliminate pathology:

capsulotomy;
phacoemulsification.

Possible complications after surgery include:

infection;
lens shift;
cystic retinal edema;
detachment of the retina;
lens damage.

Choose eye drops with delivery in an online pharmacy

Currently, there are two main methods of dealing with clouding of the lens:

Surgical. The cloudy film is cut with a special knife.
Laser. It's simple and safe way get rid of the problem. Does not require any additional examinations.

In order to prevent patients, anticatarrhal eye drops are prescribed. The dosage is selected strictly by the doctor. In the next four to six weeks after the operation, drops are used that have an anti-inflammatory effect and prevent the development of an infectious process. The only contraindication to the use of surgical intervention is the refusal of the patient himself.

In the postoperative period, patients should avoid sudden movements, heavy lifting. Do not press on the eye and rub it. During the first months, it is not recommended to visit the pool, bath, sauna and play sports. Also, in the first four weeks, it is undesirable to use decorative cosmetics.

Laser therapy was developed by an ophthalmologist who studied physics and the possibility of using a laser in medical practice for a long time. Indications for laser treatment are:

clouding of the lens with a significant deterioration in vision;
reduced quality of life;
traumatic cataract;
glaucoma;
iris cyst;
blurred vision in bright light and in poor light conditions.

Unlike invasive surgery, laser therapy is not associated with the risk of infection, and also does not cause corneal edema and hernia formation. During surgery, the artificial lens is often displaced, the laser method does not damage or displace the lens.

Stable decrease in visual acuity.
Characteristic blurred vision.
The presence of light reflections.

How long does it take to recover vision after cataract surgery?

During the day after the operation, the patient may experience a transient increase in intraocular pressure. Usually it is not dangerous, and the person's condition quickly returns to normal without outside help. If high IOP persists for a long time, the patient begins to suspect glaucoma.

Possible complications after surgery:

Damage to the intraocular lens. The reason may be the inattention of the surgeon or too tight fit of the IOL to the posterior lens capsule. Due to damage to the implant, a person has flies before his eyes, preventing him from seeing normally.
Rhegmatogenous retinal detachment. A very rare but extremely dangerous complication. With untimely detection and treatment, it can lead to complete and irreversible loss of vision.
Cystic edema of the retina. It usually develops if the removal of a secondary cataract was performed earlier than six months after the previous surgical intervention.
IOL displacement. Occurs more frequently after mechanical capsulotomy than after laser discission. The dislocation of the intraocular lens leads to a noticeable deterioration in the patient's vision.
infectious complications. May develop after surgical removal of the lens or its capsule. The infection is brought into the eye cavity along with the instruments that are used during the intervention.

Daily routine and diet

After the operation to replace the lens of the eye, a person's life will change a little, as certain restrictions will be introduced to help avoid complications. To damaged cornea recovered faster, and the implant took root, it is important to reduce the load on the eyes. To do this, it is useful to observe the regime of the day, relax more and gain strength, monitor nutrition. Vision improves faster if you diversify the menu with foods rich in vitamins A, C, E, D, folic acid, fatty acid omega 3.

In the first 2 weeks, hard physical work, watching TV and a computer, staying unprotected under the influence of direct sunlight, wind, dust is contraindicated. While the artificial lens takes root, it is recommended to refrain from driving vehicles, long walks, drinking alcoholic beverages and smoking cigarettes.

Cataract removal with lens replacement is a serious procedure that requires preliminary preparation. The period between diagnosis and surgery should be as short as possible. The doctor should be made aware of the existing diseases. In addition, you must tell the specialist about the medicines you are taking.

Eight hours before the start of the operation, the patient should exclude food intake. Most often, planned surgical intervention is carried out in the morning. At night, you can take some kind of sedative, such as motherwort.

In some modern clinics, on the eve of the operation, a psychologist works with patients, as well as a surgeon who acquaints the patient with the stages of prosthetics, and also stipulates the patient's actions during the operation. Sometimes patients are asked to look at one point, not to blink, and to follow all commands. It is important not to panic, but to respond calmly and quickly to the requirements of a specialist.

In order to avoid infection, a few days before surgery, the patient is instilled with drops with an antibacterial effect.

Attention! The duration of the operation is twenty to thirty minutes.

The procedure is performed under local anesthesia and lasts within thirty minutes. In the absence of any complications, the patient goes home the next day. The surgeon makes a micro-incision in the wall of the eyeball and removes the cloudy film. The removal of the lens is carried out using a laser beam. After that, he changes the clouded film to an intraocular lens. If the cataract has affected both eyes, the operation is performed first on one visual organ and only after a while the procedure is repeated.

Do not be alarmed if after the operation it seems to you that you see objects blurry, foggy, distorted. It takes some time for the visual system to adjust to the changes in it and to adapt to the new intraocular lens that you have been fitted to replace your cloudy lens.

During the adaptation period, patients sometimes see floating flies before their eyes and small image distortions, which then disappear.

Also, your eyes may well be red and inflamed, this is due to a slight damage to the blood vessels on the surface of your eye during the operation. Over time, these injuries will heal, and the eyes will become the same as they were before the operation.

Many patients report that they can see clearly within a few hours after surgery. But each person recovers in their own way. And sometimes it takes 1-2 weeks for a person to begin to see everything brightly and clearly.

Usually the surgeon who operated on you will invite you for a consultation the next day after the operation to make sure there are no complications.

Your recovery from cataract surgery should take at least 1 month.

You will be surprised how quickly you can return to normal activities the very next day after surgery. However, you must take all precautions during the entire period of subsequent rehabilitation in order to avoid the development of infection and speed up the healing of the eye.

In order for the recovery after the operation to go well, you need to follow the following additional rules:

Do not drive the car on the first day.
Avoid heavy or strenuous work for several weeks.
After surgery, avoid bending over, work in a tilt to prevent the pressure inside the eye from rising.
If possible, try not to sneeze or cough heavily after surgery.
Be careful when moving indoors after surgery, do not bump into doors and wall corners.
To reduce the risk of infection, you can not swim in the pool or even lie in a warm bath during the first week after the operation (you can only take a gentle shower, making sure that neither water nor shampoo gets into your eyes).
Do not wear make-up for several weeks after surgery.
wear on the eye protective bandage a "blind" that will be placed around or over the eyes after surgery.

If you need cataract surgery in both eyes, your surgeon will usually wait at least a few days to four weeks after surgery on the first eye in order to repair it before performing the procedure on the second eye.

Folk remedies

Cataract treatment can be supplemented with the use of folk remedies, but in no case should it be replaced. It is impossible to get rid of the pathological process with traditional medicine recipes alone. In the home treatment of cataracts, aloe juice is used. Wrap freshly cut aloe leaves in a bandage or gauze, or refrigerate for 3-4 days. Then pass them through a meat grinder and squeeze out the juice. Dissolve 1 tablet of mummy in it. Drip the resulting product into the eye 1-2 drops. The course of treatment is 7-10 days.

An infusion of acacia, marigold, burdock, chamomile, St. John's wort and calendula brings benefits. Mix herbs in equal proportions. Pour 1 tsp. mixture of 100 ml of boiling water. Strain the finished infusion. You need to bury your eyes 1 drop 2 times a day.

Clover infusion will help remove the veil before your eyes. Pour 1 tbsp. herbs 200 ml of water. Put the container on the stove and bring the contents to a boil. Then set aside the infusion and let it cool. The resulting product is used to wash the eyes. Conduct this procedure possible in the morning and evening.

After surgery, to restore vision, a decoction of chamomile, rosehip and burdock is considered effective. Take each herb 1 tbsp. Pour 1 cup boiling water over the herbal mixture. Ready infusion cool and strain. Bury 1-2 drops in the morning and evening.

In home treatment, a string is also used. The plant contains vitamin C and carotene. Pour 200 ml of boiling water over 1 tbsp. herbs. Take the remedy throughout the day in small sips. The course of treatment is 1 month.

Reduced immunity also negatively affects eye health. In order for the treatment to bring results, it is necessary to strengthen the body's defenses. You can take Eleutherococcus extract. Take 30-40 drops 2 times a day. Also in the diet you need to include freshly squeezed juices, fruit drinks, berries, vegetables and herbs.

The course of the procedure

Clouding, degeneration of the lens leads to the development of a disease called a cataract. Pathology is characterized by the fact that a person's vision is deteriorating, he does not see the surrounding objects well, he cannot work and live in his usual mode. The causes of such a disease are varied, but in order for the patient not to lose sight at all, a lens transplant in the eye is required, after which a rehabilitation period will follow, aimed at the complete restoration of vision.

The lens of the eye is replaced by phacoemulsification. During the operation, the cataract is removed by ultrasound. After the action of anesthesia, the doctor makes a micro-incision in the cornea, after which he introduces a special microscopic instrument there. Ultrasonic waves crush the solid substance of the lens, the particles of which are then removed from the pupil. Further, the transparent body is replaced with an artificial implant, which, if used correctly, will work in the future no worse than the native one.

Relative contraindications

Sometimes doctors refuse to perform the operation, explaining this by the presence of contraindications. Since the risks are too great, the patient has to refuse surgery or wait for a more suitable time.

Absolute

In the presence of absolute contraindications, a person is strictly forbidden to have an operation. Neglect of this rule can lead to sad and dangerous consequences.

Absolute contraindications include:

clouding of the cornea, which prevents the surgeon from seeing the internal structures of the eye;
acute or chronic inflammation of the iris;
the thickness of the membrane on the posterior capsule is more than 1.0 mm;
presence of macular edema, detachment, or retinal tear.

relative

If the patient has relative contraindications, the operation must be done with great caution. The final decision on the advisability of surgical intervention is made by the attending ophthalmologist. It assesses the likely risks and warns the patient about possible complications. Relative contraindications to surgery:

a period of less than six months from the date of phacoemulsification;
inflammatory processes in the anterior segment of the eye;
the presence of decompensated glaucoma;
neovascularization of the newly formed membrane;
tight contact between the intraocular lens and the posterior lens capsule.

It must be remembered that a timely visit to the doctor and compliance with the recommendations will help to avoid complications.

Replacement of the lens of the eye is needed in the following cases:

cataract;
dislocation of the lens;
intolerance to glasses and lenses;
astigmatism;
presbyopia;
myopia;
deterioration of accommodation processes;
age-related farsightedness.

There are a number of contraindications for refractive lens replacement:

inflammatory processes in the visual apparatus;
too small anterior chamber;
retinal detachment;
diabetes;
hypertension;
progressive farsightedness, accompanied by a small size of the eyeball;
suffered a stroke or heart attack.

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 macular edema of the retina;
clouding in the cornea;
pupil membrane thickness exceeding 1.0 mm.

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.

Despite the effectiveness of laser capsulotomy, this procedure can not be performed in all patients. Absolute contraindication are considered extensive scars and swelling of the cornea, which prevent the passage of the light beam. Also, the procedure is not carried out when:

severe vascularization of the pupillary membrane;
uncompensated glaucoma;
the presence of an inflammatory process in the eye.

Relative contraindications include intolerance to anesthesia due to the somatic condition or illness of the patient. It is also highly undesirable to carry out the procedure under certain conditions, for example, in the presence of a large number residual lens masses, low corneal endothelial density, high intraocular pressure, macular retinal edema. Under such conditions, the risk of complications is very high.

Laser dissection is performed with extreme caution if the patient has retinal detachment or rupture, as well as complete contact of the posterior capsule with the IOL. If contraindications do not allow this procedure, then the treatment is carried out using ultrasound.

Complications

After removing the cataract and replacing the deformed biological lens with an artificial lens, complications rarely occur, and the patient recovers quickly. But sometimes there are negative consequences. For example, a secondary cataract, in which a black veil appears before the eyes and the patient sees everything dimly. The most common complications are:

detachment and displacement of the retina;
the formation of puffiness, which hurts and interferes with normal vision;
accession bacterial infection;
intraocular hemorrhage;
glaucoma;
deterioration of visual functions.

Often the main reason for the development of such complications after lens replacement is incorrect behavior and non-compliance with the doctor's recommendations during the recovery postoperative period. Therefore, it is important for patients who have undergone the installation of an artificial ocular optical implant to listen to the doctor and do everything that he advises.

Fortunately, complications after lens replacement surgery are rare, and most of them can be successfully treated with timely diagnosis. The risk of complications increases in the presence of concomitant ophthalmic pathology. The attending physician always tells the patient about the risks of possible complications on the eve of the operation. After that, if everything is clear to the patient, he signs an informed consent to the intervention. The most common complications after lens replacement:

Bleeding in the early postoperative period;
Infectious complications (endophthalmitis);
Increase in intraocular pressure;
Cystic macular edema of the retina or its detachment;
Dislocation of the intraocular lens;
Secondary cataract or fibrosis of the lens capsule.

For timely recognition of complications, the patient in the postoperative period is assigned periodic preventive examinations. If you experience symptoms such as severe pain, a sharp decline quality of vision against the background of the previous positive dynamics, the appearance of flashes before the eyes should immediately consult a doctor.

However, if the patient complies with all necessary medical recommendations and restrictions after lens replacement, the risk of developing postoperative complications practically excluded. Cataract surgery is one of the safest surgical interventions today. Thanks to new ultrasound and laser technologies, the risk of intraoperative complications is 1/1000 percent, and patient feedback after lens replacement is mostly positive.

Removal of a secondary cataract can lead to such complications:

lens damage;
retinal edema;
·retinal disinsertion;
displacement of the lens;
glaucoma.

Let's highlight the complications that may occur after surgery:

secondary cataract with worsening visual function;
hemorrhage;
infectious process;
increase in IOP;
rupture of the posterior capsule;
prolapse of the iris;
uveitis, iridocyclitis;
astigmatism;
retinal detachment;
corneal edema;
diplopia - double vision;
blurry vision.

Important! After lens replacement surgery, a secondary cataract may develop.

Separately, I would like to say about the secondary cataract, which can appear after the operation. What is it connected with? The fact is that during a surgical intervention, a specialist cannot completely remove all the epithelial cells of the lens. As a result, they begin to affect the implanted lens, leading to its clouding. Such a complication can develop after several months or even years.

The disease manifests itself in the form of a decrease in visual acuity, distortion and fogging. In order to correct this condition, a direct surgery or laser treatment.

In order to avoid the development of a secondary cataract, it is very important to use metabolic agents after the operation, which slow down the processes of clouding of the lens. Patients should undergo regular dispensary observation with an ophthalmologist.

In the early postoperative period Suprachoroidal hemorrhage may occur. Most often it occurs in older people who are diagnosed with glaucoma, as well as cardiovascular diseases. When the posterior capsule ruptures, the vitreous body is lost, the lens is displaced, and bleeding develops.

Replacement of the lens can also cause Irwin-Gass syndrome. The risk group for this complication includes people with uveitis, diabetes, and wet AMD. To combat the complication, corticosteroids, angiogenesis inhibitors, non-steroidal anti-inflammatory drugs are used.

Removal of a secondary cataract is a rather complicated procedure. It is performed surgically or with a laser. One way or another, you cannot avoid interference.

Injury to the implanted lens. Such an outcome is possible with poor calibration of the laser equipment or improper focusing of the laser beam.
Edema of the molecular retina. This complication often occurs if the operation takes place earlier than 6 months after the replacement of the lens. Similar consequences appear due to excessive load on the retina of the eye.
Retinal disinsertion. This is a fairly rare complication. It can be caused by surgery or restrictive laser photocoagulation.
Displacement of the implanted lens. Most often it occurs due to surgery. In the case of using a laser, the likelihood of implant displacement is extremely small.
Increased intraocular pressure. The reason for this may be a clogged drainage of the eyeball. With such a complication, special drops are usually prescribed to help normalize the pressure. In rare cases, an anterior chamber flush or puncture may be prescribed.

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.
Rhegmatogenous retinal detachment. 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 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.

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 body 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.

In the case of secondary cataract, the main indication of any intervention is not the stage of formation or the rate of the course of the disease, but the quality of vision. If the cataract progresses slowly, and visual acuity drops markedly, then this is a clear reason to have an operation. If a secondary cataract began to develop in only one eye, then it is better to wait a little with surgery. This will make it impossible for further vision correction and the use of glasses.

Secondary cataract after lens replacement: treatment and reviews

Tatyana, 56 years old, Moscow Lately I began to notice that a film appeared in front of my eye, which I wanted to constantly remove. I went to the optometrist with a complaint that my left eye was no longer able to see as well as before. After the diagnosis, I was given a disappointing diagnosis - "cataract". The doctor suggested that I have an operation to replace the lens, and I agreed.

Evgenia, 65 years old, St. PetersburgI decided to see an ophthalmologist after I noticed that my eyesight had dropped. The doctor diagnosed age-related clouding of the lens. I was offered an operation. At first I have handed over analyses. I told the doctor about the existing diseases and the drugs that I take. I was given a date for the operation. Everything went very quickly, the next day I was allowed to go home. The doctor explained to me that the rehabilitation period plays an important role in the recovery process. For a while I wore glasses and also dripped antiseptic drops.

Tatyana, 61 years old, Orel I had an operation to replace the lens. I am glad that I agreed to this procedure. Because of the cataract, my eyesight was severely reduced, which caused great discomfort. I'm glad I didn't have any complications. This was probably influenced not only by the professionalism of the doctor, but also by my awareness of rehabilitation period. I limited my TV viewing and computer work, wore glasses, dripped prescribed drops. Now I am regularly examined by a doctor, as I am worried that the situation will not repeat itself with the second eye.

So, lens replacement is a unique operation that will help restore vision. This is a sought-after and popular treatment method, which is distinguished by its availability and high rates efficiency. Lens replacement surgery occupies a leading position among other surgical interventions on the organs of vision.

September 13, 2016

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 intraocular lens. It happens that the capsule begins to become cloudy, which causes a phenomenon such as a secondary cataract after replacement of 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.

Loss of vision after cataract removal. Cataract worse after surgery

Causes of the phenomenon

Risk factors

Preventive measures

Signs of the appearance of a secondary cataract

Treatment

Surgical intervention

Cons of surgery

Features of laser treatment

In what cases is a dispensation given?

Strict contraindications

Relative contraindications

Complications

Conclusion

Causes

Symptoms

Video: Secondary cataract after lens replacement

Diagnostics

Video: Secondary cataract after lens replacement and treatment

Treatment

Forecast and prevention

Video: Do's and Don'ts for Cataracts

Causes of cloudiness

Symptoms of the disease

Treatment

Forecast

Retinal detachment

Macular degeneration

Retinal tear and vitreous detachment

diabetic retinopathy

Cataract

Myopia

farsightedness

Eye injury

Clouding of the cornea (thorn)

Keratitis

Corneal ulcer

Thyroid diseases

Spinal disorders

Diseases

Bad habits

Postoperative complications of cataract removal

Question: cataract?

Form for supplementing a question or feedback:

#6018: Poor vision after cataract removal.

Causes

Types of complications

Signs of the appearance of a secondary cataract

Symptoms

Diagnostics

Methods of treatment and further prevention

Surgical

laser

Capsulotomy

How long does it take to recover vision after cataract surgery?

Daily routine and diet

Folk remedies

The course of the procedure

Relative contraindications

Absolute

relative

Complications

Risk factors

Preventive measures

Secondary cataract after lens replacement: treatment and reviews

new entries