Cataract is a kind of disease in which the crystalline part of the eye becomes turbid due to various reasons, resulting in visual impairment.Common types includeSenile cataract、Complicated cataract、Traumatic cataract、Metabolic cataractSenile cataract is particularly common.There are many reasons, such as aging, heredity, local nutritional disorders, immune and metabolic abnormalities, etc.In addition, exposure to strong light, smoking and drinking, malnutrition, long-term useGlucocorticoidWill increase the risk of cataract.Cataract is the first blinding eye disease in the world, especially in the elderly.
The initial symptoms of cataract are usually not obvious, but with the development of the disease, blurred visiondiplopia、myopia、glareAnd may lead to complete blindness.It should be noted that cataracts are not infectious.
The main treatment of cataract is surgery, including removal of cloudy lens and implantation of intraocular lens.At present, cataract surgery is mature and effective.Drug treatment is only applicable to patients with mild symptoms who have not yet reached the surgical standard.During the recovery period, patients should keep their eyes clean, prevent infection, and recheck according to the doctor's instructions.The improvement of postoperative vision depends onthe fundus oculiandCornealThe status of.
TCM disease name
cataract
Foreign name
cataract
Visiting department
Ophthalmology Department
Multiple population
Middle aged and elderly people over 50
Common causes
Aging, heredity, local nutritional disorder, immune and metabolic abnormalities, trauma, poisoning, radiation
common symptom
Opacity and blurring of vision, decreased vision, decreased contrast sensitivity, blurred vision, monocular diplopia or multiple vision, visual field defect, glare
Hereditary or not
Congenital cataract is hereditary, but acquired cataract is not hereditary
LensIn the liquid environment of the eye, any factor that can affect the internal environment of the eye can cause metabolic disorder of the lens, leading to protein degeneration of the lens and turbidity.
Pathogenesis
Various reasons, such as aging, heredity, local nutritional disorders, immune and metabolic abnormalities, trauma, poisoning, radiation, etc., can cause lens metabolic disorder, leading to lens protein degeneration and turbidity.
Predisposing factors
Factors that increase the risk of cataract include:
diabetesGalactose and calcium metabolism disorders are related to metabolic cataract;
Strong light stimulation and excessive sunlight;
Smoking and excessive drinking;
Obesity and malnutrition;
Have a history of eye trauma, inflammation or surgery;
Long term useGlucocorticoid, miotic agents and other drugs.
symptom
Announce
edit
The early symptoms of cataract are generally not obvious, only mild blurred vision. Patients may mistakenly think it is presbyopia or eye fatigue, which is very easy to miss diagnosis.After the metaphase, the lens opacity of the patient gradually increases, and the degree of blurred vision also increases, and there may be double strabismusmyopia、glareAnd other abnormal feelings.With the development of the disease, the patient will eventually become completely blind.
It is the most important and obvious symptom that the vision is turbid and blurred, and always feels hazy and foggy.
Typical symptoms of cataract
Impaired vision
The cloudiness around the lens may not affect the vision, while the cloudiness in the central part, even if the scope is very small, will seriously affect the vision.
When the patient is in strong light, because the pupil shrinks, there is less light entering the eye, and the vision is not as good as in weak light.
When the lens is seriously turbid, the vision can be reduced to only light perception or even blindness.
Decreased contrast sensitivity and blurred vision
In daily life, the human eye needs to distinguish between objects with clear boundaries and objects with fuzzy boundaries. The latter is called contrast sensitivity.Some cataract patients may not have obvious vision decline, but the contrast sensitivity is significantly reduced, that is, visual function decline.
Refractive change
The lens refractive power of the patients with nuclear cataract is enhanced, and "nuclear myopia" appears, but for the elderly, the original presbyopia is reduced;
After cataract occurs, the opacity of each part of the lens is different, and the refraction ability of light is different, which can lead to "lenticular astigmatism".
Color vision change
The turbid lens absorbs more blue light, which reduces the sensitivity of the affected eye to these colors;In addition, changes in the color of the lens nucleus can also affect color vision.
Other symptoms
Monocular diplopia or polyopia;
Visual field defect;
Glare refers to the inability to adapt to bright lights such as sunlight and lights, and even the loss of vision when facing strong bright lights.
Medical treatment
Announce
edit
When the patient suddenly has vision changes (such as blurred visiondiplopiaIn case of sudden eye pain or headache, timely treatment is required.The elderly, diabetics and other high-risk groups should always pay attention to the changes in vision.
Visiting department
Ophthalmology Department
Relevant inspection
The doctor needs to arrange relevant examinations to confirm cataract, and eliminate other eye diseases at the same time.
ocular examination
Visual acuity and intraocular pressure were checked routinely.
Flush the lacrimal passage. This examination can help eliminate obstruction of the lacrimal passage and dacryocystitis.
Optical coherence tomography (OCT) of posterior segment, corneal endothelial cell examination, ocular B-ultrasound, corneal topography, etc.
treatment
Announce
edit
The treatment of cataract mainly includes medicine and surgery.
Drug treatment is only applicable to a few patients with mild symptoms who have not yet reached the surgical standard, or those who cannot receive surgical treatment for some reasons (such as serious cardiovascular and cerebrovascular diseases, narcotic drug allergy, etc.).
Surgery is the main treatment for cataract. The purpose is to remove the turbid lens and implant intraocular lens.The current cataract surgery is mature, effective and widely developed, and can be the first choice for patients.
medication
At present, there are many kinds of anti cataract drugs in clinic, but the effect is not clear.
Auxiliary nutrition drugs: oral drugs, includingvitamin C、vitamin EIt is used to improve the nutritional disorder of lens.
Antioxidant damage drugs:Glutathione eye dropsIt can be used for early senile cataract.
Surgery is the main way to treat all types of cataract.
Operation indications
The patient's vision decreased and affected his normal life. There was no serious fundus disease in preoperative examination.
Preoperative preparation
Complete all the previous eye related examinations.
Rinse conjunctival sac and lacrimal passage, and dilate pupils before operation.
Operation mode
Operation mode
Surgical complications
In recent years, the complications have been greatly reduced due to the improvement of surgical methods.
Posterior capsular opacification: posterior capsular opacification, which may occur months to years after surgery, can generally be treated by YAG laser in the outpatient department, and most can be cured by one laser.
Intraocular pressure rise: generally, there may be temporaryIntraocular pressureIt will rise and return to normal soon.If the intraocular pressure continues to rise, it is secondary glaucoma.
Corneal edema,retinaDetachment, etc.: The incidence rate is very low, and most can also be treated by surgery.
Endophthalmitis and expulsion hemorrhage: serious complications, but the incidence rate is less than 1 in 1000. Severe cases can lead to visual loss.
Postoperative
Keep eyes clean to prevent infection.After discharge, strictly follow the doctor's instructions, keep the eyes clean, and recheck one week, one month, and three months after the operation.
The surgical treatment of cataract has been mature, but the recovery of postoperative vision of patients depends on the fundus condition.The fundus of most patients could not be seen clearly before surgery, and the fundus should be examined carefully after surgery.Most patients' vision recovered well after surgery, but if the affected eye has fundus disease, keratopathy, glaucoma, etc., it may not improve significantly after surgery.
