Cataract is the opacity of the lens in the eye, which changes from transparent to opaque, preventing light from entering the eye, thus affecting vision. The initial turbidity has little effect on vision, and then it gradually increases, obviously affecting vision and even blindness.

Cataract is the main cause of blindness in the world. At present, about 20 million people in the world are blinded by cataracts, and another 654.38 billion cataract patients need surgery to restore their vision. In most African and Asian countries, cataracts account for at least half of the blind. According to the survey results of China, cataract is also the most important blinding eye disease in China.

There are many causes of cataracts: some are congenital cataracts (common in children), eye injuries can also lead to cataracts, and some medical diseases can also lead to cataracts. Such as diabetes, nephritis and complicated cataract, but most cases and patients are related to old age. The incidence of senile cataract is 60-70% at 50-60 years old, 80% at 70 years old and almost 100% at 80 years old.

With the extension of life expectancy in the world, the number of cataract patients will continue to increase. The most effective method for cataract treatment is surgery. Most patients can successfully recover their vision through surgical treatment.

2. What is the structure and function of the lens?

The normal lens is an elastic avascular transparent body, which looks like an oblate lenticular lens. It is located behind the iris and pupil and in front of the vitreous body, and is connected with the ciliary body through the suspensory ligament of the lens to fix its position.

The tissue structure of the lens is like a peach in a fruit, which is divided into three parts:

(1) The outer surface of the lens is covered with a transparent and elastic film called lens capsule (equivalent to peach skin).

(2) The center is the nucleus of the lens (equivalent to the nucleus of a peach), which is located in the center of the lens. With the increase of age, the range of nucleus pulposus will gradually increase and harden, and the transparency will also decrease.

(3) The tissue between the lens capsule layer and the nuclear layer is called the lens cortex layer (equivalent to the peach pulp).

Lens is one of the important refractive stroma of eyeball, and its main function is to adjust the eyes to see the scenery of Qingyuan and its vicinity at various distances. The completion of this process depends on the elasticity of the lens, the contraction and relaxation of the ciliary body and the relaxation and tension of the suspensory ligament of the lens, which is called accommodation function. With the increase of age, the elasticity of lens capsule decreases, the lens nucleus increases and hardens, the ciliary muscle weakens, and the accommodation power decreases, leading to presbyopia.

3. What are the causes of cataract?

There are many reasons for cataract, except traumatic cataract, radiation cataract, congenital cataract and diabetic cataract, there may be many factors in the process of cataract formation, and the situation is quite complicated. The common pathogenesis of senile cataract has not been fully revealed so far, which may be related to aging, long-term overexposure to ultraviolet rays, genetic factors, malnutrition and so on. In China, it has been confirmed by investigation that the incidence of cataract is relatively high in plateau areas and areas with more sunlight radiation. This is because long-term exposure to ultraviolet rays in the sun will affect the redox process of the lens, making the protein degeneration of the lens cloudy and forming cataracts. In addition, diabetes, galactosemia and hypothyroidism, which are common in clinic, can also cause cataracts.

4. Is there a risk of serious cataract without surgery?

There is no doubt that surgery is the best way to treat cataracts, but if you have cataracts, you don't have to have surgery right away. The best time for cataract surgery has been mentioned above, but some people still think that it is just as well not to have surgery when the cataract is mature, isn't it just invisible? Everyone knows that this view is very wrong and dangerous. Because, in the development of cataract, if it is not treated in time, there will be many serious complications, such as glaucoma and uveitis. These eye diseases mostly occur in the middle and late stage of cataract, such as swelling stage and over-ripening stage, which can not only cause blindness, but also cause serious inflammation of the eye, leading to eyeball atrophy; Some patients can't stand the long-term eye pain and finally have to have their eyes removed. So this reminds everyone that cataract must be treated surgically when it develops to a certain extent.

5. What are the common surgical methods for cataract?

According to the integrity of lens capsule during lens extraction, it can be divided into two types: intracapsular extraction and extracapsular extraction.

Intracapsular cataract extraction and traditional extracapsular cataract extraction have become the past. For many years, extracapsular extraction with fine manipulation of surgical microscope has been used. With the popularization of microsurgery and the improvement of technology, modern extracapsular cataract extraction combined with intraocular lens implantation has become the most widely used surgical method. The operation requirements are relatively easy, the safety is high, the complications are few, and the effect of recovering vision after operation is good.

In recent years, small incision phacoemulsification has been carried out. There is no need to suture the wound after operation, and the wound heals quickly, with less postoperative astigmatism and rapid vision recovery.

6. Extracapsular cataract extraction or phacoemulsification?

Phacoemulsification of cataract is developed on the basis of modern extracapsular cataract surgery. During the operation, phacoemulsification instrument was used to crush and suck out the lens nucleus and cortex through a corneal or scleral incision of about 3 mm, and the posterior lens capsule was reserved for implantation of posterior chamber intraocular lens. Its obvious advantages are small surgical incision, only 2.8-5.5 mm, fast postoperative incision healing, small corneal astigmatism, satisfactory early vision, outpatient surgery and no hospitalization. Disadvantages are: high cost, dependence on machines, complicated operation, great difficulty, and easy to cause permanent damage once complications occur.

Modern extracapsular cataract surgery is a mature and effective cataract surgery method, which requires a large incision and large corneal astigmatism after operation, and it takes two weeks to achieve high vision. However, this surgical method has been mastered by quite a few ophthalmologists, with low cost, no need for special machinery, good postoperative vision recovery and low incidence of complications. Therefore, whether it is phacoemulsification or modern extracapsular cataract extraction, as long as the indications are mastered, the operation must be mastered skillfully.

We believe that extracapsular cataract extraction is still advocated in poor rural areas of China, and it is the most economical to correct vision with large convex lens (hyperopia) after operation.

7. Can cataracts also lead to sudden blindness?

The symptoms of cataract are generally gradual decline in vision and finally blindness. There are no symptoms such as eye pain in the whole process. If the patient suddenly feels that his vision is obviously decreased without pain, he should consider that there may be fundus diseases, such as fundus hemorrhage, optic papillopathy or retinal detachment, and he must see an ophthalmologist immediately to avoid mistaken cataract. In the development of senile cortical cataract, there is a period in medicine called swelling period. During this period, there is more water in the lens, which makes it expand rapidly, increase its volume and make the anterior chamber shallow. At this point, the patient can feel the speed of vision loss. Individual patients may have glaucoma due to lens swelling and high intraocular pressure caused by shallow anterior chamber. Patients may have systemic symptoms such as envy, eye pain, headache, nausea and vomiting, and their vision will drop sharply.

8. Is there an age limit for cataract surgery?

With the aging society in China, due to the improvement of living standards, more and more elderly people need cataract surgery. There is no uniform medical restriction on the maximum age of cataract surgery. Some patients' families think it is too dangerous for the elderly over 90 to have surgery. In fact, some elderly people are healthy, their blood pressure and heart condition are stable, and at present, eye anesthesia (surface anesthesia) is mostly used in cataract surgery, so the pain is very small and they can withstand the operation. At present, the highest age of cataract surgery in Beijing Tongren Hospital is 103 years old. Therefore, whether you can withstand cataract surgery does not depend on your age, but on your physical condition.

9. What tests do you need to do before cataract surgery?

Cataract surgery is a complicated operation in ophthalmology. In order to ensure the effect of the operation, adequate preoperative examination is needed. The preoperative examination of cataract is divided into two parts: eye examination and general examination. Eye examination generally includes vision, visual function, intraocular pressure and lacrimal passage, corneal curvature, A-ultrasound and B-ultrasound, among which corneal curvature and A-ultrasound are used to calculate the degree of intraocular lens implantation during surgery. General examinations generally include routine hematuria examination, liver and kidney function examination, anti-Australian examination, blood sugar examination, blood pressure, electrocardiogram and other medical examinations. Its purpose is to know the general situation of patients, whether they have hypertension, diabetes and its severity, heart function, and whether they are qualified for cataract surgery. If necessary, do nervous system examination as needed to understand the cerebrovascular situation.

10, can patients with heart disease have cataract surgery?

Senile cataract patients, because of their older age, all internal organs of the body have declined to varying degrees, and cardiac insufficiency is also very common in clinic. Whether senile patients with heart disease can undergo cataract surgery depends on the severity of heart disease and the state of heart function. Cataract surgery is a common microsurgery in ophthalmology. Under local anesthesia, the operation time is short and has little effect on the function of the whole body organs. General heart patients can tolerate cataract surgery, but the following points should be paid attention to during surgery:

(1) Before the operation, we should have a comprehensive and detailed physical examination, fully estimate the possible situations during the operation, prepare first-aid drugs and rescue instruments, formulate first-aid measures, and ask cardiologists to cooperate with the monitoring of the patient's heart function when necessary, so as to ensure the safe and smooth completion of the operation.

(2) Do a good job in ideological work before operation, so that patients can eliminate their nervousness. Give appropriate sedatives, such as diazepam and lumina, the night before operation and the day of operation.

(3) Cataract surgery should be fully anesthetized to reduce pain. When pressing the eyeball to reduce the intraocular pressure, or pulling the eye muscles to fix the eyeball, the movement should be light, so as to avoid eye reflex, slow down the heart rate or suddenly stop. The operation method should be simple and effective, and the operation time should be shortened as much as possible.

(4) Don't rest on your back for a long time after operation. You should use a semi-recumbent position, get out of bed properly, eat more fruits and vegetables, and keep your stool unobstructed.

1 1. What should patients do before cataract surgery?

Preparation before cataract surgery is very important. In addition to cooperating with the doctor to do a series of eye and physical examinations, we should also make physical and mental adjustments. Cataract is a kind of surgery to restore vision, and most of them have good results. However, due to individual differences between people, some complications may occur. Therefore, as the family members of patients, we should fully understand the complications and possible abnormalities during and after operation and cooperate with doctors for treatment. Before the operation, patients should pay attention to rest, adjust diet, quit smoking and drinking. Patients with systemic diseases should adjust their blood pressure, blood sugar and cardiovascular and cerebrovascular indexes to the best state under the guidance of doctors. Routine antibiotic eye drops before operation. Patients with cataract surgery can eat normally before surgery, but don't overeat, except that they are forbidden to eat or drink anything 8 hours before general anesthesia surgery in children.

12, what is an intraocular lens?

From the meaning of the word intraocular lens, as the name implies, a special lens made of synthetic materials is called intraocular lens, and its components include silica gel, polyoxymethylene acrylic nail, hydrogel and so on. The shape and function of intraocular lens are similar to the lens of human eyes, and it has the characteristics of light weight, high optical performance, no antigenicity, no inflammation, no carcinogenicity and biodegradability. After cataract surgery, the turbid lens is removed and the intraocular lens is implanted in the eye to replace the original lens, so that external objects can focus on the retina and the surrounding scenery can be seen clearly.

13, which intraocular lens is "best"?

Cataract patients want to choose the "best" intraocular lens before operation, and even think that the most expensive intraocular lens is the best. I am afraid that choosing the wrong lens will affect my postoperative vision. This kind of worry is completely unnecessary. We already know that intraocular lens implantation is to replace the function of the original lens, focus imaging in the original position, so that the eyes can see things clearly. Therefore, whether it is domestic intraocular lens or imported intraocular lens, as long as the materials used to make intraocular lens are non-toxic, the technology is excellent and the disinfection is strict, the effect is the same after implantation in the eye. Moreover, at present, the raw materials, manufacturing equipment and technology of domestic intraocular lenses are basically the same as those of foreign manufacturers, but the price is much cheaper than that of imported intraocular lenses. Therefore, under the premise of ensuring the quality, the effect of domestic intraocular lens and imported intraocular lens in cataract surgery is the same, not the most expensive but the best.

14, what are the characteristics of intraocular lens implantation in the treatment of cataract?

Intraocular lens is equivalent to the convex lens of human eye +9d-+ 12d. If the patient has no ametropia before operation (no myopia, hyperopia, etc.). ), the cataract surgeon removes the lens, and the operating eye is in a state of high hyperopia, so it is necessary to wear a convex lens with the same degree for correction. This kind of "hyperopia mirror" is unsightly, inconvenient for patients to wear and poor in visual quality, which makes patients feel uncomfortable. However, intraocular lens can: (1) replace the function of normal human eye lens in anatomical position. (2) Implanting intraocular lens after monocular cataract surgery solves the problem that the other eye has better vision because of monocular cataract surgery in the past; Because the eyes can't wear corrective glasses after operation, the vision is still not improved obviously, and the discomfort caused by binocular parallax can be alleviated, such as dizziness, nausea and sometimes diplopia. (3) The intraocular lens has no visual distortion, circular scotoma and narrow visual field caused by aphakia.

15, what is after cataract?

After extracapsular cataract extraction or lens trauma, the lens cortex can't be completely absorbed, and the remaining part is turbid, which mixes with the lens residual capsule to form an opaque organic film, or forms a transparent pearl-like body due to epithelial cell proliferation, which seriously affects vision. It is called after cataract, or after cataract for short.

16, what is the laser treatment of after cataract?

Usually, laser treatment of cataract refers to primary cataract incision with YAG laser. After extracapsular cataract extraction or traumatic cataract surgery, the lens cortex remains, epithelial cells under the anterior lens capsule regenerate, and the surgical reaction and inflammatory reaction form an opaque film with the posterior lens capsule, which seriously affects vision. In this case, using the high energy of YAG laser, the central part of the pupil area is equivalent to the visual axis of human eyes, exposing a transparent area, and the patient's vision will be improved immediately. If it is a very hard organic membrane, YAG laser can't cut it, and after cataract can only be surgically removed. YAG laser in the treatment of after cataract has the advantages of safety, reliability, convenient operation, no pain to patients and quick recovery of vision.

17. How did congenital cataract happen?

Congenital cataract is a common eye disease in infants. The partial or total opacity of the lens in the first year after birth is called congenital cataract; Divided into two groups: the first group is congenital cataract; The second group is cataracts that occur a few weeks or months after birth, which are called infant cataracts. There are basically two reasons for lens growth and development disorders: ① Endogenous factors: refers to chromosome gene variation, which causes lens embryo development process disorders, with genetic and family history. ② Exogenous factors: It is the main cause of congenital cataract. If the mother is infected two months before pregnancy, or suffers from rubella, chickenpox, measles, mumps and other infectious diseases within six months of pregnancy, it will cause damage to the fetal lens. Thyroid insufficiency, malnutrition and vitamin deficiency may all lead to congenital cataract. In addition to cataract, some patients are accompanied by congenital malformations such as iris defect, microphthalmia or brain hypoplasia.

18, when is the operation better for congenital cataract?

Congenital cataract has different clinical manifestations, and the degree of vision decline is related to the location and scope of lens opacity. At present, surgical treatment is still the main treatment for congenital cataract, and grasping the appropriate surgical opportunity is an important link to determine whether children can recover their vision. Generally, the following principles should be mastered:

(1) Patients with binocular complete cataract after birth should be operated as soon as possible because the retina can not be stimulated normally, which seriously affects the development of visual function. Surgery is usually performed within 1-2 months after birth, and no later than 6 months. The other eye should be operated within 1 week after the first operation, and the monocular covering should not exceed 1 week after operation to prevent form deprivation amblyopia caused by monocular covering after operation.

(2) Cataract with incomplete eyes: If the binocular vision is lower than 0. 1, those who can't see the fundus clearly should also strive for early surgery.

(3) For monocular congenital cataract, if the lens opacity is located in the pupil area, or the binocular vision is lower than 0.3, surgery should be performed as soon as possible at the age of 2-3.

(4) Opaque local shots will not affect the performance at ordinary times. If the vision is above 0.3, the operation can be postponed to 4-5 years old, but not later than 6 years old, otherwise it may cause irreversible amblyopia.

(5) Patients with rubella syndrome should not be operated too early, because rubella virus still exists in the lens at the early stage after infection, which can cause virus release and iritis during operation. Generally speaking, it is recommended to operate at the age of 2-4.

In short, we must emphasize the importance of early surgery, wear corrective glasses as soon as possible after surgery to avoid amblyopia, and then carry out secondary intraocular lens implantation according to the patient's eyeball development and vision.

19. Can congenital cataract be implanted with intraocular lens?

Theoretically and technically, intraocular lens surgery should be performed at any age, but care should be taken for intraocular lens implantation in children and adolescents with congenital cataract. The purpose of infant intraocular lens implantation is not only to improve vision, but also to prevent amblyopia and develop fusion. However, due to the characteristics of infant eye tissue, postoperative complications are obviously more than adults, so it can not be used as routine surgery. The age of implantation is generally limited to 2 years old. Intraocular lens implantation must be cautious, cases should be strictly selected, operators should have skilled operation techniques, and postoperative close observation and amblyopia training should not be ignored.

20. Can vision be improved after congenital cataract surgery?

A baby's visual development is very important within 6 months after birth. Stereoscopic vision and color vision are formed in 2-3 months after birth, and vision improves rapidly in 6 months after birth. If cataract occurs at this stage, it will not only cause visual damage, but also destroy the development of binocular visual function and color vision. In order to restore vision and obtain perfect visual function, cataract with obvious occlusion of monocular visual axis should be operated within 2 months after birth, otherwise form deprivation amblyopia will occur. If binocular cataract has obviously affected vision, surgery should be performed as soon as possible. Moreover, in order to shorten the time when one eye is inhibited by cataract, the operation interval between the two eyes should be arranged as close as possible. Generally, after the first eye operation 1 week, if there is no obvious surgical response, the second eye operation can be performed. If the cataract is not serious, or the lens is cloudy, the child still has some vision and can live a normal life. The operation time should be carefully considered. Don't rush to operate, but you must take measures to promote vision development (such as training to correct amblyopia) and wait until the child is older. In a word, even if the operation is successful, the recovery of vision after cataract surgery in children is often not satisfactory compared with senile cataract. Therefore, the prognosis of children's cataract vision recovery depends to a great extent on the timing of surgery, the choice of surgical methods, the refractive correction of aphakia after surgery and the treatment of amblyopia after surgery.

2 1. Can intraocular lens be implanted after traumatic cataract surgery?

The application of intraocular lens is also limited. Not all cataracts can be implanted with intraocular lens, especially traumatic cataracts, because if the intraocular lens is forcibly implanted, there will be serious complications after surgery. Therefore, whether to implant intraocular lens after traumatic cataract surgery should follow the following principles:

(1) After cataract extraction, the posterior capsule of traumatic cataract is intact, and intraocular lens can be implanted in one stage.

(2) Cataract caused by acute trauma should be treated after debridement and suture, and the second-stage intraocular lens implantation should be considered after the local situation is completely stable and the eyeball can withstand the trauma of reoperation.

(3) After traumatic cataract surgery, posterior capsule rupture is incomplete, iris defect or anterior segment structure is disordered, but the visual function is still good, so anterior chamber intraocular lens implantation or suspension intraocular lens implantation can be selected.

(4) Intraocular lens implantation should be carefully selected after traumatic cataract surgery in children. For elderly patients with good local conditions, intraocular lens implantation can be tried out.

(5) Traumatic cataract complicated with central leukoplakia of cornea, extensive adhesion or defect of iris, adhesion of chamber angle, high vitreous opacity, fundus injury, etc. It seriously affects visual function and is not suitable for intraocular lens implantation.

Respondent: Tang Ziwei Champion1Grade 4-27 14: 44.

The questioner's evaluation of the answer:

thank you

The lens in the eye of ordinary people is transparent tissue. Once the lens is turbid for any reason, it is called cataract disease, so cataract is a disease that occurs on the intraocular lens. According to this point, any lens opacity can be called cataract, but when the lens opacity is light, it does not obviously affect vision, and it is not included in the cataract. According to years of investigation, cataract is the most common cause of blindness and visual disability. It is estimated that about 25% of human beings have cataracts. Fortunately, this is an eye disease that is easy to cure.

How to treat cataract?

The treatment of cataract can be divided into non-surgical treatment and surgical treatment. Non-surgical treatment: Cataract, phenytoin and other eye drops can be added in the early stage of cataract to control the development. Surgical treatment: The visual acuity of cataract is below 0.3. As long as the fundus is in good condition and the symptoms of systemic diseases are not obvious, surgical treatment is feasible.

How many surgical methods are there? At present, there are two commonly used surgical methods: one is extracapsular cataract extraction with a pair of glasses after operation; The other is the most advanced surgical method in the world: extracapsular cataract extraction+intraocular lens implantation; Normal vision can be restored immediately after operation. At present, our hospital has introduced the most advanced equipment and instruments in the world and has first-class ophthalmologists in China. The incision of cataract surgery is small, and the operation can be completed in 2 ~ 5 minutes by phacoemulsification. In our hospital, more than 8,000 cataract patients were implanted with intraocular lenses, which enabled them to see again. The postoperative visual acuity of more than 90% patients reached 65438 0.0.

Can the elderly do cataract surgery? People over 90 can have cataract surgery, regardless of age, as long as they are in good health. Because I can see the light again after operation, I feel comfortable and can prolong my life.

What are the drugs for early cataract treatment?

Generally, there are the following drugs to treat cataract: ① Nutritional supplements, such as Li Yanming and Colin Rosso. ② Drugs related to quinone theory, such as Catalin, Folklin, Bainaiting and Zhizhangning. ③ Antioxidant drugs, such as glutathione, thiophene and SOD. (4) Other types such as parotid hormone, nitrocellulose, Lu Shiming, etc.

Traditional Chinese medicine has a certain effect on improving the vision of some patients. Commonly used acupoints are Jingming, Houqiu, Zhuzhu, Fish Waist, Hegu, Zusanli and Sanyinjiao. Traditional Chinese medicine treatment is mainly based on systemic syndrome differentiation, and early cataract is mainly based on nourishing liver and kidney, and Qiju Dihuang Pill or Dendrobium luminous Pill is selected; The weak of spleen deficiency and qi were given the method of invigorating spleen and benefiting qi, and Buzhong Yiqi Decoction was selected. For patients with liver heat disturbance, clearing away heat and calming the liver, cinnamon powder is selected; Those with yin deficiency and damp heat should nourish yin and clear away heat, be lenient and promote diuresis, and choose Ganlu drink.

What are the methods of cataract surgery?

Commonly used cataract surgery methods include cataract extraction, cataract needle aspiration and cataract needle dialing. With the development of microsurgery, modern cataract extraction, intraocular lens implantation and phacoemulsification have appeared.

The traditional cataract extraction is to remove all the lens including the capsule, but not the posterior capsule.

Modern extracapsular cataract extraction is characterized by closed aspiration and perfusion of anterior chamber under operating microscope. Because the intact posterior lens capsule is preserved, it has many advantages compared with intracapsular extraction, such as reducing the chance of vitreous loss, thus reducing complications such as retinal tear and retinal detachment.

Phacoemulsification is an improved extracapsular cataract extraction, which is most suitable for young patients with soft lens nucleus, especially those under 40 and 50 years old, with normal corneal endothelium, normal anterior chamber depth, dilated pupils of more than 7mm and moderate nuclear hardness. The absolute contraindications of this operation are lens subluxation and corneal endothelial decompensation. Relative contraindications mainly depend on the operator's experience and skills, such as corneal endothelial degeneration, shallow anterior chamber, small pupil, lens sclerosis and so on.

Cataract needle aspiration is suitable for congenital or traumatic cataract without hard nucleus under 30 years old.