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OPHTHALMIC SURGERY
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A cataract is a clouding of the eye's natural lens, which lies behind the iris and the pupil. Inside our eyes, we have a natural lens. The lens bends (refracts) light rays that come into the eye to help us see. The lens should be clear. If you have a cataract, your lens has become cloudy. Things look blurry, hazy or less colorful with a cataract. Cataracts are the most common cause of vision loss in people over age 40 and is the principal cause of blindness in the world. 

Though there are other risk factors for cataracts, aging is the most common cause. This is due to normal eye changes that happen after the age 40. The lens is mostly made of water and protein. The protein is arranged in a precise way that keeps the lens clear and lets the light pass through it. But as we age, normal proteins in the lens start to break down and some of the protein may clump together and start to cloud a small area of the lens. This keeps light from passing through clearly. This is a cataract, and over time, it may grow larger and cloud more of the lens, making it harder to see.

Most age-related cataracts develop gradually. Other cataracts can develop more quickly, such as those  in younger people or those in people with diabetes.

Besides aging, other cataract risk factors include:

·         Family history - having parents, brothers, sisters or other family members who have cataracts

·         having certain medical problems, such as diabetes, Hypertension, Obesity

·         having had an eye injury, eye surgery, or radiation treatments on your upper body

·         having spent a lot of time in the sun, especially without sunglasses that protect your eyes from damaging ultraviolet (UV) rays

·         Smoking

·         Prolonged use of corticosteroid medications

·         Statin medicines used to reduce cholesterol

·         Hormone replacement therapy

·         Significant alcohol consumption

·         High myopia

·         Age-related. These form as you get older.

·         Congenital. This is what doctors call it when babies are born with cataracts. They may be caused by infection, injury, or poor development in the womb. Or, they can form in childhood.

·         Secondary. These happen as a result of other medical conditions, like diabetes. They can also result from being around toxic substances, ultraviolet light, or radiation, or from taking medicines such as corticosteroids or diuretics.

·         Traumatic. These form after an injury to the eye.

·         Other things that can raise your chances of getting cataracts include cigarette smoke, air pollution and heavy drinking.

 

  • A nuclear cataract forms deep in the central zone (nucleus) of the lens. Nuclear cataracts usually are associated with aging. When a nuclear cataract first develops, it can bring about a temporary improvement in your near vision, called "second sight."
  • A subcapsular cataract occurs at the back of the lens. People with diabetes or those taking high doses of steroid medications have a greater risk of developing a subcapsular cataract. A subcapsular cataract may not produce any symptoms until it's well-developed.
  • A cortical cataract is characterized by white, wedge-like opacities that start in the periphery of the lens and work their way to the center in a spoke-like fashion. This type of cataract occurs in the lens cortex, which is the part of the lens that surrounds the central nucleus.
  • When symptoms begin to appear, you may be able to improve your vision for a while using new glasses, contact lenses, strong bifocals, magnification, appropriate lighting or other visual aids.
  • Protect your eyes from UV light by wearing sunglasses that block at least 99 percent UV and a hat.
  • If you smoke, quit. Smoking is a key risk factor for cataracts.
  • Limit driving at night once night vision, halos or glare become problems.
  • Take care of any other health problems, especially diabetes.
  • Do not use eye drops or other treatments that claim to dissolve or remove cataracts. There is no proven way to dissolve cataracts with eye drops. Surgery is the only way to remove cataracts.
  • Think about surgery when your cataracts have progressed enough to seriously impair your vision making it difficult to complete your regular activities and affect your daily life.
  • Make an informed decision about cataract surgery. Have a discussion with your ophthalmologist about:
    • the surgery
    • preparation for and recovery after surgery
    • benefits and possible complications of cataract surgery
    • cataract surgery costs
    • other questions you have
  • Many people consider poor vision an inevitable fact of aging, but cataract surgery is a simple, relatively painless procedure to regain vision.
  • Cataract surgery is very successful in restoring vision. In fact, it is the most frequently performed surgery
  • Nine out of 10 people who have cataract surgery regain very good vision, somewhere between 20/20 and 20/40
  • During surgery, the surgeon will remove your clouded lens and in most cases replace it with a clear, plastic intraocular lens (IOL).
  • New IOLs are being developed all the time to make the surgery less complicated for surgeons and the lenses more helpful to patients.
  • Presbyopia-correcting IOLs potentially help you see at all distances, not just one.
  • Another new type of IOL blocks both ultraviolet and blue light rays, which may damage the retina.

 

Many people think cataracts only happen to older people, but children can get cataracts too. Both pediatric cataracts and cataracts from aging are a clouding in the lens of the eye that can cause blurry vision or blindness.

In adults, cataracts occur after the eyes and vision are developed and stable. Most adults can have good vision again after the cataracts are removed. Because children's eyes are still developing until they're 8-10 years old, untreated cataracts can have serious long-term effects on their vision. But early detection and prompt treatment can prevent permanent vision loss in children with cataracts.

 

Understanding pediatric cataract:

  • Pediatric cataracts can be congenital (present at birth) or acquired (develop after birth).
  • They can be caused by genetic predisposition, metabolic disorders such as diabetes or trauma to the eye that damages the lens. Sometimes they occur spontaneously.
  • Traumatic cataract caused by injury to a child's eye whereby the injury also damaged the iris.
  • They can occur in one eye (unilateral) or both eyes (bi-lateral).
  • Bi-lateral cataracts can be asymmetric (one cataract is more severe than the other).
  • Cataracts may appear in different parts of the lens and range in size from tiny dots to dense clouds.

Most pediatric cataracts are detected when the child is examined at birth, before they even leave the hospital. Many more are detected by pediatricians at well-baby exams and some are noticed by parents. Acquired cataracts are most often diagnosed at vision screenings by the pediatrician or after an eye injury.

For children, whose eyes and brain are still learning to see, distortion can lead to lazy eye (amblyopia). Without proper treatment, pediatric cataracts can cause abnormal connections between the brain and the eye. Once made, these connections are irreversible.

Treatment for pediatric cataracts can vary depending on the type and severity. But the vast majority of children need surgery to remove the cataracts. Children who receive timely treatment and follow-up have a good prognosis.

Successful outcomes may require years of individualized visual rehabilitation. For most children, surgery is just the first step to rehabilitate the eyes. Ongoing treatment must repair eye-brain connections. This involves teaching the eyes how to focus properly.

Unlike adults with full-sized eyes, children require specialized surgical instrumentation and techniques. When performed by an experienced surgeon, cataract removal is generally safe. The most common risks include glaucoma, retinal detachment, infection and the need for more surgeries.

After surgery, children often need some combination of contact lenses, intraocular lenses implanted in the eye or glasses. If amblyopia has developed, the child may need patching. This treatment involves covering the stronger eye to stimulate vision in the weaker eye.

Foldable vs. Non-foldable Lenses -

In conventional cataract surgery & in SICS (Small Incision suture less Cataract Surgery) a large cut or incision is made in the eye to remove the cataract. This is followed by insertion of a rigid non flexible 6.0/6.5 mm lens through the incision into the eye. These lenses are rarely used these days.
In phacoemulsification the entire operation done through a small hole of 3.0 mm or less. It is not possible to implant a rigid lens. The doctors use very flexible lenses which can be folded and loaded in special injectors and inserted through the small hole into the eye. These are currently the preferred lens to be used.

 

There Are Two Methods Of Cataract Surgery :-

  • Conventional Cataract Surgery By Phacoemulsification

In this technique, incisions are made and the cataract is broken into smaller pieces and aspirated, and then the intraocular lens is implanted. The surgery is done under topical anesthesia, only drops are used.

  • Bladeless Laser Cataract Surgery – Lensx Femtosecond Laser

Cataract surgery is done using this femtosecond laser. It makes -bladeless, laser- made incisions, perfect circular opening and also to break the cataract into smaller pieces. It is followed up with lens removal and intraocular lens implantation. It significantly reduces the risk of complications, makes the surgery simpler, more precise, and gives more predictable visual results and faster recovery.

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