Cataract treatment
Cataract
Cataract - the refracting part of the eye - is a pathology related to the gem, in which the transparency of the gem is disturbed and cloudy. Cataracts are characterized by blurred vision, decreased night vision, decreased color vision, increased sensitivity to light, and diplopia..
Visometry, perimetry, ophthalmoscopy, biomicroscopy, tonometry, refractometry, ophthalmometry, eye UTT (UZI) examination, electrophysiological examinations are used in the field of ophthalmology to determine cataract. In the treatment of cataract, conservative and operative methods are used, the surgical procedure consists of replacing the eyeball, that is, placing an artificial intraocular lens.
Cataract (from the Greek word katarrahaktes - waterfall) is a partial or complete clouding of the eyeball, a disease manifested by a decrease in the ability of the eye to transmit light and visual acuity. According to WHO statistics, almost half of the causes of blindness are cataracts. Cataract occurs in 15% of the population in people aged 50-60, in 26-46% in people aged 70-80, and in almost all people older than 80. Cataract is the most common congenital eye disease. The high prevalence of the disease proves to be one of the urgent problems of the field of modern ophthalmology.
About the paearl of the eye
The pupil is the light-transmitting part of the eye (transmitting and refracting light), located behind the iris, opposite the pupil. Pearly capsule, capsular epithelium and pearly substance. The external structure of the gem is spherical, its diameter is 9-10 mm. The eyeball is an epithelial formation that is not supplied with blood vessels. Nutrients diffuse through the intraocular fluid that surrounds the gem.
According to the optical properties of the gem, it is like a biconvex transparent lens, and its function is to refract the incident light and collect it on the retina. The light refraction property is not constant and depends on the accommodation property of the eye (at rest - 19.11 dptr, in a strained state - 33.06 dptr).
Any changes in the gem - change in shape, thickness, condition, lead to a violation of its function. Pearl anomalies include aphakia (absence of pearl, microphakia (small size), coloboma (absence of a part and its deformation), lenticonus (bulging of its surface in the form of a cone), cataract. Cataracts can develop in any layer of the eyeball.
Causes of cataracts
Although there are several theories on the etiology of cataract and the mechanism of its development, none of them can prove the exact cause of the development of the disease. One of the most common theories in the field of ophthalmology is free radical oxidation, the formation and accumulation of free radicals in the body - molecules with an unstable unpaired electron - causing strong oxidation..
Peroxide degradation of lipids and increase of unsaturated fatty acids lead to aging and diabetic cataracts, glaucoma, cirrhosis of the liver, hepatitis, circulatory disorders in the brain. The formation of free radicals in the body occurs as a result of harmful habits and poisoning with ultraviolet rays..
Another important factor in the mechanism of cataract development is the decrease in the antioxidant properties of the body with age, lack of vitamins (vitamin A, E, etc.). In addition, changes in the physico-chemical composition of the eyeball protein are observed in older people.
As a result of inflammatory diseases of the eye, changes in the composition of the intraocular fluid, insufficient passage of nutrients to the gem, ciliary body dysfunction (Fuchs' syndrome), terminal glaucoma, pigmentary degeneration and retinal detachment are also involved in the development of cataracts. is important.
In addition to the aging factor, chronic infectious diseases, such as typhus, malaria, chicken pox, etc., starvation, anemia, intense radiation (insolation), radiation exposure, toxic poisoning (mercury, thallium, naphthalene) also play a significant role in the development of cataracts. ) can also cause cataracts.
Risk factors leading to the development of cataracts include pathologies of the endocrine system (diabetes, tetany, muscular dystrophy, adipozogenital syndrome), Down's disease, skin diseases (scleroderma, eczema, neurodermatitis, Jacob's poikiloderma)..
Cataracts that develop as a result of complications are often caused by trauma to the eyeball, burns, eye surgery, family history of cataracts, severe myopia, and uveitis..
Congenital cataracts in most cases are caused by toxic effects during the embryonic visual system formation. Congenital cataracts can be caused by infectious diseases during pregnancy (influenza, rubella, measles, toxoplasmosis), taking corticosteroids, etc..
Cataract classification:
In the field of ophthalmology, cataract disease is divided into two large groups: congenital and acquired. Congenital cataract occurs only in a certain part of the eye, and the disease does not progress. Acquired cataract is accompanied by an exacerbation of the process.
Based on the etiology of acquired cataract, cataracts developed as a result of old age, complicated, teumatic, as a result of radiation, toxic and other diseases of the general body are distinguished..
According to the tarnished part of the gem
Katarakta rivojlanish bosqichlari.
Katarakta rivojlanishida 4 bosqich farqlanadi:
Kataraktaning boshlang'ich bosqichida gavharning ma'lum bir qismida suvlanish kuzatiladi, ya'ni mag'iz qismi tolalari orasida ortiqcha suyuqlik to'planadi va bu “suvli tirqish” deb nomlanadi. Xiralashuv odatda gavharning qobig'ida joylashadi, ya'ni periferik qismida paydo bo'lganligi sababli ko'ruv o'tkirligi bilan bog'liq muammolar kuzatilmaydi.
Yetilmagan katarakta bosqichida xiralashuv kuchayib boradi va sekin-astalik bilan gavhar optik qismigacha yetib boradi. Biomikroskopik tekshiruvlar yordamida gavhar xiralashganligi aniqlanadi. Bu bosqichda ko'ruv o'tkirligi biroz pasayadi.
Katarakta diagnostikasi
Katarakta kasalligi oftalmologlar tomonidan aniqlanadi, bunda ular bir qator standart tekshiruvlarni amalga oshirishlar kerak bo'ladi.
Yuqoridagi tekshiruvlar yordamida kataraktaga xos bo'lgan quyidagi o'zgarishlar aniqlanadi: ko'ruv o'tkirligining pasayganligi, yorug'likni qabul qilishdagi o'zgarishlar, qorachiqdagi dog', gavhar dislokatsiyasi va boshqalar.
Kataraktani aniqlashning maxsus usullariga refraktometriya, oftalmometriya, ko'z UT-skanerlash tekshiruv kabilar kiradi. To'r parda funksional holati, ko'ruv nervi va ko'ruv analizatorining markaziy qismi holatini aniqlash uchun elektrofiziologik tekshiruvlardan foydalaniladi (elektrookulografiya (EOG), elektroretinografiya (ERG).
Katarakta davosi
Qarilik kataraktasining boshlang'ich bosqichlarida konservativ davo muolajalari olib boriladi, ya'ni ko'zga tomiziladigan tomchilar ko'rinishida preparatlar buyuriladi (azapentasen, pirenoksin, sitoxrom C, taurin va boshqalar). Bu muolajalar katarakta rivojlanishini to'liq to'xtatmaydi, shunchaki jarayonni sekinlashtiradi.
Bunday muolajalarning asosida yetishmayotgan moddalar o'rnini to'ldirish yotadi, ya'ni aminokislotalar, vitaminlar (riboflavin, nikotin kislota, askorbin kislota), antioksidantlar, kaliy yodid, ATF va boshqa moddalar tomchilar tarkibiga kiritilgan bo'ladi.
Kataraktani davolashda konservativ davo muolajalari samaradorligi ancha past hisoblanadi. Shu sababli mikrojarrohlik usuli bilan kataraktani bartaraf etish keng tarqalgan. Bunda gavharning xiralashgan qismi o'rniga sun'iy linzalar joylashtiriladi.
Operatsiyaga ko'rsatmalar
Operativ muolajaga ko'rsatmalar quyidagilar:
Shishli katarakta, yetilib o'tgan katarakta, gavharning o'z o'rnidan siljishi, ikkilamchi glaukomaning rivojlanishi, ko'z tubidagi yondosh kasalliklar (diabetik retionopatiya, to'r pardaning ko'chishi). Ikki tomonlama katarakta davosida avvalo ko'rish o'tkirligi pastroq bo'lgan tarafda operatiya jarayoni o'tkaziladi.
Zamonaviy oftalmoxirurgiyada gavhardagi dog' bir necha usul bilan bartaraf etiladi: ekstrakapsulyar va intrakapsulyar katarakta ekstraksiyasi, ultratovush va lazer yordamida fakoemulsifikatsiya o'tkazish.
Ekstrakapsulyar katarakta ekstraksiyasi usulida gavhar yadrosi va gavharsimon modda olib tashlanadi. Bunda gavharning orqa kapsulasi ko'zda qoladi, oldingi va orqa qismlar orasida kesishma hosil bo'ladi. Intrakapsulyar katarakta ekstraksiyasi gavhar kapsulasi bilan birgalikda olib tashlanadi. Har ikkala usul ham, jarohatli hisoblanadi va bunda ko'z olmasiga choklar tushadi.
Ultratovushli fakoemulsifikatsiya usulida ko'z oldingi kamerasi 3 mm kesiladi va asbob uchi kiritiladi. Fakoemulsifikator asbobi yordamida gavhar emulsiya holatiga keltiriladi va ko'zdan aspiratsiya (so'rib olinadi) qilinadi. Lazer yordamida gavharni olib tashlash ham yuqoridagi kabi amalga oshiriladi, farqli jihati shundagi bunda ultratovushlar o'rniga lazerdan foydalaniladi.
Katarakta oqibati va profilaktikasi
Zamonaviy oftalmologiya sohasida olib borilayotgan yangi usullar yordamida amalga oshiriladigan jarrohlik amaliyotlari xavfsiz bo'lsada, 1-1,5 % bemorlarda operatsiyadan so'ng ayrim asoratlar rivojlanishi mumkin, masalan uveit, iridotsiklit, ko'z ichi bosimi oshishi, ko'z oldingi kamerasiga qon quyilishi, to'r parda ko'chishi, ikkilamchi katarakta.
Tug'ma katarakta oqibati salbiy hisoblanadi, chunki bunday holatda nafaqat ko'z gavhari balki ko'ruv nervi, retseptorlarda ham o'zgarishlar ro'y bergan bo'ladi. Orttirilgan katarakta jarrohlik amaliyoti bilan bartaraf etilsa, inson ko'rish qobiliyati saqlanib qoladi va mehnat faoliyati ham qayta tiklanadi.
Tug'ma katarakta profilaktikasi homiladorlik vaqtida turli xil infeksion kasalliklarni davolash, radiatsion ta'sirlarga duchor bo'lmaslik kabi chora tadbirlarni o'z ichiga oladi. Orttirilgan katarakta profilaktikasida esa antioksidant moddalarni yetarlicha qabul qilish, oftalmologik patologiyalarni o'z vaqtida davolash, ko'z jarohatlanishini oldini olish hamda yil davomida kamida 1 marotaba oftalmologik tekshiruvlardan o'tib turish kabilardan iboratdir.
