Cataract
What is Cataract?
Cataract is an eye disease that results in the loss of transparency of the natural lens in the eye, resulting in decreased vision. 90% of it occurs due to advancing age. But it can be seen in any age group, including babies. In order for the light and images from outside to reach the visual center clearly, they must first be refracted in the cornea, the outermost transparent layer of the eye, and then in the lens layer inside the eye. Under normal conditions, these two layers are transparent. The lens loses its transparency, becomes opaque, changes color, becomes like frosted glass, and the patient's vision gradually decreases. Cataract is the condition in which the lens in the eye loses its transparency and becomes opaque. It is one of the leading causes of blindness that can be treated in the world.
What are the Causes of Cataract?
Although there is no known cause, there are many risk factors such as nutrition and ultraviolet rays. Depending on the opacity of the lens, patients first complain of distance or near vision impairment.
The most important cause of cataract is old age. Apart from old age, it may develop secondary to eye diseases such as uveitis and glaucoma, as well as trauma, some other eye surgeries, some medications, and diabetes cause cataracts. Factors such as vitamin C deficiency and exposure to ultraviolet rays accelerate the development of cataracts.
Cataract can also be seen in infancy and childhood. The most important factor in congenital cataracts is infections such as rubella that the mother had during pregnancy.
What are the Symptoms of Cataract?
•Gradually decrease in vision
• Sensitivity to light, glare
•Double vision
•Reading difficulty
•Night vision deterioration
• Fading or yellowing in colors
•Surgery is performed when the person's vision complaint arises. There is no need to wait.
•Waiting complicates the surgery.
Treatment of Cataract:
There is no drug treatment for cataracts. The only treatment is surgery. The opaque lens, which lost its transparency with the operation, is removed and the patient can see well again. Before the 1950s, the patients had to use thick (about + 10 size) glasses after the operation, since no lens was placed in the patient's eye after the surgery. Today, a lens is attached to the patient's eye in the surgery, so that he can see far and near clearly with very low-numbered glasses after the surgery.
The name of the method known as laser cataract surgery among the people is phacoemulsification. In this method, the cataract in the eye is ground with the help of a needle working with ultrasonic vibration and removed from the eye. This surgery is called FAKO surgery for short.
In today's developing cataract surgery; Except for special cases, general or local anesthesia is no longer applied. The patient is prepared for surgery only with eye drops that numb the eye and are instilled 4-5 times. The patient should lie on his back calmly for 10-15 minutes.
Phaco surgery begins by making a 2 mm incision on the transparent layer of the eye with a diamond blade and a special gel is injected into the eye. This gel protects the intraocular tissues.
A circular piece is removed from the anterior capsule of the cataract. The hard core at the bottom is crushed with a needle tip working with ultrasonic vibration called phaco and is pulled out of the eye.
After this process, the soft parts between the capsule and the nucleus and the anterior capsule cells are cleaned. In the meantime, utmost care is taken not to damage the lens capsule, which is 50 microns thin. The gel is filled into the capsule, which has completely emptied and turned into a transparent bag.
With the help of a special injector, the collapsible lens is placed inside the eye. Then the gel is washed with serum and cleaned from the inside of the eye. Serum is given to the incision area so that the incision is closed without stitches. The surgery has been completed.
What happens if the cataract is not treated?
•Visual function is impaired or lost at far and near.
• An increase in intraocular pressure may be observed.
• Visual laziness may develop.
• May cause inflammation called uveitis in the eye.
• Since the visual center and retina of the eye cannot be observed in the examination, the diagnosis and treatment of the problems in the eye are difficult.
When Should Cataract Surgery Be Performed?
Cataract surgery can be performed if the blurred vision is at a level that interferes with the patient's daily work (difficulty in reading, difficulty in watching television, difficulty in driving). There is no need to wait for the cataract to mature to have the surgery. The decision for surgery is determined by the ophthalmologist according to the needs of the patient.
What Should Be the Feature of Eyepiece Lenses?
The lenses attached to the eye stay in the eye for life. Therefore, the eye compatibility of the lenses should be at a high level. Lenses should have the feature of preventing the posterior capsule of the lens left in place during the surgery from becoming opaque. If they want a multifocal intraocular lens that shows far and near without glasses, they should definitely tell their doctor. Because many doctors do not use multifocal lenses unless their patient specifically states it, and they can place a standard monofocal lens inside the eye. In this case, patients lose the advantage of seeing up close without glasses. The multifocal lenses we use require a slightly more precise surgery than standard cataract intraocular lenses.
Do Cataracts Occur Again?
Recurrence of cataract is out of the question. The condition known as the recurrence of cataract among the people is the loss of transparency of the posterior capsule of the lens, which is left in place as a support for the lens attached to the eye. If the posterior capsule loses its transparency, it can be treated with a YAG laser capsulotomy in a few minutes.
Is Glasses Used After Surgery?
The number of lenses inserted into the eye is calculated before the surgery, and it is tried to ensure that the patient can see the distance without glasses after the surgery. Patients may need to wear glasses for both near and far, usually after surgery, with a lower number for distance. Postoperative glasses are often given after the first month of the operation. If glasses are given earlier, the number of glasses will change over time.
What is Congenital (Congenital) Cataract?
Congenital cataract is the unilateral or bilateral loss of transparency and opacity of the lens seen from birth. Congenital cataracts can occur due to the infections of the mother during pregnancy, the drugs used, or they can occur without any reason.
Different color (white) of one pupil from the other or a misalignment of the eye (strabismus) may be a sign of congenital cataract. When these symptoms are seen in babies, an ophthalmologist should be consulted without wasting any time. Congenital cataract obstructs vision and should be operated as soon as it is diagnosed, especially if it is unilateral. The ophthalmologist decides on the time of surgery after a detailed examination. The most important problem in congenital cataract eye is lazy eye (amblyopia). In order to overcome lazy eye, surgery should be performed as early as possible in line with the recommendation of the ophthalmologist.
Congenital cataract treatment is performed with the FAKO method, and if the age is appropriate, a foldable lens is placed into the eye. The most important part in the treatment of congenital cataracts is the fight against lazy eye, which will be done after the operation. Collaboration between family physicians is very important in this section. If this cooperation cannot be made, early surgery will be of no use.
After congenital cataract surgery, the child can use glasses and contact lenses depending on whether the lens is placed in the surgery.
Post-Operative Drug Use:
Cortisone and antibiotic drops and nonsteroidal drops are used 4-6 times a day for approximately 3-4 weeks after the surgery. Postoperative controls are performed on the 1st day, 1st week and 1st month (glasses examination).