Secondary cataracts, or clouding of the posterior capsule of the lens - is the most common complication of surgery for the treatment of cataracts; it has been observed since 1950, when it was held the first such operation. Today, for the treatment of cataracts advanced technology, the lens can be removed through a very small incision, artificial lenses are made of higher quality materials and design for decades, greatly improved, but the secondary cataract remains an important issue. Secondary cataract develops in 20-40% of patients within two to five years after surgery. This complication is more common among children, and less common in elderly patients.

Symptoms of secondary cataract

The main symptom of secondary cataract is blurred vision after surgery to remove the lens of the eye so that the patient can seem that he had again developed cataracts. Usually vision deteriorates gradually; often patients see halos around lights, as is the case in conventional cataract. If you have such symptoms as soon as possible consult an ophthalmologist.

Causes of secondary cataract

The primary cause of secondary cataracts, apparently are the lens epithelial cells that may remain after operation outside the lens capsule. Their proliferation or migration can lead to a cataract. It is supposed that the cataract surgery Cataract surgery - surgery   It leads to the fact that the remaining cells of the lens epithelium begin to actively proliferate, migrate, and ultimately leads to poor vision.

In children, the probability of occurrence of this complication is, according to various estimates, from 43.7% to almost one hundred per cent - believed to be due to the fact that the probability of proliferation of epithelial cells have especially high.

In patients with diabetes secondary cataract Cataracts - how to solve the problem completely?   also develops more likely than other patients, and often occurs in more serious forms. In addition, secondary cataracts occur frequently average patients with retinitis pigmentosa (a rare genetic disorder in which there is a slow retinal tissue destruction) and traumatic cataract. When the probability of traumatic cataract lens PCO within three years after surgery was 92%.

In addition, the risk of secondary cataracts depends upon the type of surgery has been used for removal of the lens, and the design of an intraocular lens, and the material from which it is made. As a rule, the less invasive operation was, the less chance of complications. Doctors always try to prescribe the most benign methods of surgical treatment, but unfortunately, they are not always sufficiently effective.

Treatment of secondary cataract

At present, for the treatment of secondary cataract used procedure called laser distsiziya. This method was developed by a woman who, before becoming an ophthalmologist for a long time, studied physics and interested in the possibility of application of laser in medicine. The tests of the new method began in 1978, and in 1980 held the first laser distsiziya secondary cataract. This operation quickly gained popularity as an alternative to it was much more invasive procedure often causes serious complications.

Distsiziya PCO imposed if:

• Clouding of the posterior capsule of the lens leads to a significant decrease in visual acuity;
• Because of poor vision in reduced patient quality of life;
• There are problems with vision in bright light and / or in the dark.

Contraindications to surgery are:

• Swelling, or scar tissue in the cornea, because of which the surgeon can not see well intraocular structures during the operation;
• Inflammation of the iris;
• Macular edema of the retina.

The operation should be carried out with extreme caution if the patient has previously been delamination or tearing of the retina.

Treatment of secondary cataract laser performed using local anesthesia. As a rule, the procedure does not cause patients significant discomfort.

Before the operation is applied to the cornea of ​​eye drops that extend the pupils, such as tropicamide 1.0%, phenylephrine 2, 5%, or 1-2% cyclopentolate - through dilated pupil surgeon can better see the posterior capsule of the lens. In order to prevent a sharp increase in intraocular pressure after surgery may be used apraclonidine 0.5%.

The patient can go home after a couple of hours after surgery - if you do not have any complications, which is unlikely. No stitches or bandages after laser distsizii usually do not impose. Patients prescribed eye drops with steroids, which must be used to prevent inflammation. A week after the operation the patient should be examined by an ophthalmologist to make sure that the treatment is successful. Another survey is recommended to take a month later - it is considered optional, but it is desirable to take place in time to detect possible complications. However, most complications, if they occur, then in the first days after surgery.

In most cases, PCO successfully treated in a single procedure; secondary laser distsiziya required only in rare cases.

Complications

Laser distsiziya can lead to the following complications:

• Increased intraocular pressure;
• Rupture and retinal detachment Retinal detachment - when the leaves sight ;
• Macular edema of the retina;
• Corneal edema;
• Inflammation of the cornea;
• The displacement of the intraocular lens.

Apraclonidine use significantly reduces the risk of elevated intraocular pressure. Inflammation of the cornea usually clears up on its own, but can also speed up the recovery by using topical steroids such as prednisolone acetate Prednisolone - against inflammation, allergy and pain, but with complications   or loteprednol.

Infective conjunctivitis can have different origins: bacterial, viral, fungal. A special kind of conjunctivitis caused by Chlamydia (microorganisms, occupies an intermediate position between the bacteria and viruses), it paratrahoma and trachoma. All these types of conjunctivitis require the appointment of a different treatment.

Infective conjunctivitis bacterial origin

For bacterial conjunctivitis include staphylococcal, pneumococcal, streptococcal, gonococcal, Proteaceae, Pseudomonas and other conjunctivitis caused by pathogenic and opportunistic bacteria.

Infection occurs by contact. The source of infection is usually a person with conjunctivitis or objects, which he enjoyed. Most bacterial conjunctivitis occur against a background of small injuries of the conjunctiva caused by, for example, contact lenses Contact lenses - whether they can completely replace the glasses? .

Bacterial conjunctivitis may be as purulent or pus. Especially dangerous conjunctivitis, caused by Pseudomonas aeruginosa and gonococcus, they can lead to the defeat of the cornea, a partial or complete loss of vision. The remaining bacterial conjunctivitis usually respond well to treatment with modern antibacterial drugs and prevent complications.

Infective conjunctivitis chlamydial origin

Chlamydia - a bacteria that occupy an intermediate position between the bacteria and viruses. Yet modern science refers them to the bacteria. Chlamydia, viruses penetrate the tissue cells and proliferate there, but as the bacteria have a cell wall, therefore are sensitive to antibiotics Antibiotics - whether they will help you in the foreseeable future? .

There are several serotypes (subtypes) of chlamydia Chlamydia: insidious and widespread disease . Chlamydia serotypes A - C cause trachoma, and serotype D - K - paratrahomu. Trachoma - a severe chronic damage the cornea and conjunctiva, which may end in complete blindness due to degeneration of rumen eye tissue. Trachoma - a lot of countries with a low standard of living and an undeveloped culture. In our country, it is eliminated.

Paratrahoma or chlamydial conjunctivitis - a less dangerous disease, but it is fairly widespread. Paratrahoma caused by the same serotypes of Chlamydia that sexual infections, so the infection occurs mainly by transferring the infection to the genitals to the eyes through dirty hands. The incubation period is one to two weeks, after which there are signs of acute conjunctivitis in the form of redness and swelling of the conjunctiva and eyelids transition folds, the emergence of large follicles (vesicles), arranged in rows at the bottom of the crease. These follicles may merge, forming a horizontally disposed rollers. It appears initially slight and then profuse mucopurulent and purulent discharge. Later follicles and rollers completely resolve without scarring. Sometimes the process takes initially subacute or chronic.

Treatment of infectious conjunctivitis caused by chlamydia, - local, appointed antibiotics, which are sensitive chlamydia.

Infective conjunctivitis viral origin

Viral conjunctivitis can be caused by different viruses, including influenza virus. But more often found today adenoviral conjunctivitis and conjunctivitis caused by herpes simplex virus Herpes simplex - in fact, not so simple .

Adenoviral conjunctivitis is caused by viruses, which are viruses that cause acute respiratory viral infections - SARS. conjunctivitis can proceed against SARS, or independently. Adenoviral infection is transmitted mainly by airborne droplets from an infected person to a healthy. But there are also the contact (dirty hands and objects) and nutritional (through food) ways of infection.

The incubation period is 4-8 days. Onset acute affected one eye, and a few days later a second, and in a milder form. There are lacrimation, photophobia, redness and swelling of the conjunctiva and eyelids. On the conjunctiva can appear petechial hemorrhages. Infectious conjunctivitis in children caused by adenoviruses often have a film character. Discharge is usually scant and purulent. At the bottom of transitional fold often appear small follicles. Most adenovirus causes corneal lesions. But some subspecies may spread to the cornea, causing keratitis. The latter usually finishes favorably without scarring and reduced vision.

Treatment of adenoviral conjunctivitis held antiviral and immune-stimulating drugs for topical application. For example, in the eyes instilled solution can Poludan 1-2 drops 6-8 times daily. As the inflammation subsided number instillation cut to 3-4 times a day.

Infective conjunctivitis requires clarification of diagnosis and proper treatment.

Galina Romanenko