The cataract is a disease of an eye at which there is a permanent turbidity of his cornea. The main reasons for development of a cataract are injuries of a cornea, burns chemicals, inflammatory or infectious diseases. It is clinically shown by sharp decrease in visual acuity up to a total blindness, change of color of a cornea. Diagnostics consists in carrying out survey, a vizometriya, tonometriya, biomicroscopy with use of a slot-hole lamp, ultrasonography of an eyeball and KT of orbits. Treatment of a cataract of a cornea only surgical. Apply various options of a keratoplasty or a keratoprotezirovaniye.
The cornea cataract, or leykoma is the disease of a cornea of an eye caused by a trauma or an inflammation which is characterized by sharp decrease in visual acuity and is shown by permanent turbidity of a cornea. The trauma of a forward piece of an organ of vision in ophthalmology makes up to 60% of total number of injuries of eyes. Pathology of a cornea takes the fifth place around the world among the blindness reasons. Even at small pomutneniye of a cornea with peripheral or central localization it is possible to observe essential decrease in sight which leads to an invalidization of able-bodied population. Weight of process, variety of clinical outcomes, difficulties of treatment, difficulty of rehabilitation of patients with a cataract of a cornea give special relevance to this problem. Frequency of occurrence of a leykoma at men and women identical.
Reasons of formation of a cataract of a cornea
Allocate the congenital and acquired cornea cataract forms. The Etiopatogenetichesky factors of the acquired pomutneniye leading to violation of transparency of a cornea are very various. Burns of eyes belong to them (chemical or thermal); the getting cornea wounds; inflammatory diseases of various nature (gerpesvirusny, bacterial); cornea ulcers; recidivous pterigiuma 3-4 degrees (to them false pterigiuma, especially after burns of eyes treat with formation of a simblefaron). Besides, any surgery on an eyeball is risk factor of development of a cataract of a cornea. The congenital form results from pre-natal infection of a fruit with virus agents and is followed by malformations of other bodies and systems.
The pathogenetic mechanism of development of a cataract looks as follows: after influence of a traumatic factor or the infectious agent in a cornea inflammatory process begins to develop, there is stroma hypostasis, and special enzymatic substances and hemoattraktant begin to develop cells of a cornea (keratotsita). Expansion of perikornealny vessels of a limb results. In a zone of damage movement of leukocytes from the blood course begins, inflammatory cellular infiltration in addition becomes more active. At the same time the damaged cages begin to throw out angiogenny factors which stimulate movement and distribution of endotelialny cages of vessels that leads to a neovaskulyarizatsiiya and replacement of the high-differentiated cornea fabric with rough connecting fabric.
Cornea cataract symptoms
The congenital form of a cataract is shown at newborn children in the form of change of transparency of a cornea and often combined with other eye pathology (glaucoma, a cataract, mikroftalmy or a mikrokornea, an iris atrophy). The acquired form of a cataract of a cornea is a final stage of a trauma or infectious process in a cornea therefore complaints of the patient to the ophthalmologist depend on primary disease, on the area of defeat and an arrangement of turbidity of rather optical zone of a cornea. At injuries - it is a pain syndrome, feeling of a foreign matter, . The patient with an inflammatory disease of a cornea shows complaints to decrease in sight, a photophobia, dacryagogue, severe pain. At development of a cataract in an optical zone visual acuity is sharply reduced or completely is absent. If the cataract is localized in a paraoptical zone, visual acuity can remain. The struck cornea becomes milky-white color.
Depending on depth of damage of an eyeball mark out the following categories of a post-traumatic cataract:
- Cornea cataract without involvement of other departments of an eye. Existence of cicatricial changes in a cornea of a different form and extent is noted.
- The cataract soldered to an iris. It is shown by existence of the intensive, vascular turbidity of a cornea spliced with an iris.
- Cataract in combination with a traumatic cataract. Turbidity of a cornea, forward sinekhiya and a cataract of various intensity comes to light.
- Cataract in combination with a secondary cataract.
- Intensive turbidity of a cornea of an eye, forward and/or back sinekhiya, traumatic cataract and turbidity in a vitreous body.
- The cataract complicated by an otsloyka of a retina, development of an atrophy of an eye.
Diagnostics of a cataract of a cornea
The congenital form is diagnosed in maternity hospital for the newborn, after carrying out an oftalmoskopiya. For detection of changes in glubzhelezhashchy environments of an eyeball ultrasonography of an eyeball is carried out, if necessary in addition appoint KT of orbits. Diagnostics of the acquired form of a cataract includes the standard list: collecting the anamnesis at the patient, carrying out external examination, a vizometriya (at localization of turbidity in a paraoptical zone), tonometriya. The biomicroscopy by means of a slot-hole lamp is the main method of diagnostics. With its help the ophthalmologist carefully examines turbidity, defines its borders, density, degree of transparency and the area of distribution. Considering impossibility to examine glubzhelezhashchy structures of an eye, obligatory performing ultrasonography of an eyeball, KT or MPT of orbits is necessary.
Treatment of a cataract of a cornea
Treatment only surgical. Apply a through or layer-by-layer keratoplasty (replacement of an affected area of a cornea with a transplant). At impossibility of carrying out change the keratoprotezirovaniye (replacement of an affected area with an artificial corneal implant) is necessary. Feature of surgeries at congenital pomutneniye of a cornea is the combined nature of intervention that significantly increases injury. Operations are technically difficult because of narrowness of an eye crack, a possible collapse of an eyeball. The possibility of carrying out a keratoplasty at the child depends on the sizes of a cataract, defeat depth, operation are most often carried out aged till 1 year. Forecast of visual functions doubtful.
For restoration of sight in case of the acquired cataract use different types of reconstructive operations (the choice depends on category of a post-traumatic leykoma). At 1 category carry out various options of a partial through keratoplasty. At the 2nd category change of a cornea is supplemented with iridoplastiky. At cataracts 3 categories the complex of surgeries – a through keratoplasty with extraction of a cataract with implantation of an intraocular lens is shown. At cataracts 4 and 5 categories the keratoplasty is ineffective, the only method of treatment – a keratoprotezirovaniye.
During a keratoplasty refer perforation, rejection or bleeding under a transplant to possible complications. Results and the forecast of a keratoplasty of the acquired cataract is defined by all set of clinical circumstances, including a disease etiology, size VGD, existence of neogenic vessels, character and expressiveness of the accompanying pathology.
Prevention of a cataract of a cornea
Actions for prevention of a cataract of a cornea include observance of safety measures on productions, use of means of protection of an organ of vision during the work with chemical agents. At getting injured of an eyeball it is necessary to address as soon as possible the ophthalmologist for first-aid treatment and purpose of the correct treatment. Timely diagnostics and competent medicamentous therapy of inflammatory and infectious diseases of a cornea is an important action in prevention of development of a cataract. Decrease in emergence of congenital forms requires careful inspection of pregnant women on early terms and if necessary - carrying out a course of treatment of viral or bacterial infections.