The secondary cataract is the complication after extraction of a cataract which is characterized by secondary closure of area of a back kapsuloreksis with connecting fabric. Clinically the disease is shown by the progressing decrease in visual acuity, deterioration in color perception, violation of dark adaptation, a diplopiya, sight "zatumanivaniye". For confirmation of the diagnosis carry out a vizometriya, biomicroscopy of an eye, ultrasonography, WHOLESALE. In addition perform laboratory diagnostics. Apply the automated system of aspiration irrigation or a method of a laser distsiziya to elimination of clinical symptomatology of a secondary cataract.
Secondary cataract – the most widespread complication of the surgeries which are carried out in connection with all types of a cataract. According to statistical data, the frequency of development fluctuates from 0,5 to 95%. The broad variability of data is caused by use of different surgical techniques, age of patients and existence of associated diseases. Oftalmopatologiya is to the same extent widespread among persons men's and female. Increase in a caption of anti-lenticular antibodies at patients of children's age correlates from 75% risk of formation of a secondary cataract after extraction or a fakoemulsifikation. Data on geographical or seasonal features are absent.
Reasons of a secondary cataract
This disease arises several months later or years after surgical intervention and is shown by fibrous changes of the back capsule of a crystalline lens. Etiopatogenez is studied insufficiently. As the main reasons are considered:
- Fibrosis of the back capsule. Development of fibrosis is preceded by inflammatory processes in surrounding cellulose therefore act as risk factors of developing of a secondary cataract uveit also metabolic frustration (diabetes).
- Migration of hyper plastic epiteliotsit. Excess regeneration of an epithelium after extraction of a cataract is the reason of formation of the spherical cellular Adamyuka-Elshniga conglomerates in an epithelium of the capsule of a crystalline lens.
- Incorrect implantation of IOL. The secondary cataract develops at introduction of perednekamerny IOL, excess of diameter of its optical part (more than 7 mm) or fixings of a lens in a zone of a tsiliarny furrow more often.
Pathogenesis of a disease
Development of a secondary cataract is the cornerstone inflammatory processes which exponentiate synthesis of mediators and promotes their penetration through a gematooftalmichesky barrier. In response to formation of mediators of an inflammation cellular proliferation amplifies. Pro-inflammatory tsitokina and a number of extracellular proteins act as growth factors. Against the background of a pathological current of the postoperative period and the reduced resistance of an organism the increased risk of activation of infectious agents is noted. It involves excessive stimulation of reparative processes and synthesis of connecting fabric in a zone of the back capsule. Fibrous transformation has immunodependent character. Response to synthesis of anti-genes of a crystalline lens is formation of the tkanespetsifichesky immune answer.
According to other pathogenetic theory, formation of a film of a secondary cataract is an adaptation reaction of an eyeball to implantation of an intraocular lens (IOL). At introduction of a lens the system as the organism perceives an implant as a foreign matter is activated monocyte-derived . Subsidence of fibroblast on IOL surface in the subsequent leads to formation of a dense soyedinitelnotkanny cover. Intraoperative injury of an iris stimulates additional transition of pigmentary cages to area of a lens. Components of cages (more a protein) play a role in formation of a prelentalny membrane and turbidity of the back capsule.
The cellular structure of a film and its influence on the clinical course of a disease is the cornerstone of classification. From the morphological point of view in ophthalmology allocate the following forms of a secondary cataract:
- Fibrous. It is characterized by fibrous transformation of the back capsule. In cellular structure of a film soyedinitelnotkanny elements prevail. The fibrous type is diagnosed in the first 3 months from the moment of the beginning of development of pathology.
- Proliferative. At this option of a disease specific cages spheres of Adamyuka-Elshniga, a ring of Zemmerringa come to light that testifies to the long course of a disease (3 and more months).
- Crystalline lens capsule thickening. According to classification, it is separate nosological type as unlike other options the thickening of the capsule is not followed by loss of its transparency. It is diagnosed seldom, the etiology and pathogenesis are not established.
Symptoms of a secondary cataract
The long period the main complaint of patients is the progressing decrease in visual acuity which arose in the postoperative period. After restoration of normal visual acuity the accruing visual dysfunction does not manage to be eliminated by means of classical methods of correction. Violation is shown as at a look afar, and close. Progressing of pathology leads to disorder of dark adaptation, decrease in contrast sensitivity, is more rare to deterioration in color perception (to reduction of brightness of the image before eyes).
Patients note increased fatigue when performing visual work. Astenopichesky complaints are not followed by a pain syndrome. Frequent symptoms of pathology – doubling before eyes, distortion of a form of objects. These manifestations are caused by violation of binocular sight. Emergence of "veil" or "fog" before eyes is characteristic. It is not possible to eliminate symptoms by application of contact lenses or points. Emergence of patches of light, flashes or color auras around a light source is possible. Visual changes from an organ of vision are not noted. The first symptoms develop not earlier than in 3 months after operation.
The long course of a secondary cataract leads to the irreversible loss of sight which is not giving in to classical ways of correction. Intraoperative damage of a cornea not only complicates the course of the main pathology, but also is associated with high probability of development of a disperse syndrome and pigmentary glaucoma. The inflammatory process which is the cornerstone of pathogenesis of a disease often provokes development of a uveit, sklerit, endoftalmit. The proliferative type of a secondary cataract and a thickening of the lenticular capsule stimulate increase in intraocular pressure that is shown by clinic of an oftalmogipertenziya.
Secondary cataract – difficult diagnosed pathology to which detection the complex of tool and laboratory methods of a research is applied. Ophthalmologic inspection includes:
- To Vizometry. The technique allows to define extent of decrease in visual acuity with correction and without it.
- Eye biomicroscopy. The procedure is applied for the purpose of visualization of turbidity of optical environments, degenerate and dystrophic changes of forward department of eyes.
- Ultrasonography of an eye in And - and the V-modes. The method gives the chance to estimate anatomo-physiological features of a structure of an organ of vision, the provision of IOL.
- Optical Coherent Tomography (OCT). The technique is used for additional studying of topography of an eyeball and intra orbital structures. Inspection is shown for identification of pathological changes of the back camera (a dense soyedinitelnotkanny film and a congestion of rings of Zemmerringa, the cellular Adamyuka-Elshniga elements).
Tool diagnostics is informative only at the expressed changes of the capsule of a crystalline lens. Laboratory methods are applied at early stages or to forecasting of risk of development of a nosology. In addition at a secondary cataract it is shown:
- Measurement of level of anti-inflammatory tsitokin. The research is conducted by method of hybridization and immunofluorescence. Definition in serum of blood of the raised caption of tsitokin correlates with weight of an inflammation at a postoperative stage.
- Research of a caption of antibodies to a crystalline lens. Increase of a caption of antibodies in blood or plaintive liquid is associated with high risk of formation of a secondary cataract.
- Cytologic research of a film. Identification of cages of Adamyuka-Elshniga and rings of Zemmerringa is possible not earlier, than in 90 days after primary operational impact, testifies to the long course of a disease.
Treatment of a secondary cataract
Timely medical actions give the chance to completely eliminate clinical displays of pathology and to restore visual functions. Conservative therapy is not developed. The following surgical methods of treatment are applied:
- Laser distsiziya of a secondary cataract. The equipment of a laser kapsulotomiya comes down to drawing small punched openings with the subsequent full removal of soyedinitelnotkanny growths. Surgery is carried out under regionarny anesthesia and does not limit working ability of the patient.
- Removal of a cataract by means of aspiration and irrigational system. The automated bimanualny technique of aspiration irrigation allows to remove a proliferating epithelium of a crystalline lens by formation of two paratsentez in a cornea, introductions of a viskoelastik and mobilization of IOL. In addition implantation of a capsular ring or under an intraocular lens can be carried out.
Forecast and prevention
The forecast at timely diagnosis and treatment of a secondary cataract for life and working capacity favorable. Lack of adequate therapy – the reason of a frequent recurrence, is possible further irreversible loss of visual functions. Surgical prevention comes down to individual approach to the choice of model, material and design of edge of an intraocular lens taking into account anatomo-physiological features of a structure of an eye. Medicamentous preventive measures demand local and oral use of nonsteroid resolvents and glucocorticosteroids in before - and the postoperative period. The modern directions in prevention of a secondary cataract assume use of photodynamic therapy and monoclonal antibodies to crystalline lens epiteliotsita.