Cataract is a condition in which the normally clear lens of the eye becomes cloudy and clear change.
Cataract is the opacity of the progressive lens or the lens capsule.
Cataract is a cloudiness in the lens of each state, which can occur due to hydration (addition of liquid), lens protein denaturation, or due to both of them, usually occurs in both eyes and progressive.
Etiology
- Physical
- Chemical
- Elderly
- Disease predisposing
- Genetic and developmental disorders
- Virus infection in the future growth of the fetus.
Classification
Cataracts can be classified according to developmental and degenerative processes by:
1. Congenital Cataracts
Congenital cataract is a cloudiness in the lens that occur during the formation of the lens. Turbidity was there at the time the baby is born. Cataract is often found in infants born to mothers who had rubella, diabetes, toxoplasmosis, hipoparatiroidismo, galactosemia. There are also accompanying congenital abnormalities in the eye itself as microphthalmus, aniridia, coloboma, keratoconus, Ectopia lentis, megalocornea, hetero cornea iris.
Turbidity can be found in the form: hyaloidea persistent artery, anterior polar cataract, posterior, Axialis cataract, zonular cataract, stellate cataract, cataract totalis and congenital totalis membranacea.
2. Primary Cataracts
Primary cataracts by age, there are three groups, namely:
a. Juvenile Cataract (age <20 years)
b. Presenile Cataract (ages up to 50 years)
c. Senile Cataract (age> 50 years)
3. Senile Cataracts
Senile cataract is, all contained lens opacities in the elderly, the age group above 50 years.
Senile cataract is known in four stages, namely:
a. Incipient cataract
An early stage of cataract is clouding the lens is shaped patches of irregular opacities. Clients complain visual disturbances such as seeing double at the sight of one eye. At this stage, the process of degeneration absorb the liquid so that the anterior chamber has a normal depth. Iris in a normal position with mild cloudiness in the lens. Impaired visual acuity has not happened yet.
b. Immature cataract
Lens begins to absorb the liquid, so the lens is slightly convex, causing myopia and iris pushed ahead with a shallow anterior chamber. Anterior chamber angle can be closed so that may arise secondary glaucoma.
c. Mature cataract
An advanced lens degeneration process. At this stage, there was opacification of the lens. Fluid pressure within the lens is in equilibrium with the liquid in the eye so that the lens will return to normal size. Visual acuity had decreased and only a positive light projection.
d. Hypermature cataract
At this stage of the process further degeneration and cortical lens can melt lens, so the lens nucleus immersed in the lens cortex. At this stage, it can also happen that the degeneration of the lens capsule and cortical lens material liquid lenses that can be entered into the anterior chamber. Lens material to occlude the anterior chamber fluid, causing phacolytic glaucoma.
Clinical Manifestations
Cataracts develop slowly and do not cause pain accompanied by visual disturbances that appear gradually. Vision problems can be:
- Difficulty seeing at night.
- See the circle around the light or the light was blinding.
- Decrease in visual acuity (even in daylight).
- Frequently changing glasses.
- Double vision in one eye. Sometimes cataract lens causing swelling and increased pressure within the eye (glaucoma), which can cause pain.
- As there are dark spots in front of eyes.
- Difficult to see objects that are dazzling.
- Color change in the pupil or white.
- Difficult to do the daily work.
- Reading time illumination require brighter light.
- Night vision much less.
- 2. For a while obviously look closely.
Examination Support
- Examination of visual acuity.
- Check is performed to see visual acuity. This examination is conducted by the Snellen card is the card to see the person's visual acuity.
- Slit lamp examination. See all makeup eye front with enlargement. With these tools can see the state of the cornea, manic eyes, black lining, and lenses.
- Tonometry
- Ophtalmoscope
- Ocular examination
Pre Operative Cataract Care
- Retinal function should be good, which is checked by the test beam projection.
- There should be no infection in the eye or surrounding tissue.
- There should be no glaucoma. In the state of glaucoma, retinal blood vessels have been adapted to high IOP. If surgery is performed, at the time the cornea is cut, IOP decreased, blood vessels rupture and cause severe bleeding. Also can cause bulbus oculi prolap of content, such as iris, glass body and lens.
- Check the vision.
- General state must either: no hypertension, no diabetes mellitus (blood glucose <150 mg / dl), no chronic cough and heart disease, such as cardiac decompensation.
- Instruct the patient to bathe and wash before surgery, to reduce the risk of infection.
- Give premedication drugs, and shaving eyelashes, appropriate advice doctor.
Post Operative Cataract Care
- Limit the patient to perform an action that can increase IOP, including: coughing, bending, straining, sneezing, lifting objects weighing> 7.5 kg, was lying beside the surgery.
- Instruct the patient to wear glasses during the day and wear eye protection at night.
- Give eye drops / eye ointment suitable doctor advice.
- Observation of increased IOP is characterized by: severe pain, nausea, vomiting.
- Observe for signs of infection, and advise the patient not to rub the eyes to prevent infection.
- Instruct the patient to wash their hands before administering an ointment / eye drops.
- Observe for signs of bleeding anterior eye chamber is characterized by changes in vision.
- Observation for signs of retinal detachment, which is marked with a black dot seems, an increasing number of floaters or light and loss of part / whole field of view.
