Currently, the cost of cataract surgery in Shenzhen (surgery + domestic or imported lenses + three days of hospitalization + preoperative examination + medication) ranges from more than 4,000 to more than 6,000 (single eye). The price The fluctuations are mainly related to the different crystals chosen. Prices vary from region to region, so you'd better ask your local hospital.
I wish the old man a speedy recovery!
Current cataract surgery involves lens replacement, which is much simpler and safer than surgery in the traditional sense. As long as the elderly are in good health and have no contraindications to surgery such as high blood pressure, high blood sugar, or high blood lipids, surgery can be performed. A surgical course only takes seven or eight minutes.
There are no special dietary taboos after cataract surgery, and there is no special restriction on the patient’s activities or daily life. However, the patient should wear an eye mask for several days, and be careful not to accidentally injure the eyeballs during exercise, work, or playing with children. . After the operation, take eye drops and oral medications as directed, and return to the ophthalmology clinic for examination. Generally, your vision will gradually improve soon. If necessary, you can wear reading glasses to facilitate reading. If you experience sudden loss of vision, eye pain, or accidental injury, you need to return to our hospital for examination immediately
1. What is cataract?
Cataract is when the lens in the eye changes from transparent to opaque, blocking light from entering the eye, thus affecting vision. The initial turbidity has little effect on vision, and then gradually worsens, significantly affecting vision and even causing blindness.
Cataract is the leading cause of blindness worldwide. Currently, approximately 20 million people in the world are blinded by cataract, and another 100 million cataract patients require surgery to restore vision. In most cases, Cataracts account for at least half of the blind people in African and Asian countries. According to the results of our country's survey, cataract is also the most important eye disease causing blindness in our country.
There are many causes of cataracts: some are congenital cataracts (more common in children), eye trauma can also cause cataracts, and certain medical diseases can also cause cataracts. Such as: diabetes, nephritis, etc., as well as concurrent cataracts, but most cases and patients are related to old age. The incidence rate of senile cataract is 60-70% among those aged 50-60 years old, 80% among those over 70 years old, and almost 100% among those over 80 years old.
As the average life expectancy of the world’s people increases, the number of cataract patients will continue to increase. The most effective way to treat cataracts is surgery. Surgical treatment can successfully restore vision in the vast majority of patients.
2. What are the structure and functions of the lens?
The normal lens is an elastic, avascular, transparent body, shaped like an oblate biconvex lens. It is located behind the iris and pupil and in front of the vitreous body. It relies on the lens suspensory ligament to communicate with the ciliary body to fix its position.
The organizational structure of the lens is like a peach in the fruit, divided into three parts:
(1) The outer surface of the lens is wrapped by a transparent and elastic film, which we call It is the lens capsule layer (equivalent to the skin of a peach).
(2) The center is the nuclear layer of the lens (equivalent to the core of a peach), located in the central part of the lens. As age increases, the nuclear layer will gradually increase in size, become harder, and the transparency will also decrease. .
(3) The tissue between the lens capsule layer and the nuclear layer is called the lens cortex (equivalent to the flesh of a peach).
The lens is one of the important refractive structures of the eyeball. Its main function is to adjust the eyes to see clearly distant and near objects at various distances. This process relies on the elasticity of the lens and the ciliary body. This is achieved by contraction and relaxation and relaxation and tension of the zonular ligament of the lens, which we call the accommodation function. As age increases, the elasticity of the lens capsule decreases, the lens nucleus enlarges and hardens, the ciliary muscles weaken, and the adjustment power decreases, leading to presbyopia.
3. What are the causes of cataracts?
There are many causes of cataracts. In addition to obvious causes such as traumatic cataracts, radiation cataracts, congenital cataracts, and diabetic cataracts, the formation process of cataracts may be caused by many factors. Quite complex.
The pathogenesis of common senile cataracts has not been fully revealed so far, and may be related to aging, long-term overexposure to ultraviolet rays, genetic factors, malnutrition, etc. Surveys in our country have confirmed that the incidence of cataracts is relatively higher in plateau areas and areas with more sunlight radiation. This is because long-term exposure to sunlight and ultraviolet rays can affect the oxidation-reduction process of the lens, causing the lens protein to denature and become cloudy to form cataracts. In addition, common clinical diabetes, galactosemia, hypothyroidism, etc. can also cause cataracts.
4. Are there any dangers in severe cataracts without surgery?
There is no doubt that surgery is the best way to treat cataracts, but it does not require immediate surgery if you have cataracts. The best time for cataract surgery has been mentioned above, but there are still some people who think that cataracts should not be performed until they are ripe. It’s okay to have surgery, isn’t it just invisible? Little do you know that this view is very wrong and dangerous. Because, during the development of cataracts, if not treated in time, many serious complications will occur, such as glaucoma, uveitis, etc. These eye diseases mostly occur in the middle and late stages of cataracts, such as the expansion stage and overmature stage. Not only It can cause blindness, and sometimes it can cause severe inflammation in the eye, leading to eyeball atrophy; some patients may have unbearable long-term eye pain, and finally have to have their eyeballs removed. Therefore, this reminds everyone that surgical treatment is necessary when cataracts develop to a certain extent.
5. What are the commonly used surgical methods for cataract?
According to the integrity of the lens capsule when the lens is extracted, it is divided into two categories: intracapsular and extracapsular extraction.
Intracapsular cataract extraction and traditional extracapsular cataract extraction are a thing of the past. For many years, extracapsular enucleation was performed with fine manipulation using an operating microscope. With the popularization of microsurgery and the improvement of technology, modern extracapsular cataract extraction combined with human lens implantation has become the most widely used surgical method. The surgical operation requirements are relatively easy, it is safe, there are few complications, and the effect of restoring vision after surgery is good.
In recent years, phacoemulsification and aspiration of cataract with small incisions have been carried out. There is no need to suture the postoperative wound, the wound heals quickly, there is less postoperative astigmatism, and the vision recovers quickly.
6. Is extracapsular cataract extraction or phacoemulsification better?
Phacoemulsification surgery is developed on the basis of modern extracapsular cataract surgery. The surgery uses a phacoemulsification machine to crush and aspirate the lens nucleus and cortex through a corneal or scleral incision of about 3 mm, preserving the posterior lens capsule so that a posterior chamber intraocular lens can be implanted. Its significant advantages are that the surgical incision is small, only 2.8-5.5 mm, the postoperative incision heals quickly, and the corneal astigmatism is small. Satisfactory vision can be obtained at an early stage, and the operation can be performed on an outpatient basis without hospitalization. Disadvantages are: high cost, dependence on machines, complex and difficult surgery, and easy to cause permanent damage if complications occur.
Modern microscopic extracapsular cataract surgery is a mature and effective cataract surgery method. The surgery requires a larger surgical incision, and the postoperative corneal astigmatism is larger, and it takes two weeks to reach a higher level. vision, but this surgical method has been mastered by a considerable number of ophthalmologists, the cost is low, no special machinery is required, the effect of restoring vision after surgery is good, and the incidence of complications is low, so regardless of phacoemulsification cataract surgery or modern cataract sac surgery External cataract extraction is an ideal cataract surgery method as long as you understand the indications and master the surgical procedures.
We believe that extracapsular cataract extraction is still advocated in the relatively poor rural areas of my country. After surgery, a larger power convex lens (hyperopia) is required to correct vision, which is the most economical.
7. Can cataracts also cause sudden vision loss?
The general symptom of cataract is gradual loss of vision and eventually blindness, with no symptoms such as eye pain during the whole process. If the patient suddenly feels a significant decrease in vision without pain, he should consider that there may be fundus disease, such as fundus hemorrhage, optic nerve papillopathy or retinal detachment, etc. He must see an ophthalmologist immediately to avoid mistaking it for cataracts.
During the development of senile cortical cataracts, there is a process called the expansion period in medicine. During this period, more water accumulates in the lens, causing it to swell rapidly, increase in size, and make the anterior chamber shallow. At this time, the patient You may feel that your vision is declining at an accelerated rate. Some patients may experience glaucoma due to high intraocular pressure due to lens expansion and shallowing of the anterior chamber. Patients may experience red eyes, eye pain, systemic symptoms such as headache, nausea, and vomiting, and a sharp decline in vision. Even loss of light perception. If this kind of glaucoma is not treated in time, it will cause permanent blindness. Even cataract surgery cannot save vision.
8. Is there an age limit for cataract surgery?
As China enters an aging society and due to the improvement of living standards, more and more elderly people need cataract surgery. There is no medically set maximum age limit for cataract surgery. Some family members of patients believe that people over 90 years old are at great risk and cannot undergo surgery. In fact, this is not the case. Some elderly people are in good physical condition, with stable blood pressure and heart condition. Moreover, eye anesthesia (topic anesthesia) is mostly used for cataract surgery, which is very painful, so they can withstand the surgery. Currently, the highest age for cataract surgery at Beijing Tongren Hospital is 103 years old. Therefore, the ability to withstand cataract surgery does not depend on age but on the patient's physical condition.
9. What examinations should be done before cataract surgery?
Cataract surgery is a sophisticated ophthalmic surgery. In order to ensure the effectiveness of the surgery, adequate preoperative examination is required. The pre-cataract surgery examination is divided into two parts: eye examination and general examination. Eye examinations generally include vision, visual function, intraocular pressure and tear ducts, corneal curvature, A-ultrasound and B-ultrasound. The corneal curvature and A-ultrasound examination are used to calculate the power of the intraocular lens to be implanted during the operation. Systemic examination generally includes hematuria, liver and kidney function, anti-inflammatory, blood sugar and other tests, as well as internal medical examinations such as blood pressure and electrocardiogram. The purpose is to understand the patient's general condition, whether there is high blood pressure, diabetes and the extent of the disease, as well as cardiac function. , whether they are competent for cataract surgery. If necessary, perform neurosurgery examination as needed to understand the condition of cerebral blood vessels.
10. Can patients with heart disease undergo cataract surgery?
Senior cataract patients, because they are older, have varying degrees of decline in various internal organs of the body, and poor heart function is also common clinically. Whether elderly patients with heart disease can undergo cataract surgery depends on the severity of the heart disease and the condition of their heart function. Cataract surgery is a common microsurgery in ophthalmology. It is performed under local anesthesia. The operation time is short and has little impact on the function of systemic organs. Generally, patients with heart disease can tolerate cataract surgery, but the following points still need to be paid attention to during the operation. Points:
(1) A comprehensive and detailed body examination should be conducted before surgery, fully estimate the possible situations that may occur during the surgery, prepare first-aid drugs and rescue equipment, formulate first-aid measures, and consult a cardiologist if necessary Cooperate with monitoring the patient's cardiac function to ensure that the operation can be completed safely and smoothly.
(2) Do a good job of ideological work before surgery to help the patient eliminate tension. Give an appropriate amount of sedatives, such as diazepam, luminal, etc., the night before and on the day of surgery.
(3) Sufficient anesthesia should be provided during cataract surgery to reduce pain. When compressing the eyeball to reduce intraocular pressure, or when fixing the eyeball and stretching the eye muscles, the movements should be gentle to avoid the cardio-glacial reflex that slows down the heart rate. or sudden stop. The surgical method should be simple and effective, and the operation time should be shortened as much as possible.
(4) Do not rest on your back for a long time after surgery. You should adopt a semi-recumbent position, get out of bed appropriately, eat more fruits and vegetables, and keep your bowel movements smooth.
11. What preparations should patients make before cataract surgery?
Preparation before cataract surgery is very important. In addition to cooperating with the doctor to conduct a series of eye and body examinations, you must also make physical and mental adjustments. Cataract surgery is a sight-restoring operation, and most of the results are very good. However, due to individual differences between people, there may be some complications. Therefore, as a patient's family, you must fully understand the intraoperative and postoperative complications and possible abnormalities. , cooperate with the doctor for treatment.
Before surgery, patients should also pay attention to rest, adjust their diet, quit smoking, and stop drinking. Patients with systemic diseases should adjust their blood pressure, blood sugar, cardiovascular and cerebrovascular indicators to optimal conditions under the guidance of a physician. Antibiotic eye drops are routinely prescribed before surgery. Except for children who are prohibited from eating or drinking anything 8 hours before general anesthesia surgery, cataract surgery patients can eat normally before surgery, but do not overeat.
12. What is an intraocular lens?
From the meaning of the word intraocular lens, we have already seen that as the name suggests, a special lens made of artificial synthetic materials is called an intraocular lens. Its ingredients include silicone, polyformaldehyde acrylic nails, and hydrogel. wait. The shape and function of the intraocular lens are similar to the lens of the human eye. It is light in weight, has high optical performance, is non-antigenic, inflammatory, carcinogenic and biodegradable. After cataract surgery, the turbid lens is removed, and an artificial lens is implanted into the eye to replace the original lens, so that external objects can be focused and imaged on the retina, and the surrounding scenery can be seen clearly.
13. Which intraocular lens is the “best”?
Cataract patients all want to choose the "best" intraocular lens before surgery, and even think that the most expensive intraocular lens is the best. I am afraid that choosing the wrong lens will affect their postoperative vision. This worry is completely Unnecessary. We already know that the artificial lens implanted into the eyeball replaces the function of the original lens, focusing the image at the original position, allowing the eye to see objects clearly. Therefore, whether it is a domestic intraocular lens or an imported intraocular lens, as long as the material used to make the intraocular lens is non-toxic, the workmanship is sophisticated, and the disinfection is strict, the effect after implantation in the eye will be the same. Moreover, at present, the raw materials, production equipment and processes of domestic intraocular lenses are basically the same as those of foreign manufacturers, and the price is much cheaper than imported intraocular lenses. Therefore, under the premise of ensuring quality, domestic intraocular lenses and imported intraocular lenses can be used in cataract surgery. The effect of restoring vision is the same, and the most expensive one is not necessarily the best.
14. What are the characteristics of intraocular lens implantation for cataract treatment?
The intraocular lens is equivalent to a 9D-12D convex lens in the human eye. If the patient has no refractive error before surgery (neither nearsightedness nor farsightedness, etc.), the cataract surgeon will remove the lens, and the operated eye will be in High hyperopia needs to be corrected by wearing a convex lens of equal power. This kind of "high hyperopia" is unsightly, inconvenient, has poor visual quality, and makes the patient feel uncomfortable. However, intraocular lenses can do the following: (1) Replace the function of the normal human eye lens at an anatomical position. (2) Implanting an intraocular lens after cataract surgery in one eye solves the problem in the past that the eyesight in the other eye was better due to cataract surgery in one eye, and the operated eye was unable to wear corrective glasses after surgery, so the vision still did not improve significantly, and at the same time, the parallax band in both eyes was reduced. Discomfort may occur, such as dizziness, nausea, and sometimes double vision. (3) Intraocular lens does not have the disadvantages of visual distortion, annular scotoma, and reduced visual field caused by aphakia.
15. What is posterior cataract?
After extracapsular cataract extraction or lens trauma, the lens cortex cannot be completely absorbed, and the remaining remaining part becomes secondary opaque and mixed with the remaining capsule of the lens to form an opaque layer of organization. membrane, or due to the proliferation of epithelial cells, the formation of transparent pearl-like bodies, which seriously affects vision, is called after-onset cataract, or post-onset cataract for short.
16. What is the cause of post-laser cataract treatment?
Usually what we call laser cataract treatment refers to cataract incision using YAG laser. Due to residual lens cortex after extracapsular cataract extraction or traumatic cataract, regeneration of epithelial cells under the anterior lens capsule, combined with surgical reaction and inflammatory reaction, forms an opaque film with the posterior lens capsule, seriously affecting vision. In this case, the high energy of the YAG laser is used to open the center of the posterior barrier to reveal a transparent area in the center of the pupil area, which is equivalent to the visual axis of the human eye, and the patient's vision will immediately improve. If it is a very hard organic membrane, the YAG laser cannot cut it, and the posterior hair loss can only be cut off through surgery. The advantages of YAG laser treatment for posterior hair loss are: safe and reliable, easy to operate, the patient has no pain, and the vision can be restored. "Instant results".
17. How does congenital cataract occur?
Congenital cataract is a common eye disease in infants and young children. Partial or complete opacity of the lens that occurs in the first year after birth is called congenital cataract; it is divided into two groups: the first group is the cataract that is present at birth, which is called congenital cataract; the second group is the cataract that is present a few weeks or several days after birth. Cataracts that occur in the first month of life are called infantile cataracts. There are basically two reasons for lens growth and development disorders: ① Endogenous factors: refers to chromosomal gene mutations that cause disorders in the embryonic development of the lens, with heredity and family history. ②Exogenous factors: are the main causes of congenital cataracts. For example, infections in the first two months of pregnancy of the mother, or infectious diseases such as rubella, chickenpox, measles, and mumps within 6 months of pregnancy, can cause damage to the fetal lens. Hypothyroidism, malnutrition, vitamin deficiency, etc. can all cause congenital cataracts. In addition to cataracts, individual patients are also accompanied by congenital malformations such as iris coloboma, microphthalmia, or underdevelopment of the brain.
18. When is the best time to undergo surgery for congenital cataract?
Congenital cataracts have different clinical manifestations, and the degree of vision loss is related to the location and extent of lens opacity. Congenital cataracts are still mainly treated with surgery. Knowing the appropriate timing of surgery is an important step in determining whether children can recover their vision. Generally, the following principles should be mastered:
(1) For those who have complete cataracts in both eyes after birth, because the retina cannot receive normal stimulation, which seriously affects the development of visual function, surgery should be performed as soon as possible. Generally, the operation is performed within 1-2 months after birth, and no later than 6 months. The other eye should be operated within 1 week after the first eye operation, and the single eye should not be covered for more than 1 week after the operation to prevent form deprivation amblyopia from occurring after the single eye is covered after the operation.
(2) Incomplete cataracts in both eyes: If the visual acuity in both eyes is lower than 0.1 and the fundus cannot be seen, early surgery should be sought.
(3) For those with congenital cataract in one eye, lens opacity in the pupil area, or binocular vision less than 0.3, surgical treatment should be performed as early as possible at the age of 2-3 years.
(4) For those with localized lens opacity, which does not affect play at ordinary times and whose visual acuity is above 0.3, the surgery can be postponed to 4-5 years old, but not later than 6 years old, otherwise it may cause irreversible amblyopia.
(5) Patients with rubella syndrome should not undergo premature surgery, because in the early stage after infection, the rubella virus still exists in the lens, which can cause the virus to be released during surgery and cause iritis. It is generally recommended to be performed within 2 to 4 days. Surgery at age.
In short, the importance of early surgery must be emphasized. Corrective glasses should be worn early after surgery to avoid amblyopia. In the future, the second-stage intraocular lens implantation will be performed based on the patient’s eyeball development and visual acuity.
19. Can intraocular lenses be implanted for congenital cataracts?
Theoretically and technically, there should be no age limit for intraocular lens surgery, and it can be performed at any age. However, one should be cautious about intraocular lens implantation in children with congenital cataracts and juveniles. . The purpose of implanting intraocular lenses in infants and children is not only to improve vision, but also to prevent amblyopia and develop fusion ability. However, due to the characteristics of the eye tissue of infants and children, postoperative and postoperative complications are significantly more than those of adults, so it cannot be used as a routine surgery. Generally, the age limit for implantation is after 2 years old, and care must be taken when implanting intraocular lenses. Cases should be strictly selected. Operators should have skilled operating techniques. Close observation after surgery and strengthening of amblyopia training cannot be ignored.
20. Can vision be improved after congenital cataract surgery?
The first 6 months after birth is a critical period for the visual development of infants and young children. The fixation reflex is formed in 2-3 months after birth, and the stereoscopic vision and color vision are formed in 3-4 months after birth. , visual acuity improves rapidly 6 months after birth. If cataracts occur at this stage, it will not only cause visual damage, but also destroy the development of binocular visual function and color vision. In order to restore vision and obtain perfect visual function, cataracts that significantly block the visual axis in one eye should be operated within 2 months after birth, otherwise form deprivation amblyopia will occur. If cataracts in both eyes have significantly affected vision, surgery should be performed as soon as possible.
Moreover, in order to shorten the time for one eye to be suppressed by cataract, the operation time of the two eyes should be arranged as close as possible. Generally, cataract surgery for the second eye can be performed 1 week after the operation of the first eye when there is no obvious surgical reaction in the operated eye. If the cataract is not severe or the lens is opaque, the child still has some vision and can live a normal life. The time of surgery should be carefully considered and the surgery should not be rushed. However, measures to promote visual development (such as training to correct amblyopia, etc.) must be taken and the child can wait for a while Surgery will be done later. In short, even if the surgical treatment of pediatric cataract is successful, the postoperative visual recovery is often unsatisfactory compared with that of senile cataract. Therefore, the prognosis of vision recovery in children with cataracts depends to a large extent on the choice of surgical timing, surgical method, postoperative refractive correction of aphakic eyes, and postoperative amblyopia treatment.
21. Can an intraocular lens be implanted after traumatic cataract surgery?
The application of intraocular lenses also has certain limitations. Not all cataract surgeries can be implanted with intraocular lenses, especially for traumatic cataracts, because if the intraocular lenses are forcibly implanted, serious postoperative complications will occur. complication. Therefore, whether to implant an intraocular lens after traumatic cataract surgery should follow the following principles:
(1) After traumatic cataract removal, the posterior capsule is intact and the intraocular lens can be implanted in one stage.
(2) Cataracts caused by acute trauma are accompanied by intraocular tissue damage. After debridement and suturing, the local condition is completely stable and the eyeball can withstand the trauma of another operation before considering intraocular lens surgery. period implantation.
(3) After traumatic cataract surgery, if the posterior capsule is incompletely ruptured, the iris is defective, or the anterior segment structure is disordered, but the visual function is still good, anterior chamber or suspension intraocular lens implantation can be used.
(4) Intraocular lens implantation after traumatic cataract surgery in children should be carefully selected. For older patients with good local conditions, intraocular lens implantation can be tried.
(5) Those with traumatic cataract combined with central corneal leukoplakia, extensive iris adhesion or defect, angle adhesion, high vitreous opacity, fundus damage, etc. that seriously affect visual function are not suitable for intraocular lens implantation. .