cataracta

Causes and Symptoms. Some cataracts result from injuries to the eye, exposure to great heat or radiation, or inherited factors. The great majority, however, are “senile” cataracts, which are apparently a part of the aging process of the human body.

Blurred and dimmed vision are often the first symptoms. The patient may find that a brighter reading light is needed, or objects must be held closer to the eyes for better vision. Continued clouding of the lens may cause double vision; eventually there may be a need for frequent changes of eyeglasses. These symptoms do not necessarily indicate cataract, but if any of them are present, an ophthalmologist should be consulted immediately.

Treatment. The only known effective treatment for cataract is surgical removal of the lens (lens extraction or cataract extraction). The procedure of choice was formerly intracapsular extraction, with total removal of the lens within its capsule. This may be done by forceps or by cryoextraction using a supercooled metal probe that forms a bond with the lens capsule. The inner portion of the lens can be removed by emulsification and aspiration. More recently the removed cataract has been replaced with a plastic intraocular lens. In this procedure the inner portions of the lens (the nucleus and cortex) may be all that is removed; the capsule is retained and the intraocular lens is placed inside it.

The lens of the eye serves only to focus light rays upon the retina. After cataract extraction the loss of the natural lens is compensated for by either special eyeglasses or contact lenses. Implantation of a permanent artificial lens, either during cataract surgery or later, is an alternative to use of cataract spectacles and a removable contact lens.

Patient Care. Eye drops are administered to produce mydriasis and vasoconstriction. Because these patients may have extremely poor eyesight, care should be taken that they do not injure themselves. (See also vision.) Local anesthesia is usually preferred for the surgical procedure and preoperative medications are given to produce drowsiness. Ambulatory care surgery with same-day admission and discharge is becoming increasingly routine. Careful observation of the patient on follow-up visits is important. One needs to be on the alert for a complaint of pain in the eye followed by nausea and vomiting. These could be signs that the patient has increased intraocular pressure within the operative eye and measures need to be taken to reduce the pressure.