Operation to replace the lens of the eye: types and stages of the procedure

The lens of the eye is a "natural lens that is, a transparent body with a thickness of 4 mm to 5 mm. This part of the eye provides clarity of images, performing an important function in the work of the light refractive apparatus of the organs of vision. The operation to replace the lens for today is the only effective method of restoring vision in cataracts. In some cases, this method is used to treat other diseases of the eye.

Method definition

In those cases when, for some reason, clouding of the lens or other kinds of changes in the lens develops, this part of the eye does not fulfill its functions.Lens replacement is an operation that is necessary in the following cases:

• Cataract,associated with degenerative age-related changes in the organs of vision, some chronic diseases, exposure to radiation or eye trauma;
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• Insufficient refractive properties of the lens(while maintaining its transparency), which cause a distorted image of objects on the retina. In such cases, hyperopia or nearsightedness is diagnosed in patients.

An operation that relieves the patient from the danger of loss of vision or relieves severe myopia or farsightedness, is the removal of a partially or completely clouded lens and replacing it with artificial. A new transparent lens in its properties is extremely similar to the natural one.

Application area

The operation to replace the lens is used in ophthalmology as the most effective method of vision correction in the following diseases:

• Cataract;
• Myopia;
• Presbyopia;
• Dislocation or subluxation of the lens;
• Secondary glaucoma;
• Astigmatism.

The development of modern technologies for lens replacement operations allows not only to return the ability to see in case of irreversible turbidity. Indications for an operation to replace the lens can be professional and household reasons.

The most common indications are the need to restore visual acuity, field of vision, preservation of binocular vision, which may be related to the patient's professional activity.

Kinds

At present, in order to restore a patient's vision, ophthalmic surgical practice uses the following types of operations:

• Extracapsular extraction;
• Intracapsular extraction;
• Ultrasonic phacoemulsification;
• Laser phacoemulsification.

The advantageextracapsular extractionis that the core of the lens, as well as the lens mass, is removed while retaining the lens of the posterior capsule of the lens. The fact that the posterior capsule remains intact allows one to maintain a barrier between the vitreous body and the anterior segment of the eye. The disadvantage of such surgery is the need to make a large incision of the cornea, which also causes the procedure of suturing.

Extracapsular extraction

In comparison with other types of operations, extracapsular extraction can be considered quite traumatic. Carrying out such an operation is recommended only after reaching a significant density and size of the opacity of the lens.

Artificial lens begins to function far from immediately, since it takes time to resorb sutures.

A more modern method of treatment is phacoemulsification.Phacoemulsification is an operation to remove the lens, which is performed with the help of an ultrasound device.The tip of the device is inserted into the anterior chamber of the eye through a minimal incision. The crushing of the substance of the lens occurs under the influence of ultrasonic vibrations. Then the substance is removed from the eye. The problem with the operation may be the impact of ultrasound on the area of ​​intraocular structures and the posterior epithelium of the cornea. The degree of damage depends on the exposure time and ultrasound power.

New methods of phacoemulsification can reduce the operating time of ultrasound (minimize the traumatic effect). This also achieves uncomplicated passage of the postoperative period. Stitches after surgery are not superimposed. Healing of a small wound lasts from 2 to 4 hours.

Laser phacoemulsification is the use of the systemlaser-based, which allows you to safely crush the substance of the lens in a short period of time. This operation does not cause significant trauma to the posterior epithelium of the cornea.

In those cases when the indications for surgery are trauma to the eye with significant damage, an intracapsular operation is performed-complete removal of the lens along with the capsule. The lens in this case is removed through a large incision. The operation is carried out with the help of a cryoextractor, which allows the lens to be frozen with a capsule to the tip of the device. This technique is now almost not used in connection with the great danger of eye trauma.

Laser phacoemulsification

After the removal of the lens, an IOL is implanted inside the eye (an artificial lens). Lenses are made of synthetic polymers of elastic structure.

Treatment

It is important for the patient to inform the doctor of all the existing diseases.Also, to determine the effect of medications on the anesthetic solution, the surgeon should be aware of any medications taken.

A few days before the operation, the patient receives information about the sequence of actions during the operation and about the subsequent rehabilitation period.

Pre-take care of the presence of eye medicines prescribed by the doctor for use after the operation.

Preparation of the patient

The preparatory stage preceding the lens replacement operation:

1. Ophthalmic examination, determination of visual acuity.The doctor can perform autorefractometry, biomicroscopy, visualization of the fundus to clarify the patient's condition. The measurement of intraocular pressure, the study of peripheral vision, helps to eliminate complications. Before the operation, ultrasound pachymetry, determination of the thickness of the cornea at different sites, ultrasound of the eye, analysis of the number and consistency of the tear may be performed;
2. The patient is assigned laboratory tests: a general blood test, tests for sugar and blood coagulability;
3. General examination of the patient: cardiogram, examination of the dentist therapist, ENT doctor.

   Biomicroscopy before operation

In the treatment center, you need to have a change of shoes, a set of underwear, a bathrobe, a passport and a payment document. 8 hours before the operation, it is not allowed to eat.

Procedure

Operation phacoemulsification, the most common type of procedure for replacing the lens, is performed under local anesthesia.An anesthesiologist selects the drug individually for each patient. Usually this drug is applied in the form of drops. Sometimes there is a need for an injection.
The main stages of the operation:

• Immediate preparation for the operation, which is carried out on the operating table, includes the use of disinfectants and drops, dilating the pupil, local and intravenous administration of analgesic drugs, treatment of the operating fields;
• Incision in the region of the cornea;
• Opening and removal of the anterior capsule of the lens;
• Crushing and removal of the nucleus of the lens;
• Cleaning of the capsular sac from the lenses of the lens mass;
• Installation of artificial lens(IOL).

  Carrying out the operation to replace the lens

After that, the cut is sealed.

Rehabilitation period

After more traumatic surgical interventions (extra-capsular or intracapsular), the patient remains in the hospital for 5 to 9 days.With phacoemulsification, it is possible to go home 2-3 hours after the end of the operation. But even in this case it is desirable for the patient to take care of the escort.
Vision after surgery is restored immediately after its termination. In most cases, there are no painful sensations. If the pain is felt, the patient is prescribed anesthetic drugs.

The bandage is applied to the operated eye.For some time after the operation, it is necessary to use the drops prescribed by the doctor, which contribute to the rapid healing of the incision. Such medicines are necessary for the accelerated regeneration of tissues, prevention of infection and the occurrence of complications.In most cases, the doctor appoints several medicines: disinfectant, anti-inflammatory, drops, as well as mixed preparations.

If the need to wear glasses remains, they need to be selected five days after surgery.

results

Modern technologies for performing operations to replace the lens can restore vision in cataracts, correct corneal astigmatism, get rid of spectacle dependence.The result largely depends on which artificial lens was implanted in the patient. There are different types of artificial lenses (IOL):

1. Monofocal IOL- used in most cataract surgery. Its use makes it possible to obtain a good perception of distant objects with varying degrees of illumination. Vision near requires correction (glasses);
2. Accomodulating monofocal IOLit is important to get an opportunity to see well without using glasses. The lens imitates the natural accommodation of the lens;
3. Multifocal IOLallows you to achieve equally good vision without using glasses (at any distance). Such lenses have ultra-precise optical characteristics;
4. Aspheric IOLcorresponds to all the characteristics of the young lens of the eye. Aspheric IOL makes it possible to achieve high sharpness and contrast of vision.

The toric intraocular lens completely cures astigmatism (up to 12.0 diopters).

Advice to patients

After the operation to replace the lens, a number of precautions must be followed:

• Do not drive vehicles;
• Do not lift weights;
• Avoid sudden movements;
• During sleep, choose a position of the body that does not allow pressure on the operated eye;
• Avoid sudden temperature changes;
• Do not make any mechanical impact on the eye(for example, do not rub eyes);
• Do not wash eyes with water, soap or other means, do not use make-up;
• Do not stay in an inclined position for a long time;
• Wear a bandage on the area of ​​the operated eye for the period prescribed by the doctor;
• Do not drink alcohol for the first 30 days after the procedure;
• Wear sunglasses.

In case of non-observance of the listed rules, complications may occur in the form of infection in the eye and impairment of vision.

Video

conclusions

The least traumatic method of surgical intervention is phacoemulsification with the subsequent installation of an artificial lens from modern materials. This technique is used even in outpatient settings, it is characterized by a minimal incision, it can be used at any stage of the disease development. The operation has no age restrictions. Modern phacoemulsification is the safest technology for treating cataracts. The patient can immediately after the operation lead a habitual way of life without serious limitations of visual and physical exertion.