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- After surgery, replacing the lens of the eye sees dull
During the operation and the postoperative period, which follows the surgical replacement of the lens in cataracts, there are a number of risks and complications that can cause visual impairment.
Types of complications
Rupture of the posterior lens capsule. This complication is considered one of the most serious, as it is associated with damage to the vitreous body, the displacement of the lens, less often, expulsive bleeding. If the time of treatment of this complication is missed, the following consequences are possible: a pupil pulled upward, formation of vitreous opacities, the occurrence of secondary glaucoma, posterior intraocular lens dislocation, retinal detachment. its volume. Basic rules include:
- Removal of lens masses into the anterior chamber through the introduction of viscoelastic behind the nuclear masses, which will prevent hernia of the vitreous body;
- Elimination of a defect in the capsule by introducing a special gland over the lens mass;
- Removal of the vitreous body by vitreotomy.
The resulting complication can cause the impossibility of implantation of the intraocular lens, since the residual masses of the lens substance can interfere with the visualization of the patient’s fundus. IOL implantation can be combined with vitrectomy.
Posterior prolapse of the lens substance. In the process of breaking the lens capsule, dislocation of lens fragments may occur in the vitreous region. This complication is quite rare, but can cause the development of secondary glaucoma, retinal detachment, chronic uveitis, macular edema. To eliminate the consequences of a complication, the first step is treating glaucoma and arising uveitis, then a vitrectomy operation is prescribed to eliminate the lens substance.
Regarding the timing of elimination of the consequences of complications, experts disagree. Some believe that the removal of lens residues should be carried out within a week, others adhere to the point of view, according to which, firstly, normalization of intraocular pressure and treatment of uveitis is necessary, and vitrectomy to clean the space from lens masses can be carried out after three weeks.
Rear dislocation of the intraocular lens. When the posterior capsule IOL is displaced towards the vitreous body, this may indicate, in the first place, an incorrect implantation of the lens. Such a complication can cause retinal detachment, vitreous hemorrhage, cystic edema of the macula. Its treatment is vitrectomy in order to remove, reposition or replace an IOL.
Suprachoroidal hemorrhage. This terrible, but very rare complication may be due to expulsive bleeding due to rupture of the ciliary arteries. The factors contributing to its occurrence are: the patient’s advanced age, a large amount of the anteroposterior segment, glaucoma, and cardiovascular diseases, although its exact cause is still not clear.
Signs of suprachoroidal hemorrhage are considered to be:
- Dynamic shredding of the anterior chamber, increased IOP, prolapse of the iris.
- The expiration of the vitreous body, the appearance in the pupil of a dark tubercle, the disappearance of the reflex.
- In complex cases, the contents of the eyeball can drain through the incision area completely.
The condition requires immediate action, including closing the incision and performing posterior sclerotomy. Although the recommended surgery may increase bleeding, resulting in loss of eye. In the postoperative period, steroids are prescribed to the patient to relieve inflammation (locally and systemically).
Corneal edema. Reversible, associated with surgical traumatizing endothelium complication. Patients with endothelial dystrophy have an increased risk of its occurrence. Other factors of its occurrence can be considered prolonged surgery time and postoperative IOP elevation.
Iris prolapse. This rather rare complication may accompany small incision cataract surgery. The main signs of iris prolapse are considered uneven scarring of the wound, carotid macula edema, astigmatism, epithelium ingrowth, endophthalmitis.
In this case, the tactics of treatment depends on the timing of the operation. If a prolapse is detected immediately (within 2 days after the intervention), then in the absence of infection, the iris should be repositioned and stitched. If the operation was performed a long time ago, the iris that fell out is excised because of the high risk of developing an infection.
Retinal cystic edema. This complication is associated with rupture of the lens capsule and loss or pinch of the vitreous body. It may occur after a few months even in the absence of operative complications.
Video of our doctor on the topic
The operation of the replacement of the lens with cataract involves a certain recovery period when it is necessary to follow the recommended rules for the rapid restoration of vision. These rules are common to all patients who have undergone surgery. However, the attending physician reserves the right to wear some adjustments in them, if required by the specifics of a particular case.
General recommendations in the postoperative period:
- Exclude touching the operated eye and pressure on it;
- Be sure to use sunglasses outdoors, even in cloudy weather in winter;
- Follow the schedule of visits to the doctor and follow all the necessary recommendations.
Mode. The operation of replacing the lens does not require compliance with bed rest. Specific requirements exist only for sleep: do not sleep on the side of the operated eye and on the abdomen for the first three days after surgery.
Hygiene. During bathing and washing it is necessary to exclude the ingress of water into the operated eye. If this does happen, wash the eye with a solution of furatsilin (02%).
Bandage. It is recommended to wear it only for the first 3 days after the operation to replace the lens. The bandage will protect the injured eye from dust and bright sunlight or artificial light. It is done very easily; for this purpose, the usual pharmacy gauze is folded in several layers and attached to the forehead with an adhesive plaster.
Drops. To prevent the development of infection and the fastest healing of the wound surface, the attending physician necessarily prescribes several drugs in drops according to the following scheme: the first week – 4 times a day, the second – 3 times, the third – 2 times. Then all drugs are canceled.
After some time, all restrictions are completely removed and the person returns to his usual way of life and work. But there remain preventive visits to an ophthalmologist for an examination in order to monitor the dynamics of recovery and restoration of vision.
Having addressed to the Moscow Eye Clinic, each patient can be sure that one of the best Russian specialists will be responsible for the results of treatment. Confidence in the correct choice will certainly add a high reputation of the clinic and thousands of grateful patients. The most modern equipment for the diagnosis and treatment of eye diseases and an individual approach to the problems of each patient is a guarantee of high results of treatment at the Moscow Eye Clinic. We diagnose and treat children older than 4 years and adults.
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