Suvremeni pristup liječenju katarakte

Abstract

Katarakta je zamućenje leće i vodeći uzrok sljepoće u svijetu. Radi se o multifaktorijalnoj bolesti za čiji se nastanak navode brojni faktori rizika, no kao najvažniji uzrok smatra se starija životna dob. Starenjem nastaju razne promjene u sastavu leće oka koje doprinose njezinom zamućenju. Simptomi počinju s progresivnim, bezbolnim padom vida, a u mnogim slučajevima javljaju se i miopizacija, smanjenje kontrastne osjetljivosti te monookularne i biokularne dvoslike. Na kataraktu treba posumnjati kod svakog bolesnika s navedenim simptomima. Dijagnoza se postavlja na proširene zjenice pretragom pomoću biomikroskopa kojim se uočavaju zamućenja. S obzirom na nalaz i postojeće indikacije za operaciju, oftalmolog savjetuje operativni zahvat. Postoje dvije osnovne vrste operacije katarakte, intrakapsularna ekstrakcija katarakte (ICCE) i ekstrakapsularna ekstrakcija katarakte (ECCE). ICCE se danas vrlo rijetko izvodi, uglavnom kod nekih trauma te subluksiranih i dislociranih leća. Pod suvremene metode operacije katarakte spadaju klasična ekstrakapsularna ekstrakcija katarakte koja se danas sve rjeđe izvodi zbog čestih postoperativnih komplikacija. Fakoemulzifikacija znači standard u operaciji katarakte. Tom metodom se pomoću ultrazvučne sonde razbijaju lećne mase, a potom slijedi njihova aspiracija te ugradnja mekih, savitljivih, intraokularnih leća (IOL) kroz vrlo mali korneoskelaralni rez veličine 2,8 - 3,2 mm. Ta metoda je dovela do značajnog smanjena postoperativnih komplikacija, smanjenog broja astigmatizma, većeg zadovoljstva pacijenata te boljih postoperativnih rezultata. Pod novije metode operacije katarakte spadaju i femtosecond laser te koaksijalna i bimanualna mikrokirurška operacija. Nakon operacije u pseudofakično oko se ugrađuje IOL. Nove generacije IOL se dijele na monofokalne koje se u pravilu najčešće koriste i multifokalne. Postupnim razvojem specijalnih IOL kirurgija katarakte postala je i refraktivna kirurgija.Cataract is a clouding of the lens and the leading cause of blindness in the world. Cataract is a multifactorial disease with numerous risk factors, but as the most important cause is considered to be older age. Aging entails various changes within the lens of the eye that contribute to its blur. Symptoms begin with a progressive, painless drop in sight, and in many cases, it is myopisation, reduced contrast sensitivity and monoocular and biocular double vision. The cataract should be suspected to exist in all patients with these symptoms. Diagnosis is made using the pupillary examination with a bio microscope with which blur is observed. In view of the findings and the current indications for surgery, an ophthalmologist advises surgery. There are two main types of cataract surgeries, intracapsular cataract extraction (ICCE) and extracapsular cataract extraction (ECCE). ICCE is now rarely performed, mainly on some trauma and subluxated and dislocated lens. Modern methods of cataract surgery include a traditional extra capsular cataract extraction that is rarely performed due to frequent postoperative complications. Phacoemulsification is a standard in cataract surgery. This method uses ultrasound probe with which the lens mass is broken, followed by their aspirations and installation of soft, flexible intraocular lenses (IOL) through a small incision corneoscleral cut with the size from 2.8 to 3.2 mm. This method has led to a significant decrease in postoperative complications, in reduced number of astigmatism, greater patient satisfaction and in better postoperative results. Recent methods of cataract surgery include the use of femtosecond laser and coaxial and bimanual microsurgical operations. After the operation, the IOL is built into pseudophakic eye. New generation IOL are divided into the monofocal which are generally the most commonly used and the multifocal ones. Through the gradual development of special IOL cataract surgeries refractive surgery has come into being