What Is a Secondary Cataract?

Secondary cataract (after-cataract) refers to a special state in which the lens cortex remains in the pupil area or a fibrotic membrane is formed after the cataract is surgically removed, or after the traumatic cataract is partially absorbed.

Secondary cataract

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Secondary cataract (after-cataract) refers to a special state in which the lens cortex remains in the pupil area or a fibrotic membrane is formed after the cataract is surgically removed, or after the traumatic cataract is partially absorbed.

nickname

Secondary cataract

TCM disease name

Secondary cataract

English name

after-cataract

Common locations

Eye

Residual part of the cortex can aggravate turbidity, resulting in deformed vision and decreased vision. This complication is particularly prevalent and severe in early IOL implantation where the importance of lens epithelial cells and cortical clearance is not well understood. Even in the 1990s, after ECCE combined with posterior chamber intraocular lens implantation, this complication is still a major clinical problem, and its incidence is as high as 25% to 50%. The structure and morphology of posterior capsular opacity (PCO) are very complicated, mainly related to the amount of residual cortex after surgery, the presence or intactness of the posterior capsule, and the severity of postoperative inflammation. After the occurrence of secondary cataract, it is necessary to choose puncture sac, capsulotomy or excision, YAG laser incision, etc., and the prognosis is generally good. Patients should stop smoking and drinking to avoid overeating. Eat more vegetables, fruits, and foods rich in VC and VE. Pay attention to combining work and rest with your eyes. Reading and watching TV is not easy.

Secondary cataract

after-cataract

Secondary cataract

Ophthalmology> Cataract> Cataract

H26.4

In general, the incidence of secondary cataracts after extracapsular surgery is significantly higher than that of intracapsular extraction. This is because in addition to the above-mentioned complications, the simple opacity of the posterior capsule itself is also included. According to statistics, 3 to 6 months after extracapsular cataract extraction, the incidence of posterior capsule opacity is as high as 30% to 60%. Modern cataract surgery techniques have significantly reduced the incidence of such complications. With the improvement of modern surgical technology and IOL materials, the ratio of posterior capsular opacity (PCO) that requires Nd: YAG laser posterior capsular incision is reduced to 10% when entering the new millennium. ~ 15% or less. PCO occurs almost exclusively in childhood cataract surgery.

Residue of lens capsule, epithelial cells or lens fiber during cataract extraction.

Normal lens epithelial cells are distributed only under the anterior capsule of the lens to the equator and the equator arch. It is composed of a single layer of columnar cells. These cells are divided into two biological bands, the anterior central zone (corresponding to the anterior lens capsule) and the lens equatorial arch (E cells). The former is composed of a single layer of flat columnar cells. These mitotically active epithelial cells are in the stationary phase, and their prototype cells (A cells) are stimulated to proliferate to form fibrous tissue, so-called pseudofibrosis. In the most important area, the cell differentiation and proliferation in this area is very active, and new lens fibers are continuously produced from this.

Clinically, most cases of PCO are caused by residual or newly-proliferated epithelial cells in the capsular bag after cataract surgery, especially the newly-generated epithelial cells play a greater role. Its appearance is similar to pearl or fibrous tissue, or a combination of two forms. The former is called Elschnig's pearls. Anterior epithelial cells are one of the reasons for the formation of PCO fibers due to fibrosis of their primitive cells. Although the equatorial epithelial cells swell and form vesicles, they can eventually become fibrotic. When the posterior capsule is completely cloudy due to fibrosis, a posterior membrane cataract or secondary cataract is formed. If it is accompanied by cortical residues and incomplete encapsulation of the anterior and posterior capsular membranes, absorption is more difficult. In addition, additional processes such as bleeding and exudation constitute a more complex mechanized membrane tissue. This kind of membrane tissue, because it is thick and dense, seriously affects vision. Sometimes the organizing membrane tissue is widely adhered to the surrounding iris, causing the pupil to be severely deviated or blocked, causing secondary glaucoma. In some cases, a large number of new blood vessels can grow in the membrane tissue, making it almost impossible to perform another operation. In other cases, due to the large amount of residual cortex, especially the peripheral parts, and the large number of E cells, a ring-shaped hump was finally formed near the equator, and the pupil area was not affected. This ring-shaped hump was called the Mayer's ring ( Soemmerring ring). The Mayer's ring can maintain long-term stability, and the posterior capsule in the pupil area will remain transparent, which will not affect vision in general. If the Mayer's ring is ruptured and the released substance enters the anterior chamber, it can cause a serious inflammatory response and promote the later The onset of the disorder must be removed by surgery. If the formation of Soemmering ring is effectively prevented, the incidence of PCO can be greatly reduced.

Disengagement of the Soemmering ring into the anterior chamber can trigger acute inflammation and glaucoma.

Cataract secondary to capsulotomy, linear enucleation, or extracapsular excision, swollen residual fibrous lens fluid, forming large, round bladder-like cells with fluids, Markov balls, and transparency Like clumps, cholesterol or calcium can also deposit. Equatorial epithelial cells often proliferate significantly and appear mitotic phenomena. It can be considered that the regeneration of the epithelium, cystic epithelium proliferation, can even grow around the front of the capsular rupture, forming large vacuoles in the proliferating epithelial cells, called lens epithelial Elschnig beads. Occasionally, cystoid epithelium is also visible. When blood enters the sac, spindle cells and fibers can proliferate and take the shape of fibrous tissue. When the iris pigment particles break down from the pigment epithelium, the lens capsule can be covered with pigment. It is fashionable to see the proliferation of pigmented epithelial cells mixed in lens cells and lens material. When there are changes in inflammation, polymorphonuclear leukocytes can enter secondary cataracts. For example, after the formation of the ciliary membrane, they are often connected with secondary cataracts and can enter them.

Patients who have doubts or special requirements about the effect of surgery, and patients with other eye diseases suspected of special eye examination.

After extracapsular cataract extraction or ocular trauma, the residual cortex or epithelial cells on the posterior lens capsule proliferated and became cloudy.

1. Have corresponding surgery or trauma history.

2. Presented as simple secondary cataract, Soemmering ring, Elschnig beads, mechanized membrane and other forms.

3. Sometimes there may be adhesions behind the iris.

4. There are different degrees of visual impairment.

5. YAG laser treatment or surgical treatment can be performed according to the situation.

Secondary cataracts are formed after cataract surgery and have very significant clinical characteristics.

After the occurrence of secondary cataract, it is necessary to choose sacral puncture, capsulotomy or excision, YAG laser incision, etc., as appropriate. When secondary cataracts affect vision, Nd: YAG laser can be used to cut the posterior lens capsule of the pupil area. If laser treatment is performed unconditionally, or after the capsule has passed, surgery can be performed to puncture or cut the posterior capsule of the lens in the pupil area. Postoperatively, glucocorticoids were used to prevent inflammatory reactions and observe changes in intraocular pressure.

The prognosis of secondary cataract is good.

The principle of prevention of posterior capsule opacity can be divided into two aspects: that is, intraoperative efforts to remove residual lens epithelial cells and cortex; if some cells remain, create a physiological barrier at the edge of the optical region of the intraocular lens to prevent self-equivalence The growing cells reach the optic axis.