Other lens disorders

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Symptoms

Picture deformation, peripheral vision distortion, or loss of sharp vision often develops after an injury or surgical procedure.

Causes

The most common cause of injury is lens detachment from its original position, which means it moves from the visual axis, sometimes falling forward into the vitreous body. Such dislocation can occur in a human lens or in a contact lens usually as a result of an injury, or possibly after an operation. Secondary cataract is also a type of lens disease and it can develop after cataract operations.

Examination

Besides the standard thorough eye examination (see eye defects), the doctor will examine the inner eye using a slit lamp. A slit lamp is a special microscope allowing the eye to be seen and its parts to be examined in detail. It is a pain-free procedure. You will be seated in front of the device with your forehead and chin leaning against a special construction and the doctor will examine both of your eyes. Sometimes it is necessary to apply special drugs in the form of drops to dilate your pupil (artificial mydriasis). Shortly after the exam (a maximum of a few hours), you might experience worsening of your vision or higher light sensitivity due to the previous pupil dilatation. Therefore, we strongly recommend no driving immediately after the examination. However, the above mentioned symptoms will wear off when the drug effects disappear.

You will also be examined by an ophthalmoscopy – directly or indirectly. In both cases, it is an exam that will not cause you any difficulties or discomfort. The direct ophthalmoscope is a device that is held in the doctor’s hand. Using a special light installed inside the ophthalmoscope, the doctor will look into your eyes. As far as indirect ophthalmoscopy is concerned, the doctor will wear a special binocular device with a light inside when examining your eyes.

Conservative treatment

There is no treatment available for patients suffering from lens diseases.

Surgical treatment

Pars plana vitrectomy and lens implantation

Correcting detached retina movement, or for complete retina removal after it falls forwards, a surgical procedure known as pars plana vitrectomy can be performed. It is done under local anesthesia with the doctor observing the whole procedure under a microscope. The devices are inserted into the eye through the ciliary body, a circular structure at the front of the eye serving to maintain the proper position of the lens and for accommodation.

This procedure includes a cut of 0.9–1 mm in the ciliary body area by using a special knife. The detached lens is removed by vitrectomy. The doctor then performs secondary implantation of the artificial inner lens, placing (or attaching) it onto the anterior chamber or onto the iris. The wound is finally sewed up by self-dissolving stitches that do not need to be removed later on.

The surgery is done on an outpatient basis and takes 30 – 40 minutes. The pain is suppressed by analgesics. Irritation and eye reddening fade away in the days following the operation. Follow the doctor’s advice and apply into your eyes the prescribed drops or ointments.

Secondary cataract YAG laser treatment

After a cataract surgery, the posterior capsule may become opacified (cloudy) which leads gradually to repeated worsening of vision. These secondary cataracts can be treated by using the YAG laser. Using the laser, the doctor makes a small opening in the center of the posterior capsule (capsilotomy) which enables the patient to gain sharp vision. The edges remain undamaged and serve as an artificial inner lens support. Before the procedure, it is essential to dilate the pupil by applying special drops. The procedure is pain-free and lasts around 10 minutes. After surgery, drops and medications are administered to block the growth of inner pressure or the development of inflammation.

Posterior lens capsule polishing

After undergoing cataract surgery, results may gradually worsen in some patients due to the residuals of the lens that had been removed by phacoemulsification in its posterior capsule or due to the presence of other tissues. Correction may be done by mechanical polishing; a procedure in which a thin cannula is inserted into the eye and the posterior capsule is then polished.

Equipment/device used

YAG laser

It is currently the most common firm fiber laser type (the active crystal material is Yttrium Aluminium Granate) used in many medical fields. Concerning ophthalmology, it is used mainly to remove secondary cataracts. A small opening is made by a laser in the posterior lens capsule, thus allowing sharp vision to be regained. Furthermore, the laser can be used to create an opening in the iris while decreasing the inner eye pressure. In our clinic we use a Carl Zeiss YAG laser.

Vitrectom

A device used for operating on the posterior segment of the eye. It is a high-frequency mini-knife that serves for removal of the vitreous body and other damaged tissue. It is not necessary to sew up the wound afterwards. Vitrectom is operated by a PC, which provides the maximum amount of safety throughout the procedure. We use the Constellation device from the Alcon Company.

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