2 Overview Senile cataract is the most common type of acquired cataract, which mostly occurs in the elderly over 40 ~ 50 years old. The lens itself gradually became cloudy, but no obvious reason was found in the whole body and local area. Often bilateral, it can occur successively or simultaneously, and it can last for months to years from onset to maturity. According to the turbid parts, senile cataracts can be divided into nuclear and cortical types. Cortex can be divided into peripheral cortex type and posterior cystic cortex type.
The main manifestations of senile cataract are decreased near and far vision and slow development. Wearing appropriate glasses at an early stage can maintain good vision. Sometimes there is hyperopia. In severe cases, cataract can develop to the point where vision drops to 0. 1 or only the index finger of the hand in front of you can be seen. Diabetic patients develop rapidly, from the initial stage to the mature stage, which varies from person to person, ranging from months, years and decades.
The reason of senile cataract is that the lens nucleus in the eyeball is dehydrated and hardened, and the older it is, the more turbid it becomes. Glutathione, vitamin B 1, B2, C, E, etc. The trace elements in the blood of the elderly are reduced, and the proportion is out of balance, such as selenium deficiency, and the oxygen content in the blood is reduced, which makes the local metabolism of crystals disordered and the crystal protein denatured and causes turbidity. There is also the long-term absorption of radiation such as ultraviolet rays.
The treatment of cataract in the elderly can be treated with drugs, such as phenytoin and blindness. More importantly, it is necessary to prevent cataracts. The elderly should try their best to reduce the time spent working at close range and reading under the light, and supplement some conditional glutathione such as vitamin B 1, B2, C and E appropriately. The radical treatment is extracapsular cataract extraction and intraocular lens implantation. Cataract phacoemulsification and intraocular lens implantation can also be done.
3. Treatment measures 3. 1 Drug therapy is mostly used in the early stage of cataract or when it is not fully mature, so as to delay its development or improve vision. From the clinical observation, most drugs have no obvious effect on turbid crystals. Based on the biochemical study of lens, these drugs can promote the metabolism of nicotinamide, mononucleotide and nucleoside phosphate in lens epithelial cells, thus preventing the formation of cataract. Or protect the SH group of crystallin to prevent the degeneration of crystallin, or supplement a large amount of vitamin C and inorganic salts (such as potassium, sodium, calcium, etc.). ) prevent the chemical composition of the lens from changing. At present, you can try the following drugs.
Glutathione)
It is a tripeptide composed of glutamic acid, cystine and glycine, and the reduced form is GSH；; The oxidation type is GSSG, because the SH group of reduced GSH can participate in the redox reaction in vivo, and can also detoxify and activate some important enzyme systems. Therefore, it is very important to maintain the normal metabolism of the lens. 1966, Xiao Kou and others used GSH to treat senile cataract for the first time, and achieved good results.
1. Main pharmacology
(1) (1) GSH can maintain the transparency of the island lens.
⑵ SH group of GSH can maintain the activity of some enzymes.
(3) Prevent soluble protein from becoming insoluble protein.
⑷ lens opacity is related to the formation of quinones caused by metabolic abnormalities such as tyrosine. SH group can prevent the formation of quinone.
2. Usage: 100mg, intramuscular injection, once every other day. 4% solution eye drops, 4 ~ 6 times a day.
Diα thiopropionyl glycine (α mercaptopropionyl glycine).
It is a SH gene compound with a similar structure to GSH, which has a strong reducing effect, can maintain the transparency of lens, and prevent and reverse the pathological process of lens opacity.
Usage: ① Take 1 ~ 2 tablets orally, three times a day. ② Eye drops: 6 ~ 10 times a day.
Catalin (eye drops for cataract)
This product is 1 hydroxypyridine, which is an aldose reductase inhibitor.
It has been proved that there is abnormal tryptophan metabolism in senile cataract, and quinone diacid, the product of abnormal metabolism, can lead to cataract.
This product can be used for injection, eye drops and oral administration, and can be used for traumatic, complex and senile cataracts.
Tetrahydroxylysine (crystal lysin)
This product is 5 12 sodium dihydroazapentadisulfonate. It is easy to enter the lens through tissues, and has a strong affinity for the soluble protein of the lens. It can prevent quinones from oxidizing or even clouding the lens, activate proteolytic enzymes in aqueous humor, and promote protein decomposition and absorption of the cloudy lens. This product has redox effect, and can promote the metabolism of lens and the whole eyeball tissue, thus preventing the development of cataract.
This product is eye drops for external use, 3 ~ 5 times a day.
Infinite noring
The main components of this product are calf crystallin 10mg, vitamin C5mg, vitamin B20.2mg, potassium iodide 0. 1mg and strychnine 0.0 1mg.
Usage: Take 1 raw materials sublingually three times a day before meals.
Liu Liming eye drops
Eye drops containing potassium iodide, sodium iodide and vitamin B 1, C, etc. Three to five times a day.
Heparin sodium
It can adjust the abnormal permeability of lens capsule, and is mainly used for senile cataract.
Usage: intramuscular injection of parotid hormone 3mg twice a week. Or 0.2mg subconjunctival injection; 10 ~ 12 mg orally, 2 ~ 3 times a day.
Eight thyroid hormones
It can promote the amino acid synthesis of protein and make the lens transparent. Can use this product 0.02% solution eye drops, 2 ~ 3 times a day.
The other nine people
Use vitamins C, B2 and E all over the body.
Ten TCM therapies
Such as magnetic bead pills, stone-dissolving luminous pills and the like.
3.2 surgical treatment 1. Needle aspiration for cataract.
2. Extracapsular cataract extraction.
3. Cataract extraction.
4. Cataract needle dialing.
4 Etiology Senile degeneration: Senile malnutrition, metabolic disorder and senile hyper-accommodative lens degeneration are similar to hair whitening and skin wrinkles.
There are two factors that lead to lens opacity due to pathological changes: ① the lens fiber absorbs water and expands; ② The morphology and properties of epithelial cells in lens capsule changed.
In senile cataract, it begins between lens nucleus and cortex. At first, there were long and narrow cracks and cavities between the crystal fibers, and then the crystal fibers themselves expanded, changed their volume and became as turbid as fine sand. The lens fiber evolved from epithelial cells is highly swollen and becomes a big bubble with a nucleus called vesicle cell. This fiber eventually degenerates and forms many spheres of different sizes called myelin globules, that is, Magnisgloules. The epithelial cells of capsule lost their normal arrangement, and some of them disappeared and proliferated. In the later stage, the degenerated substances in the cortex lost water, which led to the shrinkage of the crystal. Clinically, white spots on the capsule are seen, which are the hyperplasia of some capsule epithelium.
6 Clinical manifestations 6. 1 Clinical manifestations Turbidity first appeared in the lens cortex, and then developed into all. Before turbidity appears, the crystal fiber lamellae with water squeeze out transparent cracks, which is called hydration phenomenon. These include transparent blisters, centripetal separation of fiberboard and radial longitudinal water cracks, which can be regarded as the early manifestations of this disease.
6.2 Clinical staging 1. Onset: Gray-white opacity first appeared in the deep part of lens equatorial olfactory cortex, which was wedge-shaped and arranged radially. When the turbidity does not spread to the pupil area, the vision has no obvious effect.
2. Expansion period is also called development stage: wedge-shaped turbidity gradually progresses in the center, and other parts of the crystal also have different thicknesses, forming various turbid areas. The cortex is swollen due to the increase of water. At this time, the anterior chamber becomes shallow, and the crystal performance is often uniform and silky. Because there is a layer of transparent cortex under the anterior capsule, iris projection can be seen in oblique photography. This period may lead to glaucoma glaucoma. At this time, the decline in vision has become obvious and more and more serious.
3. Immature stage: After several months or years, the excess water contained in the crystal gradually subsided and the swelling phenomenon disappeared. All the lenses are cloudy and the iris shadow disappears. The operation at this stage is ideal.
4. Over-maturity: The length of maturity is uncertain. After too long time, the water is absorbed, and the star pattern of the crystal is lost, and it becomes uniform grayish white, or there are irregular small white spots on the grayish white turbidity. The lens fiber liquefies into emulsion, and the brown crystal nucleus sinks below, which is Magney's cataract.
The anterior capsule relaxes to form wrinkles, and the capsule can become thick and opaque. At the same time, the deepening of anterior chamber, iris tremor and lens nucleus swinging with the eyeball can cause capsule rupture, lens dislocation and secondary glaucoma, and at the same time, it can also liquefy vitreous body, which brings difficulties to cataract surgery. In recent years, the equipment and surgical methods have been continuously improved, and satisfactory surgical results can be obtained in both the expansion stage and the over-mature stage.
7 auxiliary inspection to understand the whole picture of the crystal, fully mydriasis after darkroom inspection. The specific method is as follows:
1. Focus illumination inspection method: directly illuminate with light to see if the crystal is turbid or misaligned.
2. Iris projection method: 45? If the lens opacity is located at the core, there is a crescent-shaped transparent area between the opacity area and the pupil margin, and the heavier the opacity, the narrower the shadow. If the crystal is completely turbid, the crescent shadow disappears completely.
3. Method of penetrating ophthalmoscope: When the light enters the pupil area, you can see the uniform red shadow normally. If the lens or refractive stroma is turbid, black spots or black blocks can be seen in the red shadow. During the examination, the patient can turn his eyes to see if the shadow moves, so as to understand the turbid part.
4. Slit lamp examination: From front to back, there are multiple layers of light and dark, representing lens nuclei in different periods, and the transparency of each layer is not completely consistent, among which the anterior capsule, the anterior surface of adult nucleus and the posterior surface of embryo are clearer.
Acupoints for treating senile cataract are clear.