Senile cataract is a common eye disease in the old people. It
refers to the case in which the crystalline lens itself
gradually becomes aged, denatured and opaque without other
systemic or local pathogenic causes. It usually occurs in two
eye but the affections of the two eyes may differ in time,
degree and progressive speed. Clinically only cortical senile
cataract and nuclear senile cataract are common. In addition,
there exists a capsular senile cataract as a complication of
mature or hypermature stage of cortical cataract. The disease
belongs to the category of "yuanyi neizhang" "ruyin neizhang" or
"baiyi huangxin neizhang" (cataract) in TCM.
Main
Points of Diagnosis
1. At the early stage, blurred vision or fixed
black shadow before the eye or monocular diplopia or monocular
polyopia may occur. In the daytime, the patient can not see
things as clearly as at night. In the advanced stage, the
patient's eyesight becomes gradually weakened until only light
sensation exists.
2. Cortical cataract: At the initial stage cortical peripheral
opacity of the lens in a zigzag shape can be seen. In the
expansive stage, the crystalline lens becomes completely opaque
and swollen. The anterior chamber becomes shallow and iridic
projection results; at the mature stage, the crystalline lens
becomes completely as white as ice, the depth of the anterior
chamber remains normal and the projection image of iris
disappears; at the hypermature stage, there is opaque
crystalline lens, decomposed or dissolved fibra, loosened cyst
membrane, sunken lens nucleus and deepened anterior chamber.
3. Nuclear cataract: At the initial stage embryonic nucleus
becomes opaque, and then the opacity spreads gradually to the
adult nucleus, further to the senile nucleus and the color turns
from yellow to dark brown, even to brownish black color.
4. Capsular cataract: It complicates at the mature and
hypermature stage of cortical cataract. It is manifested as
opacity of cyst membrane of the pupillary collar part, slightly
elevated with uneven surface of presence of plicae.
Differentiation and Treatment of Common Syndromes
1. Internal Treatment
1) The Type of Deficiency of Liver-Yin and Kidney-Yin
Main Symptoms and Signs: This disease belongs to early cataract
characterized by senile debility, dizziness, tinnitus, soreness
of the loins, red tongue with scanty fur or absence of tongue
fur, thready and rapid pulse.
Therapeutic Principle: Nourishing the kidney and liver.
Recipe: Decoction for Nourishing Yin and Supplementing the
Kidney.
prepared rehmannia root
Chinese yam
dogwood fruit
moutan bark
alisma rhizome
poria
schisandra fruit
Chinese angelica root
sesame seed
mulberry fruit
cassia seed
wolfberry fruit
All the above herbs are to be decocted in water for oral
administration.
2. The Type of Deficiency of the Liver-Yin and Dampness of the
Spleen.
Main Symptoms and Signs: The disease is manifested as early
cataract, plump constitution, mental fatigue and lassitude,
swollen lower limbs in the afternoon or in fatigue, pale tongue
and feeble pulse.
Therapeutic Principle: Tonifying the liver, reinforcing the
spleen and eliminating dampness.
Recipe: Decoction of Four Ingredients and Decoction of Two Old
Herbs.
prepared rehmannia root
Chinese angelica root
ligusticum root
white peony root
red tangerine peel
prepared pinellia
licorice root
plantain seed (wrapped in a piece of cloth before decocted with
other herbs)
areca seed
chrysanthemum flower
pleione rhizome
poria
All the above herbs are to be decocted in water for oral
administration.
2. External Treatment
Mature senile cortical cataract and advanced nuclear cataract
are indicated to be treated surgically. Here, only the method of
using metal needle to pluck the cataract is introduced as
follows:
1) Preoperative Preparation: A few days before the operation,
anti-inflammatory eye drops should be applied to the patient's
affected eye and lacrimal passage irrigated. Two hours prior to
operation, 1% atropine solution should be applied to the
affected eye so as to have the pupil fully dilated. Then routine
sterilization should be done to the palpebral skin and the
conjunctival sac and apply the eye pad onto the eye. Just before
the operation, sterilization and surface anesthesia should be
done once more.
2) Surgical Instruments: Flat-headed cataract needle, dilating
needle, eye-lid hook, fixation forceps, smooth conjunctival
forceps, eye scissors, double-edged razor blade, needle-holder,
mosquito forceps, suturing needle and suturing thread and so on
are to be prepared for the operation.
3) Operative Procedure: Take the left eye as an example. The
patient should take a semirecumbent position or a sitting
position on the eye, ear, nose and throat examining chair, with
the head slightly leaning backward. Then a hole-towel is spread
and subcutaneous infiltration anesthesia performed at the
postbulbar and 1/3 part of lateral lower to pull up the upper
palpebra and uses suturing thread to tract the lower palpebra.
The operator holds the fixation forceps with is left hand to
gripe the bulbar conjunctiva of the corneal margin at 6 o'clock
part to have the eyeball fixed and tracted toward the upper part
of the nose; meantime takes the hemostatic forceps with the
right hand to gripe tight the ready-prepared triangular blade,
then at the part 4 mm away from the 4 to 5 o'clock surface of
the corneal margin cut a 3 mm-long incision with the point of
the knife vertical to the scleara, which is parallel to the
corneal margin and passes through the full thickness of the
eyeball wall.
The operator should hold the cataract needle with the right
hand, with the curved surface of the needle facing downward, and
the point of the needle being vertical to the sclera. After the
flat part of the cataract needle to inserted 3mm in depth, get
the manubrium of the needle to incline toward the face, keep the
front part of the front part of the needle between the ciliary
body and the lens and have it move forward. When it passes the
posterior surface of iris to reach the pupillary center, press
the concavity of the front part of the needle close to the
crystalline lens, have it steer clear of the 4 to 6 o'clock
surface part of the lens. In this way the ligment of the 4 to 6
o'clock surface can be directly cut off.
Lay flat the needle with its front part resting at the
retrolental 7 to 8 o'clock surface of the equatoral part, draw
it horizontally backward to the 4 to 5 o'clock surface to make
the first laceration (scarification) of the vitreous prozonal
membrane, At this time the curved surface of the needle has
turned upward, therefore, it is necessary to rotate the needle
outward so as to get its curved surface facing downward. Then
withdraw the needle a little and insert it into anterior surface
of the lens again Successively press the 1 to 4 o'clock surface,
9 to 12 o'clock surface of the margin of the lens so as to have
the lens incline backward and downward, meantime, ligament of
the corresponding part should be cut off, now move the needle
horizon tally. from the left to the right to make the second
laceration (scarification) of the vitreous prozonal membrane at
the lower 1/e of the pupillary zone. Finally move the end of the
needle to the lens margin at 8 o'clock surface, pluck the lens
to the intraocular subtemporal zigzag margin of the retina. With
the exception of leaving a little ligament at the 6 o'clock
surface, ligaments of any other parts should all be severed.
Press the lens for a few minutes, till it no longer floats up,
when the needle is withdrawn. After the needle is withdrawn,
insert a dilate needle into the incision, twirl the needle
slowly to dilate the incision until a tightened and unsmooth
sensation appear in the hand. Use the left hand to let go the
fixation forceps, then withdraw the dilating needle, transposite
the conjunctival incision and the scleral incision so as to get
the scleral incision covered by the conjunctiva.
When the operation is finished, apply 1% atropine eye ointment
and antibiotic eye ointment to the operated eye, cover the eye
with an eye with an eye pad and wrap it up with bandage.
After the operation the patient should lie on his back with the
head slightly raised or on the first or the second day, take
semi-recumbent position of 30 to 40 degrees, and have a ordinary
diet, take care of himself in shit and urination and other
matters in daily life. Dressings should be changed once a day.
In 4 or 5 days after the operation, the eye pad may be taken
off. Before the pupil contricts to normal, the patient should be
forbidden to hang his head down, otherwise, the vitreous may
herniate into the anterior chamber. Two months after the
operation optometry can be done.
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