Cataract

認識白內障​

Cataracts occur when the transparent lens inside the eye, which focuses light, becomes cloudy due to aging or disease. The lens functions like a camera lens, helping the eye focus accurately so images can be projected onto the retina to form clear pictures. Composed of proteins, the lens regulates light.When the lens becomes cloudy, its transparency decreases, preventing light from passing through. This leads to reduced vision and the formation of a cataract.

白內障最常見是老年性白內障,一般出現於大約五十歲以上人士,而糖尿病患者和深度近視較容易及較早會出現白內障。

湯文傑醫生為眼科專科醫生,白內障手術是其專長之一。湯醫生曾赴美國哈佛大學附屬醫院深造 培訓,並與當地眼科專家就白內障治療相關課題進行學術交流。
圖片_老年性_白內障症狀

白內障的成因


年老


眼睛創傷


眼部手術


先天性


其他眼疾引致

(如:虹膜炎、 急性青光眼、深近視)


其他疾病引致
(如:糖尿病)


藥物副作用
(如:類固醇)

白內障的症狀

圖片_視力模糊_白內障_症狀
Visual acuity chart
圖片_看事物出現眩光_白內障
See glare appearing on objects
圖片_影像顏色變得晦暗_白內障的症狀​
The image color has become dull.
圖片_對光敏感_畏光_白內障
對強光敏感及畏光
圖片_白內障的症狀​_單眼重影
單眼重影
圖片_近視數度突然飆升_白內障的症狀​
近視數度突然飆升,
可能在一個月內提高兩至三百度

白內障手術前後的視覺模擬

(左)白內障          (右)正常視力

圖片_白內障_手術前後的視覺模擬

我應何時接受白內障手術?白內障需要等熟了才做手術嗎?

圖片_白內障_手術
圖片_白內障手術_什麼時候做白內障手術

如果白內障變得成熟,就會為患者帶來一系列併發症:
例如:青光眼、葡萄膜炎

現時並不需要等待白內障成熟時或出現併發症後才進行手術。

  1. 當視力逐漸加深,視力不足以應付日常工作或生活需求

  2. 護士檢查發現視力下降

  3. 經過醫生檢查及進行商討後,才決定何時接受手術。

 

圖片_晶狀體混濁分級系統_LOCS III

如何治療白內障?

手術是醫治白內障的唯一方法。一般白內障手術在局部麻醉下進行的,醫生在手術室內使用顯微鏡下進行,利用超聲波乳化技術,將原本混濁的晶體取出,植入適合的人工晶體。這是一項微創手術,手術切口會比較細,不一定需要縫針,因此傷口康復時間也相對較快。

  1. 一般進行白內障手術需點局部麻醉藥水即可
  2. 將角膜開約 0.2 至 0.3 公分的小切口
  3. 以超音波探頭將混濁的晶體吸出
  4. 將人工晶體置入眼球中,取代原本的水晶體
圖片_白內障治療方法
圖片_ 手術後可能發生的併發症_青光眼_視網膜_細菌感染
手術後可能發生的併發症

如何選擇人工晶體?

圖片_選擇人工晶體_人工晶體種類

人工晶體

特點

Monofocal Intraocular Lens

高階單焦人工晶體

  1. 黄鏡/白鏡
  2. 高阿貝數,低折射率,高對比靈敏度
  3. 角膜球差(+0.28)和晶狀體球差(0.18 20歲;-0.160歲)剩餘球差(範圍:+0.1 > 40.18)
  4. 可以用單眼視覺治療老花

散光人工晶體

  1. ≥/= -1.50
  2. 散光定位,中心定位

廣視人工晶體

多焦人工晶體

  1. 一併改善患者的近視/遠視和老花
  2. 不適合高數值 angle kappa
  3. 有機會出現光暈和眩光人工晶體

如何預防白內障?

白內障並沒有資料顯示可以使用任何藥物或眼藥水可以有效治療或防止白內障的形成。
只要避免太陽的紫外光,因為眼睛長期曝曬在烈日下會提高白內障的機率,所以外出時,在烈日下應配戴防紫外光的太陽眼鏡。

白內障常見問題

如何確定哪種 IOL 最適合您?

您應想想以下問題:

  • Do you frequently use smartphones and tablets?
  • 你晚上經常開車嗎?
  • Do you have moderate to severe astigmatism?
  • Is it accompanied by eye diseases such as glaucoma or diabetes?
人工晶體的壽命多長?

For over 100 years, no cases have been reported where vision was impaired due to the aging of intraocular lenses. Therefore, there is no need to worry about the lifespan of these lenses. However, due to manufacturing issues, there have been extremely rare instances where lenses required replacement.

白內障手術前要準備什麼?
  • 家人陪同 :
    手術當天,應由一位成人陪同下準時到達,以便給予病人作手術前準備及術後護理。

  • 飲食 :
    手術當天不用禁食,但不宜進食過飽及飲過多水份。

  • 藥物 :
    除醫生指示外,原有日常服用之藥物請繼續服用。

  • 個人衛生 :
    手術前應事先沐浴及洗頭。

  • 服飾 :
    請穿著清潔衣物,避免穿窄領口上衣。
手術後要注意什麼?
  • For one week after surgery, protect your eyes with glasses, sunglasses, or an eye shield. Do not rub your eyes with your hands to avoid causing inflammation at the incision site. Gently wipe the area around your eyes with sterile cotton pads or clean tissues.
  • When applying eye drops, first pull down your lower eyelid and place the drops or ointment inside. Do not allow the tip of the eye drop bottle to touch your eye.
  • Patients may resume normal activities after routine cataract surgery without the need for bed rest. However, patients with traumatic injuries or complex cases such as those with concomitant glaucoma may require activity restrictions.
  • Regarding diet, there are no specific restrictions after surgery. However, it is advisable to limit consumption of spicy or irritating foods. For individuals with allergies, it is recommended to avoid foods high in protein content.
  • 手術後一個月內,不宜游泳、做劇烈運動及避免提重物(約超過三十磅)。頭部彎低時要小心,以免碰撞。
  • Do not remove the gauze or eye shield yourself on the day of surgery. The gauze and eye shield will be removed by the clinic nurse the day after surgery. You may shower, wash your hair, and wash your face starting the day after surgery, but use the showerhead carefully to avoid getting dirty water in your eyes. After the gauze and eye shield are removed, you may gently clean the upper and lower eyelids daily with cotton pads moistened with cooled boiled water or distilled water to remove secretions.
  • Follow your doctor's instructions and continue follow-up visits at the ophthalmology clinic until you are fully recovered. At each follow-up appointment, please bring the eye drops prescribed by your doctor for postoperative use.
  • If you experience unbearable pain at the wound site or a sudden decline in vision, seek immediate medical attention at a clinic.
白內障術後需要戴眼鏡嗎?

Whether glasses are required after cataract surgery depends on the type of intraocular lens implanted. Monofocal lenses, due to limitations in their optical design, necessitate glasses for correcting either distance or near vision postoperatively. Multifocal lenses can accommodate both distance and near vision, but are not suitable for patients with retinal diseases. Patients with astigmatism ranging from 150 to 400 degrees may consider toric intraocular lenses to achieve more comfortable postoperative vision.

白內障開過了還會再「復發」?

So-called "recurrent cataracts" refer to the intentional retention of the "posterior capsule" during cataract surgery to accommodate an intraocular lens. Over time, this capsule may thicken and become cloudy again. Fortunately, this type of "recurrent cataract" does not require another surgical procedure. Vision can be restored by simply using laser treatment in an outpatient setting to open the cloudy posterior capsule.

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