Cataract
Cataract
Mula Tarigan, SKp
PSIK FK USU
Wh t i
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t?
What is a cataract?
• A cataract is an opacity(or cloudy changes)
of the lens that can cause vision problems.
of the lens that can cause vision problems.
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• Keadaan yang menunjukkan adanya
kekeruhan lensa dari yang hanya terbentuk
titik sampai kekeruhan lensa yang
titik sampai kekeruhan lensa yang
menyeluruh.
LENS
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• The lens is surrounded by a thick lens capsule which is
the basement membrane of the lens epithelial cells.
• Epithelial cells at the lens equator continue to be
produced throughout life,so that older lens fibers are
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compressed into a central nucleus; younger fibers around
the nucleus make up the cortex.
causes
• Aging
most common
• Long-term ultraviolet (UV) light, especially from
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sunlight
• Diabetes or other systemic disease
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• Past eye infections, injuries or surgery
• Smoking
• Long term use of certain medications (such as
• Long-term use of certain medications (such as
steroids)
• Heredity
Heredity
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Pathogenesis
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• The lens is made mostly of water and protein. The
protein is arranged to let light pass through and
focus on the retina Sometimes some of the protein
focus on the retina. Sometimes some of the protein
clumps together. This can start to cloud small areas
of the lens, blocking some light from reaching the
retina and interfering with vision.
Cli i
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Clinical Findings
Symptoms
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Blurring or dimness of vision
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Blurring or dimness of vision
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Colors appear faded
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Sensitivity to light and glare
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Sensitivity to light and glare
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Double or multiple vision
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Ch
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Eye Exam
• Vision acuity test
• Slit lamp
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• Ophthalmoscope
• In most cases, eye drops are used to dilate (widen)
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(
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pupils before the exam.
• There are three major types of cataract
that are named depending on the
that are named depending on the
location within the lens that is most
affected These are cortical nuclear and
affected. These are cortical, nuclear and
posterior subcapsular.
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Cortical cataract
the most common type of age-related
cataract
four stages as follows:
four stages as follows:
Incipient stage
• Cortical changes may begin as small peripheral
ater clefts
water clefts
Intumescent stage
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The lens takes up water, it becomes intumescent
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Mature stage
• Liquid escapes and the lens shrinks
• The lens protein is totally opaque
The lens protein is totally opaque
Hypermature Stage
• A long-standing or very mature cataract may
undergo liquefaction of the lens cortex. This
liquid may escape through the intact
capsule,leaving a shrunken lens with a
wrinkled capsule
Thi
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This slide shows a lens that has been
removed at surgery.
Nuclear cataract
• Early onset (after middle age)
• The earliest symptom may be improved near vision
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(“
d i ht”)
without glasses (“second sight”)
• Other symptoms may include poor hue discrimination
or monocular diplopia.
Posterior subcapsular cataract
• Located in the cortex near the central posterior
capsule
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• It tends to cause visual symptoms earlier in their
development owing to involvement of the visual axis.
• Common symptoms include glare and reduced vision
Common symptoms include glare and reduced vision
Congenital Cataract
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Present at birth or appear shortly thereafter
These cataracts may show many different patterns.
The opacity may be confined to the area of the
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embryonic or fetal nucleus with clear cortex
surrounding this.
Etiology
•
Intra-uterine
virus infection
Maternal ingestion of Thalidomide, steroids,…
Hereditary
•
Hereditary
autosomal dominant
recessive X-linked
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Cataract Treatment
• Surgery
is the only way to remove the cataract.
However, if symptoms from a cataract are mild, a
change of glasses may be all that is needed for you
to function more comfortably.
• Cataract surgery should be considered when
cataracts cause enough loss of vision to interfere
with daily activities.
ECCE IOL
ECCE+IOL
• Extracapsular cataract extraction is a preferred
method of cataract surgery
• It preserves the posterior portion of the lens capsule
• Posterior chamber IOL can be implanted in the
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Intraocular Lens
• An IOL is a tiny, transparent, convex lens
made of polymer which is inserted in the eye
during surgery.
IOL
IOL
折式
可折式
6mm
6
Posterior chamber
Posterior chamber
type
Anterior chamber
type
type
Advantages of IOL
• Since the lens is placed inside the eye, the
patient need not wear glasses for distant
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vision.
• Images are clear and of the same dimension
Images are clear and of the same dimension
without distortion.
• Full vision is obtained soon after surgery
• Full vision is obtained soon after surgery.
Phacoemulsification
• Phacoemulsification
or phaco refers to ultra-sonic
vibration which dissolves the hard nucleus such that
the nuclear material and cortex can be aspired
through an incision of approximately 3mm.
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• it is the key to advanced , small-incision cataract
surgery.
Complications
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• posterior capsule opacification
• cystoid macular edema
• glaucoma
• hyphema
• ptosis
• infection
• retinal detachment
• lens dislocation
Cataract
Surgery
animation
animation
Nursing Diagnoses
a. Perubahan sensori perseptual: visual b/d kekeruhan pd lensa d/d pupil tampak putih, pasien mengeluhkan pandangan
kabur, berkabut, atau pandangan ganda dan gangguan , , p g g g gg penglihatan.
b. Ketakutan/ ansietas b/d kerusakan sensori dan kurang
pemahaman mengenai perawatan pasca operasi, pemberian pemahaman mengenai perawatan pasca operasi, pemberian obat.
c. Resiko cedera b/d penurunan visus atau berada di lingkungan yang kurang dikenal
d. Resiko cedera b/d komplikasi pasca operasi spt; pendarahan atau peningkatan tekanan intra okuler.
e Defisit perawatan diri b/d kelemahan visual dan perawatan e. Defisit perawatan diri b/d kelemahan visual dan perawatan
mata pasca operasi.
f. Resiko tinggi infeksi b/d prosedur invasif (bedah pengangkatan katarak)
pengangkatan katarak)
g. Kurang pengetahuan ttg kondisi pengobatan dan perawatan pasca operasi b/d terbatasnya informasi atau kesalahan
interpretasi informasi interpretasi informasi.
a. Perubahan sensori perseptual: visual b/d kekeruhan pd lensa d/d pupil tampak putih, pasien mengeluhkan pandangan
kabur, berkabut, atau pandangan ganda dan gangguan , , p g g g gg penglihatan.
Tujuan : Pasien mendemonstrasikan peningkatan
kemampuan untuk memproses rangsangan visual dan kemampuan untuk memproses rangsangan visual dan mengkomunikasikan pembatasan pandangan.
Kriteria Hasil:
Visus meningkat – Visus meningkat
Intervensi
Mandiri: 1 kaji ketajaman penglihatan klien Mandiri: 1. kaji ketajaman penglihatan klien
2. berikan pencahayaan yg plg sesuai dgn klien 3. cegah glare atau sinar yg menyilaukan
4. letakkan brg2 pd tempat yang konsisten
5. gunakan materi dgn tulisan besar dan kontras
c. Resiko cedera b/d penurunan visus atau berada di lingkungan yang kurang dikenal.
Tujuan: Klien tidak mengalami cedera akibat jatuh.
Kriteria Hasil:
- Pasien mengenal lingkungan
Intervensi:
1. kurangi resiko bahaya dari lingkungan klien.
2 beritahu klien utk mengubah posisi secara perlahan 2. beritahu klien utk mengubah posisi secara perlahan.
3. beritahu klien utk tdk meraih benda untuk stabilitas saat ambulasi.
4. dorong klien utk menggunakan peralatan adaftif (tongkat atau walker) untuk ambulasi sesuai kebutuhan.
5. tekankan pentingnya utk menggunakan pelindung mata saat melakukan aktifitas beresiko tinggi.
g.Kurang pengetahuan ttg kondisi pengobatan dan perawatan pasca operasi b/d terbatasnya informasi atau kesalahan
interpretasi informasi.p
Tujuan : menyatakan pemahaman kondisi/ proses penyakit dan pengobatan.
Kriteria Hasil:
- Respon verbal memahami proses penyakit dan pengobatan - Menunjukkan tindakan yang kooperatif
Intervensi :
1. kaji informasi ttg kondisi individu, prognosis, tipe prosedur atau lensa.
2. tekankan pentingnya evaluasi perawatan rutin.
3. informasikan pasien utk menghindari tetes mata yg dijual bebas.
4. diskusikan kemungkinan efek/interaksi antara obat, mata dan masalah medis pasien.
5. dorong pemasukan cairan adekuat, makanan berserat/kasar, g p , , gunakan pelunak feses yg dijual bebas, bila diindikasikan.
6. identifikasi tanda/gejala yg memerlukan upaya evaluasi medis.
Warning Signs
Warning Signs
• Reduction in visual acuity • Photophobia
• Purulent discharge • Purulent discharge • ‘Red Eye’
Post Operative Requirements
Post Operative Requirements
• Discharge with eyedrops
–Dexamethasone
–Topical steroid – reduces post-op inflammationTopical steroid reduces post op inflammation
• Do not lift weights of over 10kg for al least 6 weeks • Do not bend from the waist for prolonged periods
W hi ld t i ht f th fi t 14 d t t • Wear an eye shield at night for the first 14 days to prevent
• 1st day post-op follow up for specific patient groups only:
– Glaucoma – DiabetesDiabetes
–Non-standard or complex surgery
• Review in clinic two weeks after surgery • Autorefraction
• Autorefraction
• Was the post-op outcome as expected • Visual acuity; pathology or refraction?
