CataractCataractMula Tarigan, SKp

PSIK FK USUPSIK FK USU

Wh t i t 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.

K d j kk d• Keadaan yang menunjukkan adanya kekeruhan lensa dari yang hanya terbentuk titik sampai kekeruhan lensa yangtitik sampai kekeruhan lensa yang menyeluruh.

LENSTh l i d d b thi k l l hi h i• 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

d i l l fib dcompressed into a central nucleus; younger fibers around the nucleus make up the cortex.

causes• Aging most common• Long-term ultraviolet (UV) light, especially from

li hsunlight • Diabetes or other systemic disease

P t i f ti i j i• Past eye infections, injuries or surgery • Smoking • Long term use of certain medications (such as• Long-term use of certain medications (such as

steroids) • HeredityHeredity

P h iPathogenesisTh l i d tl f t d t i Th• 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 proteinfocus 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.

normal Vs. cloudy lens

Cli i l Fi diClinical FindingsSymptoms

Blurring or dimness of visionBlurring or dimness of vision Colors appear faded Sensitivity to light and glareSensitivity to light and glare Double or multiple vision Ch i f iChange in refraction

Eye Exam

• Vision acuity test • Slit lamp p• Ophthalmoscope • In most cases, eye drops are used to dilate (widen) , y p ( )

pupils before the exam.• Tonometryy

• There are three major types of cataract that are named depending on thethat are named depending on the location within the lens that is most affected These are cortical nuclear andaffected. These are cortical, nuclear and posterior subcapsular.

C i lCortical cataractthe 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 cleftswater clefts

• Radical pattern opacity

Intumescent stage

The lens takes up water, it becomes intumescent.A t i h b t h llAnterior chamber gets shallow

Mature stage

• Liquid escapes and the lens shrinks• The lens protein is totally opaqueThe 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 capsulewrinkled capsule.

Thi lid h l th t h bThis 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

ith t l (“ d i ht”)without glasses (“second sight”) • Other symptoms may include poor hue discrimination

or monocular diplopia.or monocular diplopia.

Posterior subcapsular cataract

• Located in the cortex near the central posterior capsuleIt t d t i l t li i th i• It tends to cause visual symptoms earlier in their development owing to involvement of the visual axis.

• Common symptoms include glare and reduced visionCommon symptoms include glare and reduced vision under bright lighting conditions.

Congenital Cataractbi h h l h fPresent at birth or appear shortly thereafter

These cataracts may show many different patterns. The opacity may be confined to the area of the

b i f t l l ith l tembryonic or fetal nucleus with clear cortex surrounding this.

Etiology

• Intra-uterine virus infectionMaternal ingestion of Thalidomide, steroids,…

Hereditary• Hereditaryautosomal dominant recessive X-linkedrecessive X linked

C t t T t tCataract Treatment• Surgery is the only way to remove the cataract.

However, if symptoms from a cataract are mild, achange of glasses may be all that is needed for youto function more comfortably.

• Cataract surgery should be considered whencataracts cause enough loss of vision to interferewith daily activities.

ECCE IOLECCE+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

capsular sac

I l LIntraocular Lens• An IOL is a tiny, transparent, convex lens

made of polymer which is inserted in the eye during surgery.

IOLIOL折式可折式

6mm6

Foldable IOLoldable O

Posterior chamberPosterior chambertype

Anterior chambertypetype

Advantages of IOL

• Since the lens is placed inside the eye, the patient need not wear glasses for distant p gvision.

• Images are clear and of the same dimensionImages 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. i i h k d d ll i i i• it is the key to advanced , small-incision cataract surgery.

Complications

i l ifi i• posterior capsule opacification• cystoid macular edema • glaucoma• hyphema• ptosis• infection• retinal detachment • lens dislocation

CataractSurgeryanimationanimation

Inserting the new lens

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 ggpenglihatan.

b. Ketakutan/ ansietas b/d kerusakan sensori dan kurang pemahaman mengenai perawatan pasca operasi, pemberianpemahaman mengenai perawatan pasca operasi, pemberian obat.

c. Resiko cedera b/d penurunan visus atau berada di lingkungan yang kurang dikenallingkungan 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 perawatane. 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 informasiinterpretasi 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 ggpenglihatan.Tujuan : Pasien mendemonstrasikan peningkatan kemampuan untuk memproses rangsangan visual dankemampuan untuk memproses rangsangan visual dan mengkomunikasikan pembatasan pandangan.Kriteria Hasil:

Visus meningkat– Visus meningkat– Respon verbal peningkatan penglihatan

IntervensiMandiri: 1 kaji ketajaman penglihatan klienMandiri: 1. kaji ketajaman penglihatan klien

2. berikan pencahayaan yg plg sesuai dgn klien3. cegah glare atau sinar yg menyilaukan4. letakkan brg2 pd tempat yang konsisten5. gunakan materi dgn tulisan besar dan kontras

Kolaborasi : pembedahan

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 - Pasien tidak jatuh selama perawatanPasien tidak jatuh selama perawatan

Intervensi:1. kurangi resiko bahaya dari lingkungan klien.2 beritahu klien utk mengubah posisi secara perlahan2. 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.pTujuan : 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 SignsWarning Signs

• Reduction in visual acuity• Photophobia• Purulent discharge• Purulent discharge• ‘Red Eye’• Pain vs. ‘Picking’

Post Operative RequirementsPost 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 inadvertent rubbing of the eye when asleep

• 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?

That’s all for today!