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CataractMula Tarigan, SKp
PSIK FK USU
What is a cataract?
• A cataract is an opacity(or cloudy changes)
of the lens that can cause vision problems.
• Keadaan yang menunjukkan adanya kekeruhan lensa dari yang hanya terbentuk titik sampai kekeruhan lensa yang menyeluruh.
LENS
• 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 • Epithelial cells at the lens equator continue to be
produced throughout life,so that older lens fibers are
compressed into a central nucleus; younger fibers around
the nucleus make up the cortex.
causescausescausescauses• Aging most common
• Long-term ultraviolet (UV) light, especially from sunlight
• Diabetes or other systemic disease• Diabetes or other systemic disease
• Past eye infections, injuries or surgery
• Smoking
• Long-term use of certain medications (such as steroids)
• Heredity
Pathogenesis• 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
clumps together. This can start to cloud small areas 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
Clinical Findings
Symptoms� Blurring or dimness of vision
� Colors appear faded � Colors appear faded
� Sensitivity to light and glare
� Double or multiple vision
� Change in refraction
Eye ExamEye ExamEye ExamEye Exam
• Vision acuity test
• Slit lamp
• Ophthalmoscope • Ophthalmoscope
• In most cases, eye drops are used to dilate (widen)
pupils before the exam.
• Tonometry
• There are three major types of cataract
that are named depending on the
location within the lens that is most location within the lens that is most
affected. These are cortical, nuclear and
posterior subcapsular.
Cortical cataract
� the most common type of age-related
cataract
� four stages as follows:
Incipient stage
• Cortical changes may begin as small peripheral
water clefts
• Radical pattern opacity• Radical pattern opacity
Intumescent stage
�The lens takes up water, it becomes intumescent.
�Anterior chamber gets shallow
Mature stage
• Liquid escapes and the lens shrinks
• 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 capsule,leaving a shrunken lens with a
wrinkled capsule.
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 without glasses (“second sight”)
• Other symptoms may include poor hue discrimination • Other symptoms may include poor hue discrimination
or monocular diplopia.
Posterior subcapsular cataract
• Located in the cortex near the central posterior
capsule
• It tends to cause visual symptoms earlier in their
development owing to involvement of the visual axis.development owing to involvement of the visual axis.
• Common symptoms include glare and reduced vision
under bright lighting conditions.
Congenital Cataract
�Present at birth or appear shortly thereafter
�These cataracts may show many different patterns.
The opacity may be confined to the area of the The opacity may be confined to the area of the
embryonic or fetal nucleus with clear cortex
surrounding this.
Etiology
• Intra-uterine
�virus infection
�Maternal ingestion of Thalidomide, steroids,…
• Hereditary
� autosomal dominant
� recessive X-linked
Cataract TreatmentCataract TreatmentCataract TreatmentCataract 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.to function more comfortably.
• Cataract surgery should be considered when
cataracts cause enough loss of vision to interfere
with daily activities.
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
capsular sac
Intraocular Lens
• An IOL is a tiny, transparent, convex lens
made of polymer which is inserted in the eye
during surgery.
IOLIOL
可折式可折式可折式可折式6mm
Foldable IOL
Posterior chamber
type
Anterior chamber
type
Advantages of IOL
• Since the lens is placed inside the eye, the
patient need not wear glasses for distant
vision. vision.
• Images are clear and of the same dimension
without distortion.
• 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. through an incision of approximately 3mm.
• it is the key to advanced , small-incision cataract
surgery.
Complications
• posterior capsule opacification
• cystoid macular edema
• glaucoma
• hyphema• hyphema
• ptosis
• infection
• retinal detachment
• lens dislocation
Cataract
SurgerySurgery
animation
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
penglihatan.
b. Ketakutan/ ansietas b/d kerusakan sensori dan kurang b. Ketakutan/ ansietas b/d kerusakan sensori dan kurang
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
mata pasca operasi.
f. Resiko tinggi infeksi b/d prosedur invasif (bedah
pengangkatan katarak)
g. Kurang pengetahuan ttg kondisi pengobatan dan perawatan
pasca operasi b/d terbatasnya informasi atau kesalahan
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
penglihatan.
Tujuan : Pasien mendemonstrasikan peningkatan Tujuan : Pasien mendemonstrasikan peningkatan
kemampuan untuk memproses rangsangan visual dan
mengkomunikasikan pembatasan pandangan.
Kriteria Hasil:
– Visus meningkat
– Respon verbal peningkatan penglihatan
Intervensi
Mandiri: 1. kaji ketajaman penglihatan klien
2. berikan pencahayaan yg plg sesuai dgn klien2. 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
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 perawatan
Intervensi:
1. kurangi resiko bahaya dari lingkungan klien.
2. beritahu klien utk mengubah posisi secara perlahan.
3. beritahu klien utk tdk meraih benda untuk stabilitas saat 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.
Tujuan : menyatakan pemahaman kondisi/ proses penyakit
dan pengobatan.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 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, gunakan pelunak feses yg dijual bebas, bila diindikasikan.
6. identifikasi tanda/gejala yg memerlukan upaya evaluasi medis.
Warning Signs
• Reduction in visual acuity
• Photophobia
• Purulent discharge
• ‘Red Eye’• ‘Red Eye’
• Pain vs. ‘Picking’
Post Operative Requirements
• Discharge with eyedrops
–Dexamethasone
–Topical 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
• 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
– Diabetes
–Non-standard or complex surgery
• Review in clinic two weeks after surgery• Review in clinic two weeks after surgery
• Autorefraction
• Was the post-op outcome as expected
• Visual acuity; pathology or refraction?
That’s all for today!