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!