The earliest documented cataract p...

The earliest documented cataract performances date from the fifth hundred BC. The Hindu surgeon Susruta performed a archetype of cataract surgery known as couching. (1) The performance involved displacing the lens from the pupil into the vitreous cavity. Patients could papal court better, but vision was still blurry because no corrective lense were available at that time. In 1747 Jacques Daviel, MD after performing a failed couching deed completed the first cataract extraction at removing a patient's lens from its normal position behind the iris. (2) Cataract surgery still is performed today using a similar form of this technique.

Although cataract acts continued to improve since that first management patients having cataract surgery in the 18th and 19th centuries faced several obstacles. Patients with cataracts still were aphakic (ie, not having the crystalline len in the eye) and although corrective lense were available, they were cumbersome and frequently made activities of daily living more difficult for patients. Postoperative regaining was difficult as well. With these early attempts at cataract removal, patients were placed onward complete bed rest. For the first 24 to 48 hours, patients had to lie flat in bed without on a level a small pillow under the head. Sandbags were placed upon either side of the head to debar movement. Both of the patients' judgments had to be patched, which completely chokeed vision. For the first four postoperative days, patients were not allowed to head-tuft their hair, brush their teeth or fe themselves. forward the second postoperative day, the head of the bed could be elevated slightly. Dressings were remov from the nonsurgical notice and patients were allowed to sit in a chair upon the fifth postoperative day. The surgical sight remained patched for 10 to 14 days. (3)

Cataract surgery continued to improve during the 20th hundred In 1949, Harold Ridley, MD bring to maturityed and implanted the first intraocular len (4) This manner of proceeding has become the gold standard for cataract surgery today and is individual of the most commonly performed surgical operations for Medicare recipients. Today, cataract surgery has been refined significantly. Patients note the health care facility the day of surgery and many times return home within three to four hours. Implantable lense have improved in the same manner much that additional vision correction no longer is necessary, and cataract surgery comes are so favorable that patients bear the procedure as soon as the cataract interferes with their activities of daily living. In the past, the bulk of mankind suffered with worsening vision until the cataract was mature or "ripe."

ANATOMY AND PHYSIOLOGY OF THE EYE

The inspection is a soft tissue organ, which, when explain exposes the central nervous combination of parts to form a whole to outside elements (Figure 1) (5) The cornea is the transparent external surface that transmits and focuses the light as it notes the eye. The iris is the colored part that helps regulate the amount of light entering the sight The pupil is the dark center in the middle of the judgment that changes size to adjust for the amount of available light. The crystalline len is a transparent fabric situated behind the iris. The primary part of the lens is to refract (ie, bend) light rays to such a degree that they give a clear image to the retina. (6) Zonule are ligaments attached to the anterior portion of the ciliary material part that help suspend the len The ciliary visible form [i]or[/i] frame is the wedge-shaped thickening in the middle layer of the eyeball, which separate s most of the aqueous humor. The len cortex lies between the epithelium and nucleus upon the anterior and posterior sides. The len cortex also is known as secondary len fibers. Accommodation is the proces in which the ciliary muscles contract and relax tension onward the zonules allowing the len to change shape. Accommodation enables a sharp image to form in succession the retina and allows an individual to focus upon objects that are at varying distances from the notice (7)

[FIGURE 1 OMITTED]

A cataract is when the crystalline len becomes dark (8) Cataracts cause a decrease in visual acuity, blurr vision, glare, and a decrease in green-blue color vision.

ETIOLOGY OF CATARACT FORMATION

Age is the greatest in number common cause of cataract formation. As the len ages, it increases in weight and thickness, and its proteins bear a chemical change. This causes an increase in pigmentation, which lessens transparency. The lens then becomes yellowish or brownish in color. (9)

Other causes of cataract formation are

* long-term use of certain medications, like as corticosteroids and psychotropics (eg phenothiazine);

* metabolic disorders;

* congenital or infantile cataract disorders, and

* trauma.

Metabolic disorders (eg diabetes) can cause cataract formation because of an increase in ocular starch-sugar content. The glucose enters the len from diffusion and is converted into sorbitol, which is not metabolized and, therefore, remains in the lens

Congenital and infantile cataracts present itself in one in every 2000 live births. Cataracts that expand within the first year of life are known as infantile cataracts. greatest in number congenital and infantile cataracts are from undetermined causes. (10)