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Cortisone cataract

Index

The cataract is an ocular pathology characterized by the opacification of the lens, it is usually a condition related to aging, but it can arise at any age following the prolonged use of cortisone and in this case we speak of cortisone cataract.

Cortisones belong to the large group of chemical compounds called steroid compounds, or more simply steroids, present both in animals and in plants, where they have biological functions of fundamental importance. The most common cortisone in nature is the cortisol (or hydrocortisone), from which the cortisone and corticosterone. The steroids are potent anti-inflammatory and immunosuppressive agents, are the drugs of choice to combat severe inflammation (eg in the case of rheumatoid arthrosis) and to inhibit rejection reactions in patients who have undergone an organ transplant.

Furthermore, they represent real lifesavers in different situations, such as in the case of anaphylactic shock or bronchial asthma.

In the ophthalmology field, the most common and known side effect given by the use of cortisone drugs - in particular cortisone, dexamethasone and prednisone - is the development of posterior subcapsular cataract (PSC). The correlation between the prolonged use of cortisones and the formation of PSC has been known since the 60s and is valid not only for steroids administered systemically, but also for those taken topically (eye drops and ointments) and inhaled. (nasal sprays, aerosols).

There is a "dose-time effect” between the use of cortisone and the onset of cataracts: the higher the dose and the longer the treatment, the higher the probability of onset of cataracts. The inducing effect of PSC on children is faster, even at lower dosages. According to many researchers, in addition to the dose effect, individual susceptibility must also be considered, most likely due to genetic factors. In any case, the dose effect of cortisone poses a problem to which doctors must pay close attention when prescribing cortisone-based treatments to their patients, especially in view of a prolonged cure over time. 

Given the existence of an individual susceptibility to the same drug and of a different susceptibility of the same individual to different drugs, it is not possible to predict whether and when the administration of cortisone will give rise to a cataract, therefore it is always advisable to a patient under steroid treatment undergoes regular eye examinations to monitor the health of the lens.

Cortisone cataracts are usually bilateral and progress quite quickly. When the vision is so blurred that it is difficult, if not dangerous, to carry out normal daily activities - such as going down the stairs or driving the car - it is necessary to surgically remove the cataract. It is important not to linger too long, as as the lens becomes opaque, it becomes particularly hard and this can lead to complications during the surgery.

cortisone cataract

Diagnosis

When cortisone cataracts develop, the opacification of the lens makes the vision blurred and, depending on the extent and location of the opacification, there can be even very significant visual impediments. In addition to blurred vision, other typical symptoms of cataracts are: faded vision, impaired perception of colors, loss of contrast, increased sensitivity to light, glare, difficulty in night vision, need for more lighting when reading, double vision.


The instrumental examinations necessary during a thorough eye examination to diagnose and, if necessary, establish the right time to undergo cataract surgery are: the IOL Master which provides various anatomical parameters such as the length of the eyeball and the depth of the anterior chamber ( i.e. the distance between the cornea and the lens), which will have to be accessed with the surgical instruments during the surgery, the Pentacam (topography, pachymetry and no-contact biometry) which measures the thickness, the curvature of the cornea and the angular anatomical structure, the A-Scan ultrasound which is used to evaluate the size and hardness of the lens, the high resolution optical coherence tomography (OCT) that analyzes each individual retinal layer to see that there are no retinal pathologies before surgery, which they could become complicated due to an inflammatory effect linked to its execution in the post-operative period, and finally the B-Scan ultrasound which shows if the lens is well positioned and adhered for all its 360 ° to the suspensory apparatus (zonula) of the ciliary body and if there are no vitreous retinal tractions at the time of surgery such as to constitute an accessory risk factor.

Treatment

Thanks to the continuous advancement of technologies, the loss of vision caused by cataracts is nowadays easily reversible thanks to a surgery performed with the laser (femtolaser) or ultrasound (phacoemulsification) which involves the removal of the opacified lens and its replacement with an artificial lens (IOL) perfectly transparent. It is advisable to prevent the cataract from evolving to a point that causes blindness; it must be eliminated as soon as it begins to interfere with the normal performance of daily and work activities. It is always advisable not to wait for the cataract to arrive at the most advanced stage also because, as the opacification increases, the lens acquires a particularly high hardness and this can prevent the use of latest generation techniques and favor the onset of complications during surgical execution.

The intervention of cataract it is performed on an outpatient basis, lasts a few minutes (usually 10-15 minutes) and its execution is minimally invasive and absolutely painless; there are various types of anesthesia: we recommend a "blended anesthesia”, Which consists in the administration of local anesthetic eye drops and in a mild intravenous sedation which is adjusted from time to time according to the patient's state of anxiety. The post-operative period is free from particular hassles and is rather short (a few days). Cataract surgery gives excellent results, restoring perfectly clear vision in the vast majority of cases. It is also possible during the preoperative eye examination, after having performed all the instrumental examinations necessary for cataract surgery, to correct even large refractive defects (such as myopia, hyperopia, astigmatism or presbyopia), by implanting different types of artificial lenses (IOL ) according to the needs highlighted by the patient (yellow, toric or multifocal lenses).

Contraindications are very rare, but it is good to keep in mind that the risk of complications or less satisfactory outcomes is possible especially in patients suffering from serious pathologies of the cornea, retina or optic nerve; for this reason, before undergoing cataract surgery, it is very important to request an in-depth eye examination and evaluate together with your ophthalmologist how to obtain the maximum benefit of the intervention by minimizing the risk of side effects.

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Pathology and treatment on video

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