将人工制造的记忆植入大脑_我们植入一个人工晶状体（60年后您将需要它）

将人工制造的记忆植入大脑

The lens in your eye can change its optical power: when you focus somewhere on the vision, this is what happens. Payback for the «moving parts of the mechanism» — wear with age. At about 40-45 years old, problems usually begin with age-related visual impairment; in 60-70 years, you need up to three pairs of different points. At the same time, the clarity of view is reduced due to the process of sclerosis and lens opacity — it is worth thinking about replacing the lens, until it becomes dim and becomes completely rigid.

眼睛中的晶状体可以改变其屈光力：当您将焦点对准视觉时，就会发生这种情况。 «机构的运动部件»的投资回报–随着年龄的增长而磨损。 在大约40-45岁时，问题通常始于与年龄相关的视力障碍； 在60-70年间，您最多需要三对不同的点。 同时，由于硬化和晶状体不透明的过程，视野的清晰度降低了–值得考虑更换晶状体，直到变暗并变得完全僵硬为止。

To date, the technology of replacing the lens is standardized and well developed. Potential risks are generally somewhat higher than with laser vision correction, but at present this type of surgery is performed even on transparent lenses with refractive purpose (when the patient does not like to wear glasses with thick glasses), that is, it is quite a “household” task for ophthalmology.

迄今为止，更换镜头的技术已经标准化并得到了很好的发展。 通常，其潜在风险要比激光视力矫正要高一些，但是目前，即使在具有屈光目的的透明镜片上进行这种手术(当患者不喜欢戴厚眼镜的眼镜时)，也就是眼科的“家庭”任务。

什么是人工晶状体？ (What is an artificial lens?)

This is a piece of acrylic (or silicone, or polymethyl methacrylate (PMMA), or even some polymer), implanted into the cavity of the eye. The softness of the implant depends on the material from which it is made. Conventionally, models are divided into rigid, that is, incapable of “folding” and therefore implanted through wide cuts in the “original” form, and “soft, elastic” — capable of rolling into a “roll”. For example, a “hard” non-deformed PMMA lens can be placed inside the eye through an incision of 6.2 — 6.5 millimeters. In this case, the cut should correspond to the diameter of the optical zone — and the optical zone less than 6 millimeters gives a large optical distortion.

这是一块丙烯酸(或硅树脂，或聚甲基丙烯酸甲酯(PMMA)，甚至是某些聚合物)，植入眼睛的腔中。 植入物的柔软度取决于制成植入物的材料。 按照惯例，模型分为刚性模型(即无法“折叠”)，因此通过“原始”形式的宽切口植入，以及“柔软，弹性”(能够滚动成“卷”)。 例如，可以通过6.2到6.5毫米的切口将“硬”未变形的PMMA镜片放置在眼睛内部。 在这种情况下，切口应对应于光学区域的直径，并且小于6毫米的光学区域会产生较大的光学畸变。

Soft lenses began to implant historically through incisions of 3.75 mm, folding them in half with tweezers. Then they moved to smaller cuts, more similar to a 2.75 — 2.5 mm puncture, because they were made with a single instrument — a microkeratome, creating a stepped self-sealing incision. Thus began the era of seamless cataract microsurgery.

从历史上看，软晶状体开始通过3.75毫米的切口植入，然后用镊子将其折叠成两半。 然后，他们移动到较小的切口，更类似于2.75毫米(2.5毫米)的刺Kong，因为它们是用单个器械–微型角膜刀制成的，形成了阶梯状的自密封切口。 因此开始了无缝性白内障显微手术时代。

In fact, all the time in cataract surgery, the development of its removal technology goes side by side with the development of materials for intraocular lenses. If the lens is removed after 6 mm (as it was with extracapsular cataract extraction — EEC), then you can be satisfied with a rigid intraocular lens with 6 mm optics. With the advent of phacoemulsification through 2.75 mm, the need arose for such lenses that fold to a size of 2.5 mm. Previously, there was simply no need: the diameter of the cut is a limiting factor. And when we switched to microfaco emulsification through 2.0 — 1.8 mm, the lenses became more flexible and the systems for their implantation became even more jeweler. By the way, when I say we, I mean clinics where equipment is being modernized according to current trends. But still enough places

实际上，在白内障手术中，一直以来，其去除技术的发展与人工晶状体材料的发展并驾齐驱。 如果在6毫米后摘除晶状体(如使用囊外白内障摘除术— EEC一样)，那么您对6毫米光学镜的刚性人工晶状体会感到满意。 随着2.75mm超声乳化的出现，需要折叠成2.5mm尺寸的这种镜片。 以前根本没有必要：切口的直径是一个限制因素。 当我们通过2.0 – 1.8 mm的微乳化进行乳化时，晶状体变得更加柔韧，植入系统变得更加精巧。 顺便说一句，当我说我们时，我指的是根据当前趋势对设备进行现代化改造的诊所。 但是还有足够的地方

Today we remove a cataract of any density through a puncture of 1.7 mm — 1.8 mm (which requires quite expensive consumables), many clinics in Russia work with a puncture length of 2.2 — 2.0 mm (this is also a good indicator). For these sizes, special lenses are needed that can be implanted through a puncture of this magnitude — these are more modern types of lenses. It's a shame if for implantation it is necessary to expand the incision for models of older generations of IOL. The experience and skills of the surgeon are also decisive — the lens itself does not sink into the patient's eye.

今天，我们通过1.7毫米至1.8毫米的穿刺(需要相当昂贵的消耗品)去除任何密度的白内障，俄罗斯的许多诊所都使用2.2到2.0毫米的穿刺长度(这也是一个很好的指标)。 对于这些尺寸，需要特殊的透镜，这些透镜可以通过这种大小的穿刺来植入-这些是更现代的透镜类型。 如果要植入，对于老一代的IOL模型必须扩大切口是很可惜的。 外科医生的经验和技巧也很重要-镜片本身不会沉入患者的眼睛。

所以这就是手术前后 (So, this is what happens before and during surgery)

1.患者到诊所进行诊断。 (1. The patient comes to the clinic for diagnosis.)

If it turns out after it that a lens has to be replaced, the patient has time to think — usually, with the exception of injuries and serious pathologies, the operation suffers weeks. We need quite a serious comprehensive diagnosis for the correct choice of the model and the calculation of the lens. In addition to a general study of optics of the eye, control of intraocular pressure, examination of the fundus with an enlarged pupil, this complex includes the study of visual fields, counting endothelial cells of the cornea, optical or ultrasound biometry, ultrasound scanning of the vitreous body and retina, often optical coherent tomography and corneal keratotopography. This whole set of studies allows you to make the right choice of intraocular lens.

如果后来发现必须更换镜片，则患者有时间思考-通常，除了受伤和严重的病状之外，手术需要数周时间。 为了正确选择模型和计算镜片，我们需要进行认真的全面诊断。 除了对眼睛的光学进行常规研究，控制眼内压，对瞳Kong扩大进行眼底检查外，该复合体还包括视野研究，角膜内皮细胞计数，光学或超声生物测定法，超声扫描玻璃体和视网膜，通常是光学相干断层扫描和角膜角膜地形图。 这整套研究使您能够正确选择人工晶状体。

2.与患者的讨论非常注意，患者需要在不戴眼镜的情况下矫正视力。 (2. Much attention is paid to the discussion with the patient about the distance at which he needs to have vision without correction with glasses.)

We remember that a new lens with monofocal optics is calculated on a specific focus (as a rule, it is a distance), and in this case you will need glasses for reading. If a patient has an active lifestyle and a great desire not to use glasses either for distance or near, then a multifocal lens is needed. If there is astigmatism, then to compensate for it, the most correct choice of IOL is the astigmatic (toric) lens. If there is both astigmatism and the desire to get rid of glasses, then the choice is the most difficult — the multifocal astigmatic lens.

我们记得有一个新的具有单焦点光学元件的镜片是在特定焦点上计算的(通常是一个距离)，在这种情况下，您将需要戴眼镜阅读。 如果患者有积极的生活方式，并且非常希望在远距离或近距离不使用眼镜，则需要多焦点眼镜。 如果存在散光，那么为了补偿它，IOL的最正确选择是散光(复曲面)镜片。 如果既有散光又有摆脱眼镜的愿望，那么选择是最困难的-多焦点散光镜片。

Another surgeon always takes into account the state of the retina, the safety of the lens ligaments, the state of the cornea — in general, the expert should be a competent surgeon, not a neighbor or a friend

另一位外科医生总是考虑到视网膜的状态，晶状体韧带的安全性，角膜的状态-通常，专家应该是有能力的外科医生，而不是邻居或朋友

3.手术前一天，进行了具有一般治疗性质的实验室和仪器检查的准备工作。 (3. The day before the operation, a preparatory complex of laboratory and instrumental examinations of general therapeutic nature is carried out.)

在手术当天 (On the day of surgery, )

the patient leads a normal life — he eats breakfast, takes medications prescribed by other doctors and arrives at the clinic at the appointed time.

患者过着正常的生活-吃早餐，服用其他医生开的药，并在指定时间到达诊所。

He spends several hours in the clinic; most of this time is spent preparing for the operation — pupil dilation, pressure control, and other manipulations.

他在诊所呆了几个小时。 这大部分时间用于准备手术-瞳Kong扩张，压力控制和其他操作。

The duration of the operation with a standard cataract is 10-15 minutes. It is performed under local anesthesia, often only drops are sufficient. During the operation, the patient can talk himself and hears the voice of the surgeon, sees the light in front of the eye and feels watering. This is a painless procedure. In some cases, of course, you can perform the operation under general anesthesia, but for this you need to have medical indications or a patient’s desire. And if there is no evidence, then I do not recommend doing so — 10 minutes of anxiety are not worth it. The main manipulations will not be visible — tools rarely get into focus. Even the most anxious patients endure the surgery very calmly.

标准白内障手术时间为10-15分钟。 它是在局部麻醉下进行的，通常只需滴一滴就足够了。 手术过程中，患者可以说话，听见外科医生的声音，看到眼前的光并感到流水。 这是一个无痛的过程。 当然，在某些情况下，您可以在全身麻醉下进行手术，但是为此，您需要具有医学适应症或患者的意愿。 如果没有证据，那么我不建议您这样做-10分钟的焦虑是不值得的。 主要操作将不可见-工具很少成为焦点。 即使是最焦虑的患者，也可以非常平静地忍受手术。

4.手术后 (4. After surgery)

after an hour and a half, you can go home on your own, but we recommend doing this with the accompaniment, since on the way home the operated eye remains covered with a bandage. With a drop of drops, which must be dripped into the operated eye every 3 hours — it turns out 5 times a day.

一个半小时后，您可以自己回家，但我们建议您在伴奏下进行此操作，因为在回家的路上，手术眼仍被绷带遮盖。 滴一滴药水，必须每3小时将其滴入手术的眼睛中-每天可滴5次。

5.第二天早上 (5. The next morning,)

you need to come to the first postoperative examination, subsequent visits are scheduled once a week for a month. Selection of glasses is also recommended not earlier than 3-4 weeks, since after any operation the optics of the eye is restored gradually.

您需要进行首次术后检查，计划以后每个月一次，每月一次。 还建议不早于3-4周选择眼镜，因为在进行任何手术后，眼睛的视力会逐渐恢复。

晶状体超声乳化术如何运作 (How is the operation of the phacoemulsification of the lens)

The idea of ​​ultrasonic phacoemulsification of the lens appeared in the American ophthalmologist Charles Kelman, when he was in the dentist’s chair, where ultrasound was used to clean the teeth. He thought — why not crush a dense lens with energy, say ultrasound, through a small hole and remove through it the same? It took a lot of perseverance and great luck to translate the idea into reality. It was in the 60s of the last century. In 1967, the publication “Phacoemulsification and aspiration.” Appeared in the “American Journal of Ophthalmology”. A new technique of cataract removal. A preliminary report on a new technique for removing cataracts using low-frequency ultrasound in an experiment in the eyes of animals. Kelman together with the company Cavitron (CavitronKelman irrigation and aspiration phacoemulsification system — a prototype of modern phacomachines) developed and patented in 1971 the first model of phacoemulsifier. It consisted of an electronic ultrasonic energy generator unit (frequency 40 kHz) and a nickel piezoelectric transducer with replaceable needles with channels for irrigation and aspiration. So, by the way, this year, on May 8, the technology of ultrasonic phacoemulsification of the lens turned 50 years old.

超声超声乳化晶状体的想法出现在美国眼科医生查尔斯·凯尔曼(Charles Kelman)时，当时他坐在牙医的椅子上，在那里使用超声波清洁牙齿。 他想着-为什么不通过一个小Kong用一个能量(例如超声波)压碎一个密实的透镜，然后通过一个小Kong将其取出呢？ 将创意转化为现实需要大量的毅力和运气。 那是在上世纪60年代。 1967年，出版了《超声乳化和抽吸》。 出现在《美国眼科杂志》上。 一种去除白内障的新技术。 有关在动物眼中进行的实验中使用低频超声消除白内障的新技术的初步报告。 Kelman与Cavitron公司(CavitronKelman冲洗和抽吸超声乳化系统-现代超声乳化机的原型)一起开发并于1971年获得了第一台超声乳化剂的专利。 它由一个电子超声能量发生器单元(频率40 kHz)和一个镍压电换能器组成，该换能器带有可更换的针头，带有用于冲洗和抽吸的通道。 因此，顺便说一下，今年5月8日，晶状体的超声超声乳化技术已经有50年历史了。

Modern machines, like the original Kelman model, consist of an electromagnetic generator with a handle with a titanium needle connected to it, which oscillates in the longitudinal direction at ultrasonic frequencies. The lens collapses into small fragments of the fakoigla, through the hollow central opening of which they are aspirated due to the suction action of the pump. The success of the operation depends largely on the balance between the processes of cataract mass aspiration and irrigation. The balance between the inflow and outflow of fluid ensures the maintenance of spaces in the anterior segment of the eye, since the whole process takes place in a closed system. It should be noted that the invention of CDKelman was not immediately accepted into clinical practice. At the time of the invention of phacoemulsification, the most popular cataract removal technique was cryoextraction (lens freezing and removal with a capsule through a 12 mm incision), intraocular lenses were rarely implanted, and aphakia correction was essentially the prescription of spectacle lenses. Phacoemulsification changed all the canons. The widespread introduction of microsurgery (i.e., operations under an increase in the operating microscope) and, most importantly, the introduction of small incisions began.

像原始的Kelman模型一样，现代机器由电磁发生器组成，该电磁发生器的手柄上连接有钛制针头，该手柄在超声波频率下沿纵向振动。 晶状体塌陷成fakoigla的小碎片，由于泵的抽吸作用，它们通过中空的中央开口被吸出。 手术的成功很大程度上取决于白内障大量抽吸和冲洗之间的平衡。 流体流入和流出之间的平衡确保了眼睛前段的空间保持，因为整个过程都在封闭的系统中进行。 应当指出，CDKelman的发明并未立即被临床实践接受。 在发明超声乳化术时，最流行的白内障摘除技术是冷冻摘除术(镜片冷冻和通过12 mm切口用胶囊摘除)，很少植入人工晶状体，无晶状体矫正术实际上是配戴眼镜片的处方。 超声乳化改变了所有标准。 显微外科手术的广泛引入(即在手术显微镜的增加下进行手术)，最重要的是，开始引入小切口。

因此，操作的阶段如下： (So, the stages of the operation are as follows:)

1. Access to the lens is performed through the limb zone (where the transparent part of the cornea becomes opaque), two or three small punctures are made — one or two 20G each and one main a little more — 1.8-2.0 mm (depending on the technique that prefers a surgeon). In this zone, the punctures grow very well, it is convenient to work and it is difficult to find them in a couple of weeks even under a microscope.

   可以通过肢体区域(角膜的透明部分变得不透明)进入晶状体，进行两次或三个小刺Kong-每次1或2个20G，一个刺Kong稍多一点-1.8-2.0 mm(取决于偏爱外科医生的技术)。 在该区域，穿刺非常好，便于操作，即使在显微镜下也很难在几周内找到它们。

2. Through the first main puncture, an ultrasonic tip is inserted with a silicone “sleeve” on the outside. Through the second entrance of smaller diameter — a manipulation chopper (a “poker” for dividing the lens into fragments). The cap is supplied with a sterile special liquid balanced by salt and alkaline composition, and fragments of the crystalline lens, which are emulsified with ultrasound, are sucked into the needle itself. Hence the name — phacoemulsification — “facos” — the crystalline lens, emulsium — a dispersion medium consisting of microscopic droplets dissolved in a liquid.

   通过第一次主穿刺，将超声尖端插入外部带有硅树脂“套管”的位置。 通过较小直径的第二个入口-一个操纵斩波器(将镜头分成碎片的“扑克”)。 盖子提供了一种由盐和碱组成平衡的无菌特殊液体，并且经超声乳化的晶状体碎片被吸入针头本身。 因此，其名称为-超声乳化-“乳胶”-晶状体，乳胶-一种分散介质，由溶解在液体中的微小液滴组成。

3. Ultrasonic «needle», which performs reciprocating and oscillating movements with a frequency of 28-40 kHz, the lens tissue is crushed to a slurry, which draws in the aspirator. Choppers perform fractures, adhere to fragments in order to feed them into the ultrasonic zone. If the lens is soft, then its removal occurs mainly due to aspiration. If the crystalline lens is dense, then the solid fragments are first mechanically broken up into large fragments, and these in turn are split up by ultrasound to micro-dimensions, in order to remove the aspirator through the tube.

   超声波“针”以28-40 kHz的频率执行往复运动和振荡运动，将晶状体组织压碎成浆液，将其吸入吸气器。 切碎器会发生断裂，粘附在碎片上，以便将其送入超声区。 如果晶状体是软的，则其去除主要是由于抽吸引起的。 如果晶状体是致密的，则首先将固体碎片机械破碎成大碎片，然后再通过超声将其分解成微尺寸，以便通过导管除去抽吸器。

4. When the entire dense part of the core is removed, the aspiration and irrigation system removes the softer outer layers and polishes the capsule bag, which must be cleaned as thoroughly as possible. She, like a hammock, is connected by bundles with the rest of the eye.

   当去除核心的整个密实部分时，抽吸和冲洗系统去除较软的外层并抛光胶囊袋，必须尽可能彻底地对其进行清洁。 她像吊床一样，通过束束与其余的眼睛相连。

5. An artificial crystalline lens is injected (introduced by a special injector) into this capsule bag. In the tightly folded state of a tight roll. The “legs” are flexed to form something like a single base, assembled when they are closed. Such a designer is a fee for a thin incision. The surgeon fills it in a capsular bag, straightening each leg. The legs (supporting elements) are oval, square or triangular — depending on what kind of lens architecture is used. The main task is to make sure that cells from below that remain from the own lens do not germinate under the lens — they can cause a so-called “secondary cataract,” that is, another clouding. Therefore, various tricks are used — for example, a right angle on the edge of the implant does not allow the cells to “roll over” through it, and the water-repellent coating does not allow to cling to the implant. Artificial lenses made of material with “shape memory” unfold and take on their natural configuration. It is very important how many legs the lens has and how elastic they are to keep the lens in the correct position in the future with not always strong lens bundles.
   将人造晶状体注射(通过特殊注射器引入)到该胶囊袋中。 在紧卷的紧紧折叠状态下。 “支腿”弯曲成一个单一的底座，当它们闭合时组装起来。 这样的设计者要为薄切口付费。 外科医生将其填充到囊袋中，拉直每条腿。 支腿(支撑元件)为椭圆形，正方形或三角形-取决于所使用的镜头结构类型。 主要任务是确保从下方保留在自己晶状体中的细胞不会在晶状体下方发芽-它们会引起所谓的“继发性白内障”，即另一种白浊。 因此，使用了各种技巧-例如，植入物边缘上的直角不允许细胞“翻滚”通过它，并且疏水涂层不允许附着在植入物上。 由具有“形状记忆”功能的材料制成的人造镜片展现自然形态。 非常重要的一点是，镜片要有多少条腿以及它们的弹性如何，以便将来在不总是有牢固的镜片束的情况下将镜片保持在正确的位置。

During the operation there are no important and unimportant stages — so until the last moment until the blepharostat has been removed (the spring that keeps the eyelids open during the operation), the surgeon must keep the situation under control. There is a microsurgeon sitting on top of the patient, while the operation involves two hands, whose actions are controlled visually through the eyepieces of the microscope with a 5-25 fold magnification, two legs — one leg (and heel and sock) are needed to control the microscope (magnification, micro-flooding, regulation illumination of the operative field, centering the image along the XY axis), the second leg controls the operating parameters of the machine (aspiration level, irrigation height, ultrasound amount, vacuum level, change of operating modes). Since the surgeon looks into the eyepieces of a microscope during an operation, he does not have the opportunity to see the instrument panel and performance indicators,

在手术过程中，没有重要且无关紧要的阶段-因此，直到移出调光镜的最后一刻(手术期间保持眼睑张开的弹簧)之前，外科医生必须使情况保持受控。 有一个显微外科医师坐在病人的上方，而手术涉及两只手，它们的动作通过显微镜的目镜以5-25倍的放大倍率在视觉上进行控制，需要两条腿-一条腿(以及脚跟和袜子)为了控制显微镜(放大，微注水，调节手术区域的照明，使图像沿XY轴居中)，第二条腿控制了机器的操作参数(抽吸水平，冲洗高度，超声量，真空水平，更改操作模式)。 由于外科医生在手术过程中会看着显微镜的目镜，因此他没有机会看到仪表板和性能指标，

The surgeon does not have assistants and assistants who can intervene in the main process, sitting next to him can only moisten the cornea, dry something or hold it. Therefore, even the only broken toe of the surgeon will become an obstacle to the standard course of the operation — pedals are needed. Everything should be in perfect working condition — both hands with all fingers, both legs, excellent binocular vision (no matter with correction or with glasses — the microscope adjusts to the surgeon's optics) and good hearing (information in the interface is also transmitted via the audio channel). In addition, sufficient exposure, reaction rate and sufficient years of experience.

外科医生没有助手和助手可以干预主过程，坐在他旁边只能使角膜湿润，干燥或固定。 因此，即使外科医生唯一的脚趾骨折也将成为标准手术过程的障碍-需要踏板。 一切都应该处于完美的工作状态下-双手食指，双腿，双目视觉(无论是矫正还是戴眼镜-显微镜都可以根据外科医生的视线进行调节)和良好的听觉(接口中的信息也可以通过音频通道)。 此外，要有足够的接触，React速度和足够的经验。

Complications associated with this type of operation can be many — caused by inadequate technique of operation, non-compliance with device operation modes or incorrect settings, increased intraocular pressure, damage to intraocular structures, inadequate anesthesia, etc. — this is during surgery.

与这种类型的手术相关的并发症可能很多，这是由于手术技术不当，不遵守器械手术模式或设置不正确，眼内压升高，眼内结构损坏，麻醉不足等引起的。

All complications associated with the abdominal type of surgery are possible — inflammation, impaired eye tone (hypertension or hypotension), allergic reactions, vascular reactions, etc. — in the early postoperative period. In the late postoperative period, problems of astigmatism, secondary cataract, and IOL dislocation are possible. It should be noted that we are able to manage the predominant majority of these states.

与腹部手术相关的所有并发症都是可能的，例如术后炎症，炎症，视力受损(高血压或低血压)，过敏React，血管React等。 在术后后期，可能会出现散光，继发性白内障和IOL脱位等问题。 应当指出，我们能够管理这些州中的绝大多数。

In order to minimize the risk of these complications, everything must be according to technology.

为了将这些并发症的风险降到最低，所有事情都必须根据技术进行。

The result of the operation depends not only on the experience of the surgeon, calculated in years of work, but also on the surgeon’s ability to cope with all non-standard and complex situations that arise during the surgery. Experience decides. Since I have to perform a lot of reconstructive operations after unsuccessful operations performed in other clinics — extract fragments of “fallen” own crystalline lenses from the fundus, displaced artificial lenses, hem, suture, apply the retina — do not hesitate to ask your surgeon how confident he is successful completion of the operation and what risks he sees. The experience and skills of the surgeons are different — perhaps there is another one who will cope with the task better.

手术的结果不仅取决于外科医生在多年工作中的经验，而且还取决于外科医生应对手术期间出现的所有非标准和复杂情况的能力。 经验决定。 由于我必须在其他诊所进行不成功的手术后必须进行大量的重建手术-从眼底提取“堕落”的自身晶状体碎片，置换的人工晶状体，下摆，缝合线，应用视网膜-请随时向您的外科医生询问他对成功完成手术的信心有多大，看到了什么风险。 外科医生的经验和技能是不同的-也许还有另一位可以更好地应对这项任务。

等待多少时间？ (How much to wait?)

The phrase: “A cataract is not a fruit, it’s not necessary to wait for its ripening” has already become commonplace.

“白内障不是水果，没有必要等待它的成熟”这句话已经很普遍了。

But still the doctors in the clinics say to the patients that the cataract is either initial or still “immature” and is sent to wait.

但是，诊所的医生仍然对患者说，白内障是初发还是仍未成熟，被送去等待。

无需等待！ (No need to wait!)

There is nothing to wait for — it will not be better, a cataract, increasing, will force the surgeon to use more ultrasound energy, which in turn will adversely affect the structures surrounding the lens — the cornea, choroid, «maturation» will weaken the ligamentous apparatus, cause changes in the lens capsule, increase the intraocular pressure. Indications for cataract surgery — reduced vision caused by its presence. And visual acuity here is no longer important. There are, for example, types of posterior encapsular cataracts, when it is necessary to operate with vision 1.0, as the quality of vision suffers.

没什么可等待的了—白内障会越来越好，将迫使外科医生使用更多的超声能量，这反过来又会对晶状体周围的结构产生不利影响—角膜，脉络膜，“成熟度”会减弱韧带设备，引起晶状体囊改变，增加眼压。 白内障手术的适应症-因白内障手术而导致视力下降。 在这里视力不再重要。 例如，当需要使用视力1.0进行手术时，视力质量会受到影响，例如后囊性白内障的类型多种多样。

Sometimes, if you wait an extra couple of months, phacoemulsification will have to be abandoned in favor of extracapsular cataract extraction (EEC). Another wait — and the capsule will also become unusable, and only intracapsular extraction (IEK) will turn out. Naturally, the older the operation is historically, the more difficult and longer the healing process is, which leads to secondary complications. With these «manual» types of operations, a frequent problem is surgically induced astigmatism. The smaller the incision and the more precisely it is located — the better the patient will see after the operation. The larger the incision, the worse the refractive picture will be after rehabilitation. By the way, a little more than 15 years ago I was engaged in the technology of cataract removal through a 1 mm incision, using a bimanual technique and implanting an interesting model of a ThinOptix lens through the same 1 mm.

有时，如果您再等待几个月，则必须放弃超声乳化术，而采用囊外白内障摘除术(EEC)。 再次等待-胶囊也将变得不可用，并且只会出现胶囊内提取(IEK)。 自然，手术历史越久，愈合过程越困难且时间越长，这会导致继发并发症。 通过这些“手动”类型的手术，常见的问题是手术引起的散光。 切口越小，位置越精确-手术后患者看得越好。 切口越大，康复后的屈光图像越差。 顺便说一下，大约15年前，我从事一种通过1毫米切口进行白内障摘除的技术，使用的是双向技术，并通过相同的1毫米植入了有趣的ThinOptix晶状体模型。

A decade ago, the technological idea was to destroy the lens through a hole of less than 1 mm formed in the anterior capsule of the lens by rotating microlopes. But while the removal through 1.7-1.8 mm is minimal and optimal.

十年前，该技术的想法是通过旋转微角镜，通过在晶状体前囊中形成的小于1毫米的Kong破坏晶状体。 但是，通过1.7-1.8毫米的去除是最小且最佳的。

恢复多少？ (How much to recover?)

This is a very individual process. If the patient arrived at an early stage, then the next day he does not have any restrictions. And if he came in with a cataract that has been growing for decades, then recovery will take longer. In any case, during the month you will need to skip drops.

这是一个非常独立的过程。 如果患者早到，那么第二天他就没有任何限制。 而且如果他患有白内障，这种白内障已经发展了数十年，那么康复将需要更长的时间。 无论如何，在这个月中，您将需要跳过投放。

Here in the last post about the lens there are more details.

在上一篇有关镜头的文章中，有更多详细信息。

翻译自: https://habr.com/en/company/klinika_shilovoy/blog/502738/

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