From Big Medical Encyclopedia

CATARACT (cataracta; grech, katarrhaktes falls) — the disease of an eye which is characterized by a phacoscotasmus. The term «cataract» appeared in an extreme antiquity when a cause of illness considered outpouring of liquid between an iris and a crystalline lens with formation of an opaque film.


the Standard classification To. does not exist. Distinguish primary and secondary To., acquired and inborn. Acquired primary To. are subdivided on etiol, to a sign into several groups: senile, traumatic (contusional and perforation), complicated (at a myopia, uveites), beam, To. at various intoxications (naphthalenic, ergotinovy, trinitrotoluolovy, mercury, etc.).

Fig. 1. The diagrammatic representation of various forms of cataracts (forms 1 — 6 meet at inborn cataracts, forms 4 — 6 and at the acquired cataracts): 1 — a polar lobby and a back cataract; 2 — spindle-shaped; 3 — layered (zonular); 4 — nuclear; 5 — cortical; 6 — full.

To. divide also on localization and a morphological feature (fig. 1): front polar, back polar, spindle-shaped, layered, or zonular, nuclear, cortical and total (full).

An etiology and a pathogeny

from among acquired To. it is most widespread senile K. Patogenez senile To. finally it is not found out. The theory of education To. as manifestations fiziol, aging of an organism and influence on a crystalline lens of the harmful products allocated by a tsiliarny epithelium at people of advanced age it is not quite proved. The opinion is expressed that at senile To. disturbance of tissue respiration, oxidizing processes and depletion of fabrics redoxons can matter, In 2 , cysteine.

At damage of the capsule of a crystalline lens as a result of the mechanical perforating or contusional injury traumatic K. Katarakta develops can arise at impact approximately of ionizing radiation of any kind (beam To.). As a result of influence of a number of chemical substances (naphthalene, dinitrophenol, thallium, mercury, an ergot) develops toxic K. Izvestna cases of development To. at reception of high doses of streptocides. Owing to inflammatory diseases of a choroid (an iritis, a uveitis) there is a so-called complicated cataract. To. can be a consequence of various diseases of an organism — infectious, disorders of exchange, diabetes, diseases of skin — a scleroderma, eczema etc.

Inborn To. can be hereditary, transferred on dominant type, or to result from pre-natal pathology. To development inborn To. can give various infektsionnotoksichesky factors exerting impact on an embryo or a fruit. Among these factors the important place is taken by viral infections of mother — a rubella, flu, and also Toxoplasmosis. Disturbances of exchange and endocrine frustration at women during pregnancy can also be the reasons inborn To. Development of the most frequent form inborn To. — by layered — it is connected with the hypocalcemia caused by insufficiency of function of epithelial bodies.

Secondary To. develops as a result of an incomplete rassasyvaniye of lenticular masses at its bruise or forms from the remains of not completely remote cataract masses or the capsule of a crystalline lens. To education secondary To. the organization of exudate, fibrin, elements of blood, proliferation of connecting fabric can bring.

Pathological anatomy

Senile To. can be cortical, nuclear and mixed. It is most often observed cortical To.

Are exposed to microscopic examination so-called mature more often To. (completely dimmed crystalline lenses). At the same time defeat of all bast layer is noted. Between bark and a kernel of a crystalline lens the cracks caused by sclerous consolidation, wrinkling and peeling of a kernel of a crystalline lens from its bark are visible. In cracks proteinaceous liquid and vacuoles is found. Lenticular fibers are bulked up, poorly perceiving coloring. Their disintegration and turning into fine-grained weight or in large drops — morganiyeva spheres is observed. The changed fibers lose touch with the capsule of a crystalline lens, under it liquid and vacuoles appears.

Cells of an epithelium of the front capsule of a crystalline lens lose the correct outlines, bulk up, vakuolizirutsya, their protoplasm poorly perceives coloring, and kernels are often condensed and intensively painted. The capsule of a crystalline lens at To. changes slightly. Its thickening and swelling without noticeable structural changes is noted.

Changes in a crystalline lens at traumatic To. are usually localized in places of damage of the capsule of a crystalline lens, and both the epithelium, and cortical substance of a crystalline lens are exposed to changes; the capsule quite often is collected in folds and tightened to the place of damage. The epithelium of the capsule forms proliferata — single or multiple growths on a surface of a crystalline lens. Owing to migration of cells of an epithelium of a kzada its growths and under the back capsule of a crystalline lens are formed.

Substance of a crystalline lens is exposed to various changes depending on the amount of damage of the capsule, in it the numerous cracks filled with morganiyevy spheres and vacuoles are found. In the changed substance of a crystalline lens there can be an adjournment of lime or formation of crystals fat to - t.

Inborn polar To. represent the remains of embryonal educations — a pupillary membrane, an artery of a vitreous. At layered To. changes are localized between bark and a kernel of a crystalline lens where cracks with accumulation of fine-grained weight and vacuoles are formed.

A clinical picture

At primary To. the main complaint — on decrease in visual acuity. The visual disturbance appears very much early at the phacoscotasmus which is located in the field of a pupil. If process begins with the equatorial area, visual acuity can remain normal for a long time. Sometimes the first symptoms To. distortion of objects, a monocular polyopia (multiple vision of objects),

In a wedge, a current are senile To. allocate four stages: initial, unripe, mature and overripe To. (tsvetn. fig. 3 — 5).

In an initial stage patients can not show complaints, others note a nek-swarm decrease in sight, emergence of «the flying front sights», occasionally a polyopia. Biomikroskopicheski the first signs initial cortical To. — emergence of subkapsulyarny vacuoles, stratification of lenticular fibers. Changes in a front and back bast layer are similar. Duration of a current of this stage is various: at one patients it is estimated for years, at others process progresses quickly, and in 2 — 3 there comes the stage unripe, or bulking up, K. V of this stage of the phenomenon of an ovodneniye of a crystalline lens accrue, opacification takes a considerable part of bark of a crystalline lens, and patients complain of falloff of sight. At side lighting the crystalline lens has gray-white color. Swelling of a crystalline lens is followed by increase in its volume that leads to reduction of depth of an anterior chamber. At bio-microscopy it is visible that a part of lenticular fibers still keeps transparency. Stage unripe To. can last long (for years). Gradually the crystalline lens begins to lose water, and opacification gets an intensive-gray shade, becomes more homogeneous. The anterior chamber is deeper. There is mature K. V stage of this stage clearly the figure of a lenticular star representing intensive opacification in the field of lenticular seams is visible. Patients complain of absence subject to a zra a niya, at them only photoperception decides on the correct projection of light. Biomikroskopicheski is not possible to receive a full optical cut.

At overripe To. the changed lenticular fibers are exposed to dystrophy, full disintegration and homogenization. Cortical substance turns into the liquefied mass of lactescence which gradually is exposed to a resorption, the volume of a crystalline lens decreases, depth of an anterior chamber increases. The dense kernel of a crystalline lens falls to gravity from top to bottom. This a wedge, a picture carries the name morganiyevy To. (tsvetn. fig. 6). Further, if operation is not made, cortical layers of a crystalline lens can resolve completely, and in the capsule there is only a small kernel.

At nuclear To. the central sight is broken early, and sight afar suffers more. There can be temporary short-sightedness, and the patient begins to read without presbyopic points. At side lighting the crystalline lens in these cases has a light green shade. Over time the kernel of a crystalline lens gets brown-red (brown) coloring.

Brown To. develops at short-sightedness more often. The kernel of a crystalline lens large, bark thin, and all crystalline lens looks condensed.

For complicated To. opacification under the back capsule of a crystalline lens, in periblasts of back bark is characteristic. At the same time opacification at first appears at a back pole, then extends on all back surface, taking the form of a bowl; such To. call back bowl-shaped, it often does not reach a full maturity.

Diabetic To. develops at patients with diabetes. At a severe form of diabetes at young age To. arises at the same time on both eyes and quickly progresses. In an early stage of a phacoscotasmus are localized subcapsules yar but, have an appearance of pointed deposits, then vacuoles, water cracks appear. Timely treatment by insulin sometimes can detain several development To.

Fig. 1 — 7. Clinical picture of various forms of cataracts. Fig. 1. Front polar cataract: in the center of a pupil limited opacification of gray color is visible. Fig. 2. Layered (zonular) cataract: in the center of a mydriatic pupil a discal phacoscotasmus. Fig. 3. Initial age cataract: opacifications in the form of the arrows going from the equatorial area to the center. Fig. 4. Unripe age cataract: partial phacoscotasmus. Fig. 5. Mature age cataract: opacification of all layers of a crystalline lens. Fig. 6. Morganiyeva cataract: omission of a kernel of a crystalline lens down (it is specified by an arrow). Fig. 7. Secondary cataract: in the field of a pupil the dense film with a gleam in the center is visible; limits of defect of an iris (coloboma) are specified by shooters.

From inborn To. the most frequent is layered (tsvetn. fig. 2). It is characterized by opacification of one or several layers of a crystalline lens lying between a kernel and peripheral layers. To. it can be found right after the birth or develops within the first year of life of the child. At a wide pupil and side lighting it is presented in the form of a muddy gray disk with the edge which is accurately outlined or supplied with gear shoots. Layered To. more often happens on both eyes and is followed by falloff of sight. Extent of decrease in visual acuity depends not on the size of opacification, and on its intensity.

At a lobby polar To. (tsvetn. fig. 1) arises sharply limited opacification of white color located in the center of a front surface of a crystalline lens.

Back polar To. too has an appearance of small opacification of rounded shape of the grayish-white color located at a back pole of the lens. These are most often the remains of a. hyaloideae which escaped on the capsule of a crystalline lens.

Polar To. almost always bilateral. In view of the insignificant amount of opacification sight decreases slightly or even does not decrease at all.

Secondary To. (tsvetn. fig. 7) represents the film in the field of a pupil formed back and the remains of the front capsule of a crystalline lens. Quite often between leaves of the capsule of a crystalline lens the remains of mass of a crystalline lens are located. These accumulations are especially expressed behind an iris in a zone of the former equator of a crystalline lens, they form the dense roller carrying the name of a ring of Zemmerringa here.

Complications. In development To. there can be complications — phacolytic glaucoma, a fakogenny iridocyclitis. Phacolytic glaucoma develops at overripe To. owing to absorption of the breaking-up substance during the swelling of a crystalline lens, increase in its volume and as a result of disturbance of outflow of intraocular liquid (see. Glaucoma ).

At loss of cataract masses in an anterior chamber and a delay of their rassasyvaniye can arise so-called fakogenny, or fakoanafilakticheskiya, iridocyclitis (see), connected with development of hypersensitivity to lenticular protein.

The diagnosis

For diagnosis To. apply a method of side lighting, a research in a transmitted light (at an incomplete phacoscotasmus), biomicroscopy of an eye (see). It is necessary to include in a complex of inspection tonometriya (see), according to indications tonografiya (see). The research of visual functions consists in definition visual acuities (see), fields of vision (at the level of the visual acuity allowing to carry out perimetry). At decrease in sight before photoperception the careful research of a projection of light and a field of vision is necessary. In some cases there are indications for elektroretinografiya (see).


Drug treatment To. pursues the aim of prevention of progressing To. in its initial stages. Due to the insufficient validity of modern scientific ideas of a pathogeny To. its drug treatment cannot be considered as effective. However nevertheless data on an opportunity in some cases to slow down progressing of a phacoscotasmus in initial stages by means of medicamentous means are obtained.

For treatment To. apply solutions of various vitamins, amino acids, enzymes: ascorbic to - that, Riboflavinum, glutathione, Tsitokhroma, cysteine (see), etc. Various combinations of the specified medicines are issued in many countries (Vitaiodurolum, Vitaphakolum, etc.). One of domestic drugs of this group — Viceinum, the main component to-rogo is cysteine.

The drugs containing cysteine are shown at senile, miopichesky, beam To. in an initial stage of their development. Cysteine is contraindicated at bowl-shaped To., since accelerates their development. At bowl-shaped To. appoint instillations of solution of Riboflavinum of a mononucleotide. Restriction of the general and local insolation is recommended.

Purpose operational treatment primary To. extraction from an eye of the dimmed crystalline lens is.

Operational treatment To. has long history. During nearly 2 thousand years so-called reclination was applied To., at a cut the crystalline lens was displaced dislocated) from area of a pupil, but remained in an eye. Because of heavy complications reclination since the second half of 18 century gave way to removal To. from an eye through a section of covers (extraction To.). Operation can be made both under the general anesthesia, and under local anesthesia.

There are two ways of extraction To.: ekstrakapsulyarny and intrakapsulyarny.

The essence of an ekstrakapsulyarny way is that after disturbance of an integrity and partial removal of the front capsule remove a kernel of a crystalline lens, and then cortical masses; the back capsule if it is transparent, leave in an eye. There is a large number of modifications of ekstrakapsulyarny extraction To., differing in the place and way of a section (a knife Gref, a lanceolated knife), way of opening of the front capsule (a cystotome, kapsulyarny tweezers), method of sealing of a section, etc. Advantage of ekstrakapsulyarny extraction is preservation of an iridokapsulyarny diaphragm, lack of danger of loss of a vitreous. To shortcomings ekstrakapsulyar a leg of a way of extraction To. it is necessary to refer danger of leaving of a part of lenticular masses in the anterior and back chamber.

Ekstrakapsulyarny extraction was the dominating method of removal To. for more than 150 years, and only from 40th 20 century passed to an intrakapsulyarny way that was promoted by technical improvement of a technique of operation.

At intrakapsulyarny extraction To. the dimmed crystalline lens is deleted from an eye entirely in the unimpaired capsule. The method provides the best functional results in comparison with an ekstrakapsulyarny way. Removal of a crystalline lens in the capsule was carried out at different stages in various ways. The way of extraction of a cataract by means of tweezers was originally applied. Special tweezers with smooth branches take a fold of the capsule of a crystalline lens, the kachatelny movements gradually break off fibers of a ciliary body (a tsinnovy sheaf) and remove K. Nedostatk of a way the fact that at the expressed resistance of a ciliary corbel the integrity of the forefront of the capsule can be broken is; in these cases operation is completed in the ekstrakapsulyarny way.

By more effective method of intrakapsulyarny extraction To. the vacuum way is. To. take by means of the special tool — an erizofak. A working part of the tool represents a metal cup to dia. 5 mm, connected to the vacuum device. The cup of an erizofak is imposed on a front surface of a crystalline lens; the vacuum device provides suction of a cup to a crystalline lens. Rocking of a crystalline lens allows to break off a ciliary corbel and to take a crystalline lens in the capsule. There are various designs of erizofak.

The most effective method of intrakapsulyarny removal of a cataract — the cryoextraction offered by Krvavich (T. Krwawicz, 1961). The essence of a way consists in a primorazhivaniye of a crystalline lens to the tool cooled up to the temperature — 30 — 50 ° (cryoextractor). Primorazhivany substances of a crystalline lens strong coupling provides it with the tool that allows to break off a ciliary corbel and to remove a crystalline lens in the unimpaired capsule almost in 100% of cases. Intrakapsulyarny cryoextraction To. received wide, distribution, having reached an ascendent position in operational treatment of K. Primenyayutsya various designs of cryoextractors.

In 1958 for the purpose of dissolution of fibers of a ciliary corbel and less traumatic extraction of a crystalline lens from an eye by an intrakapsulyarny way it is offered enzymatic zonulolizis for what usually use a-himotripsinonim of This way it is shown at patients with a resistant ciliary corbel that especially often happens at people from 20 to 50 years.

In the past extraction To. it was in most cases combined with corectomy (see). In modern conditions operation with preservation of a round pupil was widely adopted. This method yields considerably the best functional and cosmetic results. Implementation in ophthalmology microsurgery (see), i.e. use of an operative microscope, use of microtools and a special suture material, sharply increased efficiency of surgical treatment To., performed operation less traumatic, safer, improved functional results. Thanks to the microsurgical equipment quality of an operational section and its sealing is improved that led to sharp reduction of number of postoperative complications.

In 1967 Kelman (S. of D. Kelman) offered a new way of surgical treatment To. by means of low-frequency ultrasound — a fakoemulsifikation. The essence of this method consists in crushing of a kernel of a crystalline lens by means of ultrasound to a condition of an emulsion, edge then is washed away aspirated) from an eye. Operation is carried out by means of the special device — a fakoemulsifikator. Through a small section in a limb under a conjunctival rag enter a working tip of a fakoemulsifikator which provides ultrasonic influence, introduction to an anterior chamber of liquid (irrigation) and its removal together with the emulsified mass of a crystalline lens (aspiration) into an eye. Emulsification — effective, low-traumatic surgical intervention. Advantage of a way is that through a small section (3 mm) it is possible to remove completely a crystalline lens, having kept the tail of the capsule that considerably reduces number of complications, leads to bystry rehabilitation of the patient, reduces the term of stay of the patient in a hospital.

Fakoemulsifikation treats an ekstrakapsulyarny way of removal To., but it is carried out at high technological level therefore it is deprived of shortcomings of this way.

Positive takes of a fakoemulsifikation, and also use of the microsurgical equipment revived interest in an ekstrakapsulyarny method of removal To., since at an intrakapsulyarny method more often than at ekstrakapsulyarny, complications from a vitreous and a retina can be observed.

Operational treatment of the Cataract at children's and youthful age has the features. The sheaves holding a crystalline lens are very strong in this connection an intrakapsulyarny way of removal To. it is not shown. The leading place is taken by an ekstrakapsulyarny method, and to remove soft To., not having a dense kernel, it is possible through very small section. Sometimes resort to the special tool (dual cannulas) providing at the same time aspiration and an irrigation. The microsurgical equipment considerably improved results, reduced number of complications of operations. For removal soft To. children's and youthful age with success apply also a fakoemulsifikation; the greatest indications to this method are available at layered To.

For treatment soft To. use of the laser is perspective. M. M. Krasnov, V. S. Akopyan developed a technique of perforation of the capsule of a crystalline lens by means of the modulated laser radiation — a so-called laser kapsulofakopunktura. After disturbance of an integrity of the forefront of the capsule there is a swelling of lenticular masses to their further rassasyvaniye.

At secondary To. operation consists in a section or removal of the film closing a pupil. The laser can be used to perforation of a film. By means of the modulated impulses perforation of a film secondary is made To., therefore in it the through hole is formed that considerably increases visual acuity. If secondary To. it is not complicated by other diseases, visual effect after operation usually good.

After successful surgical intervention apropos To. there is a state called aphakia (see). Optical correction of an aphakia can be made with the help points (see), contact lens (see), operations keratofakiya (see) and intraocular lens (explantation of an artificial crystalline lens).

Fig. 2. Artificial crystalline lens of M. M. Krasnov: in an anterior chamber ahead of an iris there is an artificial crystalline lens (1) attached by metal handles (2) to an iris of the eye.

The main indication to correction of an aphakia by means of an intraocular lens is the impossibility of use of points or contact lenses. It most often arises at a monocular aphakia, hl. obr. in connection with professional features (e.g., at drivers of transport, pilots, surgeons etc.). Operation is known since the beginning of the 50th and was for the first time made by F. Ridley. Most often the lens becomes stronger in a pupil (a so-called irisklips-lens). The method was offered by R. J. Schillinger with soavt, and Binkhorstom (S. of D. Binkhorst), by Epstayn is modified further (E. Epstein), S. N. Fedorov. The main complication during the use of an irisklips-lens is its shift from area of a pupil (to 10%). During the fastening of an artificial crystalline lens to an iris of the eye out of area of a pupil, by M. M. Krasnov's method, the form and functions of a pupil are not broken (fig. 2).

Operation of landing of an artificial crystalline lens shall be made according to strict indications and in the conditions of sufficient technical equipment.

Forecast senile To. at timely and uncomplicated operational treatment it is favorable. At traumatic, complicated, diabetic To. because of a number of the accompanying changes in an eye the forecast serious. At inborn To. without amblyopias (see) and associated diseases of a retina, and also at uncomplicated surgical treatment the forecast favorable.

Beam cataract

Fig. 3 — 6. Various degrees of a phacoscotasmus at a beam cataract (at the left — at a research in a transmitted light, on the right — an optical cut of back department of a crystalline lens in the light of a slit lamp). Fig. 3. Opacification under the back capsule of a crystalline lens in 7 years after single gamma and neutron impact on area of an eye in a dose 150 I am glad. Fig. 4. Opacification in back layers of a crystalline lens of the same patient in 15 years after gamma and neutron influence. Fig. 5. Opacification under the back capsule of a crystalline lens in 2 years after single gamma and neutron impact on area of an eye in a dose more than 300, but less than 700 I am glad. Fig. 6. The expressed opacification in back layers of a crystalline lens of the same patient in 5 years after gamma and neutron influence.

Beam cataract — the cataract resulting from damage by its ionizing radiation. The beam cataract can develop after radiation of area of an eye at radiation therapy of tumors of the person and head, at persons, is long affected by ionizing radiation, and also at emergencies.

A crystalline lens — the most struck tissue of an eye at impact of ionizing radiation. Under the influence of small doses beam To. it can be shown as a monosymptom of damage, at considerable radiation — together with defeat of other tissues of eye and its appendages. However damage of a crystalline lens is clinically shown always later, than defeat of other tissues of eye.

Clinically at development beam To. distinguish two periods: the first — the latent (hidden) period covering a time term from the moment of radiation before identification of the first symptoms of a disease, and the second — the period of progressing proceeding before stabilization To. or full phacoscotasmus.

Intensity of a phacoscotasmus, duration of stage of latency, speed of progressing To. depend on a type of ionizing radiation, size and dosage rate of radiation, a time factor and age of the victim. The smallest dose single beta or gamma influences, at Krom development beam was observed To., makes apprx. 200 I am glad at absorption directly in a crystalline lens; at fractional influences the dose increases to 400 — 550 is glad and more.

Neutrons have bigger kataraktogenny ability, than other types of ionizing radiation. At the single combined gamma and neutron influence in doses 150 — 700 I am glad approximately beam To. it is clinically possible to find in 2 — 7 years after radiation. Within the next 3 — 6 years after detection of the first signs beam To. opacification of various degree depending on a dose of radiation forms. Then development beam To. stops, and opacification gradually extends to deep layers of bark of a crystalline lens (fig. 3 — 6).

At doses higher than 700 I am glad development beam To. it is found in 0,5 — 2 after influence; in cases of defeat of a choroid of an eye in 2,5 — 5 years after influence there comes the full phacoscotasmus.

The place of primary radiation injury of a crystalline lens is the germinative (rostkovy) zone of an epithelium of a crystalline lens which is under the front capsule near the equator.

To reveal beam To. it is possible at a research of an eye in a transmitted light and in optical cuts (at biomicroscopy) with the most mydriatic pupil. The first sign beam To. accumulation of the pointed, shtrikhovidny opacifications and vacuoles which are located between the back capsule and bark of a crystalline lens is. In process of progressing To. these accumulations merge in one opacification at a back pole, a cut gradually increases in sizes, becomes more dense and thicker.

At a research in a transmitted light it represents cellular, sharply delimited from the environment, roundish or irregular shape opacification in the form of lace in the beginning. Then opacification on the periphery becomes more dense and reminds a bagel. Further around it there is a border from accumulation of the pointed opacifications and vacuoles which are located in the beginning in the form of the languages directed to the equator, and then covering all back surface of bark of a crystalline lens.

At a research in an optical cut opacification comes to light at a back pole between the capsule and bark, has an appearance of a tufa. In a form it represents a meniscus, concave-convex in the beginning, then convexo-plane, further — biconvex, the lying layers of a crystalline lens squeezing ahead.

The opacification under the front capsule of a crystalline lens consisting of accumulation of pointed, shtrikhovidny opacifications and vacuoles usually appears later and never reaches such intensity, as at a back pole.

When the ground mass of the damaged cells moves from the equator to poles of the lens, opacification is stabilized and gradually removed by normally growing transparent lenticular fibers from the back capsule in a crystalline lens. In such state opacification can remain (without progressing) during all subsequent life of an organism. The full phacoscotasmus can develop as a result of radiation injury of a choroid of an eye. Extent of decrease in visual acuity depends on the size of a phacoscotasmus.

Conservative treatment beam To. ineffectively. However some authors in initial stages recommend cysteine in the form of trays and an ionophoresis (from 2 — 5% solution of cysteine) and instillations in a conjunctival sac of Viceinum, Vitaiodurolum, taurine. At the intensive phacoscotasmus considerably lowering visual acuity (0,1 and below), apply operational treatment.

The forecast favorable at a small phacoscotasmus and at uncomplicated operational treatment mature To. At emergence of various complications in the postoperative period the forecast can be adverse.

See also Eye , Crystalline lens .

Bibliography: Krasnov M. M. Extra-kapsulyarnaya extraction of a cataract and its perspective, Vestn, oftalm., JVe-1 * page 3, 1977, bibliogr.; Krasnov M. M. and Akopyan V. S. Use of a laser kapsulofakopunktura at treatment of «soft» cataracts, in the same place, No. 1, page 22, 1976; Krasnov M. M., Coopers V. E. and Dvalim. L. Fakoemul-sifikation. cataracts with implantation of an artificial crystalline lens, in the same place, No. 5, page 29, 1975, bibliogr.; Medico-sotsial-nye aspects of disability at pathology of a crystalline lens, under the editorship of E. S. Liebman, M., 1975; The Multivolume guide to eye diseases, under the editorship of V. N. Arkhangelsky, t. 2, book 2, M., 1960; The Guide to eye surgery, under the editorship of M. M. Krasnov, page 218, M., 1976: Fedorov G. H. Implantation of an artificial crystalline lens, M., 1977, bibliogr.: Shmelevav.V. Microsurgical technology of extraction of a cataract, Vestn, oftalm., No. 5, page 64, 1969; Shulpyna N. B. Biomikro-skopiya of an eye, M., 1974 Jaffe N. S. Cataract surgery and its complications, St Louis, 1976; K elm an G. D. Phacoemulsification and aspiration, Amer. J. Ophthal., v. 64, p. 23, 1967; it, Phacoemulsification and aspiration of senil cataracts, Ganad. J. Ophthal., v. 8, p. 24, 1973; Krwawicz T. Intracapsufar extraction of intumescent cataract by application of low temperature, Brit. J. Ophthal., v. 45, p. 279, 1961; Microsurgery of cataract, vitreous and astigmatism, ed. by D. Pierse a.H. J.Kersley, Basel, 1976; System of ophthalmology, ed. by S. Duke-Elder, v.10, L., 1967.

Beam To. — Abdullaev of V. M. Patogistologicheskiye of change of eyes at radiation defeat, Baku, 1976, bibliogr.; Vishnevsky N. A. ides of river. Initial signs and classification of a beam cataract, Vestn, oftalm., No. 5, page 65, 1961; V. V. Wolves and the III silt I am e in V. G. The combined damages of eyes, page. And, etc., L., 1976, bibliogr.; Kovalyov I. F. Pathogeny of beam cataracts (pilot study), Uchen. zap. Mosk. nauch. - issled, in-that glazn, Bol., century 15, page 316, 1968; Medvedovskaya Ts. P. About a threshold dose of bystry neutrons of the cataract causing education. Radiobiology, t. 17, century 1, page 126, 1977; H and at e C. Pehandlung okularer Affektionen durch ionisierende Strahlen, in book: Akt. Ophthal, probi., hrsg. v. H. Remky, S. 147, Stuttgart, 1974; R a d n 6 t M. Effects of irradiation on the eye lens, Atomic energy Rev., v. 7, No. 4, p. 129, 1969; R o t h J. o. Effects of fast neutrons on the eye, Brit. J. Ophthal., v. 60, p. 236, 1976.

V. V. Shmelyova of V. M. Abdullaev (I am glad.).