Cataract surgery is now the most common and the most successful surgery that is performed in the medical field. During cataract surgery, the clouded natural lens is replaced with a clear artificial lens. There are two types of cataract surgery with lens implantation. Phacoemulsification is the most common way to do cataract surgery. In this type of surgery, the incisions are small and sound waves (ultrasound) are used to break up the lens into small pieces. A needle-thin probe, which transmits ultrasound waves, is inserted through a tiny incision of about 3 mm into the lens substance to break up (emulsify) the cataract. Since the incisions are very small, they usually seal themselves without stitches. After removing the cataract, a foldable clear artificial lens is inserted through the same small incision. Once inside the eye, the foldable lens unfolds itself and fills the empty place. It normally takes about 10 to 15 minutes, does not require general anesthesia, and can be performed with local anesthetics. Sometimes the cataract lens may be too stiff, and it cannot be crushed by ultrasound. In these cases, the surgeon may have to perform the cataract surgery by another technique, called Extra Capsular Extraction. In this type of surgery, the clouded lens is removed in one piece. With its larger incision (6- 10 mm), delicate stitches are required to close the incision, thus the recovery period is a little longer than Phacoemulsification method.
In children and in certain cases (e.g. cataract due to traumatic) cataract surgery may be done by another method called lensectomy.
With the best eye surgeons, the latest and highly sophisticated medical equipment and advanced Phaco Machines, Noor hospital proudly provides all required facilities for the patients, so that they can confidently undergo the surgery and enjoy their vision recovery.
In general cataract surgery involves removing the clouded lens and ,in most cases, replacing the natural lens of the eye with an artificial intraocular lens. However, in some rare circumstances, intraocular lenses may not be inserted.
The most common incisions to perform the surgery are 3-mm incisions(less than 1/3 cm). Due to their smallness, these incisions require no stitches and after surgery they heal by themselves.
The surgeon then creates a circular opening on the lens surface (capsule). This process is called capsulorhexis procedure and requires a lot of attention since the lens capsule thickness is 4/1000 mm.
In Phacoemulsification, ultrasounds is used to break the cataract into small pieces. The cataract and lens pieces are removed from the eye using suction. The very back of the lens (the lens capsule) is left intact to serve as a place for the artificial lens to rest.
Extracapsular cataract extraction method is used when the lens is very strong and the waves used in Phacoemulsification are not able to break it into smaller particles. In this method, an 8 mm to 10 mm incision is made in the eye, the lens is removed in one piece and the created incision needs to be sutured.
In Phaco, the intraocular lens is foldable and the surgeon sends it into the eye through a small incision. This lens which is 6 mm in optical, unfolds itself adjacent to the posterior capsule and can be fixed inside the capsule by its lateral arms, called hap tic. Usually there is no need for stitches to stabilize the lenses inside the eye.
In spite of no need for hospitalizations, you should take the following steps:
Activity: Activity limitation depends on the type of surgery. In Phacoemulsification surgery (with small incisions) which is performed in Noor Eye Hospital, the patient doesn’t have any movement limitation. You can enjoy reading or watching TV. Keep in mind the following tips:
Diet: After surgery, there is no need to change your diet. Just prevent constipation by eating the right amount of vegetables, fruits and water.
Medications: Usually, the day of surgery, your surgeon will give you a prescription about the type and timing of eye drops. These drops contain anti-inflammatory drops for healing and also reducing glare and antibiotic drops to reduce the risk of infection. These drops usually must be taken for 3 weeks. Start the eye drops in the surgical eye only as directed by your surgeon.
Drug use is as follows:
How to Use Eye Drops Properly:
Follow up visits:
Postoperative examinations on the first and third days, third and fourth weeks, after six months and then once a year is recommended.
The time to determine eye score:
Usually the first few weeks after surgery, your eye score is changing. So it is better to wait a few weeks and then determine the score of the glasses (particularly reading glasses). A percentage of patients, particularly those who suffer from preoperative astigmatism, will need hyperopic glasses after surgery.
In a long run:
After cataract surgery, keep on having regular follow-up examinations. During these visits, the ophthalmologist will examine the surgical outcomes and you will be ensured of the continued improvement in both eyes.
What happens during cataract surgery?
What happens after cataract surgery?
What are the risks of cataract surgery?
If there are cataracts in both eyes, can they be operated at the same time?
What tests are required before cataract surgery?
What are the different types of intraocular lenses implanted after cataract surgery?
Are intraocular lenses able to correct refractive errors?
Does cataract surgery cause changes in the appearance of the eyes?
What is Posterior capsule opacification or secondary cataract?
There have been many advances in cataract surgery techniques in recent years, thus the procedure is performed on an outpatient basis and it needs no especial preparation, although some pre-operation routine examinations and vascular checkups are necessary. Usually the patient is asked to be present at hospital an hour before the surgery time. Before surgery, eye drops will be placed in patient’s eye to lessen pain, prevent infection and inflammation, and to dilate his pupil. A local anesthetic is used, and the patient will remain quite conscious and awake during the surgery. But in some cases, as asked by the patient or decided by the surgeon, some mild sedatives may be prescribed. During surgery, the patient is usually asked to stare at the light of the surgical microscope. The procedure is usually performed in 20-30 minutes. After surgery, the patient will be monitored for any problems, then he will be allowed to return home.
After surgery, your doctor will schedule exams to check on your progress. Usually your doctor will want to examine you the day following surgery, and then at various intervals after that. You will also be given a specific schedule of antibiotics and ant inflammation eye drops for one month, then gradually they will be discontinued. Based on the surgery method performed on you and your doctor’s decision, you may also be asked to wear an eye shield at night .Avoid rubbing or pressing on your eye during the first post operation weeks.
Normally, patients can resume their routine activity like watching TV or reading books the day of surgery or the day after, but you should wait around 3-4 weeks to get a final prescription for your new eyeglasses. Most people need glasses, at least for reading, after cataract surgery, while for their far vision they don’t need any eyeglasses.
Although Cataract surgery is a routine procedure with the least risk of side effects, rare complications may arise. Symptoms can vary from vision loss to a mild inflammation. In general, loss of vision occurs very rarely, but it can be caused by inflammation or bleeding during surgery, or retinal detachment that may happen month or years after surgery. Normally there may be some slight symptoms such as cornea swelling, cystoids macular edema, an increase in eye pressure, and inflammatory eyelids which are dissolved with medications.98% of cataract surgery cases can be carried out successfully without creating any particular complications, and in 95% of cases, vision is improved. People whose vision is not improved after cataract surgery, usually suffer from age-related macular degeneration, diabetic retinopathy, or other diseases.
If there are cataracts in both eyes, can they be operated at the same time?
In this case, your doctor usually schedules a second surgery. In fact, he waits for the first eye to heal before the second eye surgery takes place. He allows 1-3 weeks pass before removing the cataract in your other eye.
Prior to surgery, your doctor will carefully measure the size and shape of your eye to calculate the appropriate power of intraocular lens to implant. These tests are done by ultrasound or LOLMaster machine.
A multifocal lens has more than one point of focus; one at distance and the other at near, thus makes the recipient less dependent on glasses or contact lenses. Two different types of multifocal lenses are currently available: the diffractive multifocal and the refractive multifocal. Each of these lenses has its own set of advantages and disadvantages.
The refractive multifocal lens implant provides excellent intermediate and distance vision. The near vision is typically acceptable but people may have problems in seeing details.
The diffractive multifocal lens implant provides very good reading vision and also good distance vision, but there may be some problems in intermediate vision, for instance some patients may need to sit closer to the computer, or make the font size larger on the screen. In addition some patients may note glare and haloes around lights at night.
The accommodative lens: Human’s healthy crystalline lens normally adjusts itself with focal point of the eye to allow a sharp, clear near vision. As people grow older and lose their lens flexibility, this adjustability is gradually reduced. Accommodative lenses are designed to function in a similar manner to the natural eye, although their amount of adjustment is less than what people need.
In highly myopic and presbyopic patients, with increase in the accuracy of eye score measuring and prescription equipments, more than 90% of patients won’t need to wear glasses for far vision. In patients who suffer from extreme astigmatism, especial cuts or toric intraocular lenses should be used to correct astigmatism, although part of their astigmatism remains.
The treatment is a potential alternative for patients whose refractive error is outside that treated by LASIK-higher nearsightedness and farsightedness.
No. After cataract surgery, the appearance of person's eyes will not change. It means that other people, by looking at your eye, won’t realize that you’ve undergone a cataract surgery. The only difference is that the intraocular lens, due to its high transparency, causes light reflection and may seem brighter than patient's own lens.
This occurs when the back or ‘posterior’ of the capsule, which had remained intact to support the new lens, becomes hazy or clouded and results in blurry vision. It is also called “posterior capsule opacification’’ and may develop as early as a few months, to several years after cataract surgery. Nowadays, due to improvements in surgery techniques and changes in designing intraocular lenses, this complication is much less frequent than the past. Whereas 50% of patients needed to perform Capsulotomy in the past, today less than 10% of patients may need it. Posterior capsule opacification occurs because lens epithelial cells remaining after cataract surgery have grown on the capsule. The treatment of a secondary cataract is a quick and simple procedure called a YAG laser capsulotomy. In this technique the laser is used to cut a hole in the center of lens capsule, thus providing a clear path for light rays to reach retina. Capsulotomy means cutting a hole and entering the capsule and YAG is an abbreviation for Yttrium Aluminum Garnet, a kind of laser machine. It takes less than 5 minutes to perform this outpatient procedure. After the operation, you may rest in your doctor’s office for almost an hour until he makes sure that your eye pressure has not increased.