Cataract Surgery

Cataract surgery is the removal of the natural lens of the eye, also called crystalline lens when a cataract has developed.

Some facts about Cataract Surgery:

• The natural lens of the eye that  has developed an opacification will be replaced with an intraocular lens.
• The cataract is developed because of metabolic changes of the crystalline lens fibers over time.
• Impairment or loss of vision will be caused by the development of the cataract.
• Infants are sometimes born with congenital cataracts.
• Cataract formation can be due to certain environmental factors.
• Strong glare from lights, reduced acuity at low light levels and small light sources at night are some of the early symptoms of cataract.
• The cloudy natural cataract lens of the patient will be removed, either by emulsification in place or by cutting it out during a cataract surgery.
• Generally, a cataract surgery is performed by an ophthalmologist in an ambulatory setting at a surgical center or hospital.
• An artificial intraocular lens (IOL) will be implanted in place of cloudy natural cataract lens.
• Your doctor may suggest cataract surgery if a cataract makes it difficult for you to carry out your normal activities.
• The surgery is also recommended when a cataract makes it difficult for your eye doctor to examine the back of your eye to monitor or treat other eye problems, such as age-related macular degeneration or diabetic retinopathy.

Types of Cataract Surgery:

A number of different surgical techniques are used in cataract surgery. These include:

Phacoemulsification (phaco):

A machine with an ultrasonic hand piece equipped with a titanium or steel tip is used in Phacoemulsification. A tiny incision ill be made in the cornea and a needle-thin probe will be inserted into the lens substance where the cataract has formed.
The probe, which transmits ultrasound waves, will be used to break up or emulsify the cataract and suction out the fragments. The lens capsule is left intact to serve as a place for the artificial lens to rest. The tiny incision in your cornea will be closed by the help of stitches at the completion of the procedure.

Manual small incision cataract surgery (MSICS):

This technique involves an evolution of ECCE where the entire lens is expressed out of the eye through a self-sealing scleral tunnel wound.

Extracapsular cataract extraction (ECCE):

The entire natural lens will be removed and the posterior capsule is left intact to allow implantation of an intraocular lens in this method.
Surgical tools are used to remove the front capsule of the lens and the cloudy lens comprising the cataract. The lens capsule is left intact to serve as a place for the artificial lens to rest. Stitches are required with the larger incision

Intracapsular cataract extraction (ICCE):

The lens and the surrounding lens capsule in one piece will be removed in intracapsular cataract extraction. There is relatively high rate of complications in this method due to the large incision required and pressure placed on the vitreous body.  

Intraocular lens (IOL) implantation:

An IOL is usually implanted into the eye after the removal of the cataract. It can be done either through a small incision, usually 1.8 mm to 2.8 mm using a foldable IOL, or through an enlarged incision, using a polymethyl methacrylate lens.
Cataract surgery can be performed to correct vision problems in both eyes. An intraocular lens that provides near vision will be inserted in one eye and an IOL that provides distance vision will be inserted in the other eye.
An additional lens will be inserted over the already implanted one for patients who need high degrees of vision correction. This type of IOLs procedures is considered an option whenever the lens result of the first implant is not optimal and is called as piggyback IOLs. Implanting one more IOL over the existent one is considered safer than replacing the initial lens.

Preparation for Cataract Surgery:

• Your eye will be measured by your surgeon to determine the proper focusing power for your IOL.
• A painless ultrasound test will be done to measure the size and shape of your eye to help etermine the right type of lens implant.
• Your vision can be improved by focusing light on the back of your eye using intraocular lens, or IOL.
• Eye-drop medicines may be prescribed to start before surgery which help prevent infection and reduce swelling during and after surgery.
• You will be asked not to eat any solid food at least 6 hours before your surgery.

Procedure for Cataract Surgery:

• Cataract surgery, usually takes an hour or less to perform.
• Eye drops will be placed by your doctor in your eye to dilate your pupil.  
• Local anesthetics will be given to numb the area, and you may also be given a sedative to help you relax.
• The clouded lens is removed, and a clear artificial lens is usually implanted during cataract surgery. A cataract may be removed without implanting an artificial lens in some cases.

Recovery from Cataract Surgery:

• Your vision will begin improving within a few days after cataract surgery.
• At first, your vision may be blurry as your eye heals and adjusts.
• Colors may seem brighter after your surgery as a new, clear lens is used.
• You should visit your eye doctor a day or two after your surgery, the following week, and then again after about a month to monitor healing.
• Avoid rubbing or pushing on your eye as itching and mild discomfort feeling for a couple of days after surgery is normal.
• An eye patch or protective shield will be provided to wear on the day of surgery.
• Wearing the eye patch for a few days after your surgery and the protective shield when you sleep is recommended during the recovery period.
• Infection can be prevented, inflammation can be reduced and eye pressure can be controlled by eye drops or other medication.
• Most of the discomfort should disappear after a couple of days. Complete healing occurs within eight weeks.