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Cataract surgeryModern cataract surgery has evolved considerably to become a very successful procedure leading to improvement in vision for a large majority of patients. This usually takes a few minutes as a day case and is done with local anaesthesia, either with drops or injected aroud the eye.
A keyhole opening is made at the top or around the side of the transparent part of the eye. In this way, no significant scars are left in the eye. This allows a fine ultrasonic needle to vibrate rapidly thus liquifying the cataract which is then aspirated outside the eye. A special plastic lens implant is then folded thinly, introduced in the eye and unfolded and centered to replace the focusing strenght of the eye. At this stage, the strenght of the eye can be changed, generally to provide good vision in the distance and reserving glasses for near vision. In this way both long and shortsightedness can be much reduced. Theare are other alternatives utilising special lenses which can be discussed with your surgeon. At the end of the operation the eye is usually allowed to heal without the need of stitches. |
Complex cataract surgery |
There are a number of situations when particular features in a person's eye increase the chance of problems during the operation. Particularly, the structure that supports the lens (the capsule) which has become a cataract may become disengaged or split. This can lead to fragments of cataract to fall to the back of the eye and the vitreous jelly which fill the posterior cavity of the eye to come forward to the front of the eye. Around 1% of cataract operations may experience this complication which if not treated appropriately can result in loss of vision. Additionally, a conventional lens may no longer be implanted and a special lens will either go behind the iris or clipped to the iris itself.
A number of additional steps may become necessary to complete the operation safely, including a vitrectomy operation. At this stage the expertise of a retinal surgeon will be necessary to retrieve the dislocated cataract fragments and complete the operation. Some of the features and conditions that may make a cataract operation complex are: previous retina surgery, injury to the eye, constitutional predisposition like "pseudoexfoliation syndrome", small poorly reacting pupils, tamsulosin medication, very high longsightedness or shorthsightedness, rare types of congenital cataracts, Marfan syndrome. |
Combined cataract surgery |
Sometimes a patient who may need vitrectomy retinal surgery also has a cataract already developing. In this situations, the cataract operation can be carried out at the same time with no additional risk. In this way only one combined operation can be conducted, instead of two separate procedures.
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Toric lenses |
The optical focusing part of the eye is not perfectly round, but rather elongated like the bottom of a spoon. As such, the image is then stretched in one direction and shrunk in the other. This is called astigmatism. For most people this effect is so small that it has no consequence. For others, it is enough to make the vision blurry necessitating glasses to correct it. Cataract surgery may interfere with the astigmatism and it is sometimes possible to reduce it modifying the operation technique and using special "toric" lenses. This can help in reducing dependence on glasses. As this requires complex calculations, your surgeon will need to carefully advise you on whether this is a suitable solution for your specific case.
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