What You Need To Know About Cataract Surgery

When you schedule a cataract operation, your surgeon may require that you have a medical workup first. Since these operations are now commonly performed in an outpatient setting, your general practitioner can order the necessary tests. The whole operation procedure, either cataract surgery alone or a combined cataract and filtering operation, can take ninety minutes to perform if the case is uncomplicated. Depending on your condition and the surgeon's preference, you may stay overnight in the hospital or you may go home after the operation.

During the operation, if you are having local anesthesia, your surgeon will inject the anesthetic around your eye. It may hurt, but the discomfort will last for only a few seconds. The surgeon will then perform the cataract surgery. If you are having glaucoma surgery at the same time, that will be done immediately after the intraocular lens implant has been put in place.

After the operation, your eye will be bandaged overnight. In the morning, your eye will be checked by your surgeon and your IOP measured. You will most likely be advised to take an assortment of drops, including antibiotics to prevent infection and steroids to reduce inflammation. You will also be given an eye shield, a perforated plastic oval to fit over your eye, to protect your eye when you sleep, and you will be advised not to bend your head, lift anything heavy, or strain during bowel movements (a stool softener can be used if necessary to prevent this problem). Otherwise, you can assume your daily activities. Some surgeons say you can shower; others advise against it.

Within four to five weeks, depending on how quickly your eye stabilizes, you may then be fitted with glasses. Many ophthalmologists prefer to implant lenses that make the eye slightly myopic and then correct distance vision with eyeglasses or contact lenses, especially with patients who are already nearsighted. They have found that people who are accustomed to viewing the world myopically don't adapt well if their vision is fully corrected.

The decision as to what strength lens implant to use is based on a combination of measurements, including the curvature of the cornea, the depth of the anterior chamber, and the dimensions of the eye itself. You have something to say about the strength of the intraocular lens as well. You are entitled to discuss in advance with your doctor what you feel will be most comfortable for you.

At this stage, unfortunately, bifocal intraocular lenses are not available, so you may decide on a reading-strength intraocular lens with additional correction (glasses or contact lenses) for distance. This combination feels familiar to most nearsighted people. Some doctors and patients have opted to have one eye fitted with a reading-strength lens and the other with a distance lens. While this arrangement is convenient and eliminates the need for glasses, it makes it impossible for the eyes to converge and work together properly, which is important for close work and depth perception.

As with any type of surgery, complications can arise with cataract removal, and people with glaucoma may be more likely than others to experience some problems. Pupillary block is uncommon, but it may occur as a complication of cataract surgery. In this condition, the aqueous fluid is unable to squeeze through the space between the lens and the iris, and pressure builds up, pushing the iris forward to block the drainage channel. This can cause a dramatic increase in intraocular pressure. Pupillary block can be corrected with an iridectomy or iridotomy. Studies indicate that there are fewer cases of pupillary block if extracapsular extraction is used.

Another difficulty may occur if the intraocular pressure decreases to a critical stage. While people who have glaucoma want to have low intraocular pressures, too-low pressure may result if the aqueous fluid passes from the anterior chamber too rapidly, causing the chamber to flatten. When the chamber is flat, parts of the eye like the iris and cornea, which are normally kept apart by the fluid, can touch and stick together - and that is a decidedly undesirable event. An IOP under 5 mm Hg may be an indication that this is happening.

Bleeding may also be a problem. Any intervention into your eye (or any other part of your body, for that matter) can cause the disruption of blood vessels. Most often these bleeding vessels can be cauterized or will seal themselves, but in some cases it may take a day or so for such a situation to resolve. In most cases it does resolve, but until the blood clears away your vision will be blurry.

If you have a fragile cornea, something called corneal decompensation may occur. In this condition, the cornea begins to lose cells and is unable to regain its former shape and consistency. This problem occurs if your cornea has a scarcity of cells, which may result from laser treatment or the use of medication. Glaucoma patients are more prone to this effect.

Your eye may also react to the implanted lens material by forming adhesions at the lens's points of contact. If the lens is improperly positioned, chronic iritis (inflammation of the iris) may result. If there is recurrent bleeding, neovascularization may develop, promoting a condition similar to the neovascular glaucomas. In some cases, a Cataract operation can also precipitate an attack of narrow-angle glaucoma, for with this operation there can be a slight shifting of the parts in the eye, and these - the pupil, the ciliary body, or even trapped air - can block the angle through which the aqueous fluid flows.