Surgery day; the day everyone has been anxiously waiting for! Every cataract surgeon has their own individual protocol, so I won’t pretend to speak for exactly how your day will go. I have been very fortunate to follow an ophthalmologist performing cataract extractions, so I have witnessed first-hand what the patient experiences. Here are some general insights on what to expect:
1) Bring a driver. You probably guessed that already, but you will need someone to take you to the appointment and (more importantly) drive you home after the surgery.
2) Surgeries are typically performed on an out-patient basis, so you will only be in the hospital for a short time! That is usually great news for my patients. First you will be in a waiting area where the surgeon will likely come speak to you and go over which eye will be operated on today. Then an attendant will come to give you a sedative to ensure that you are relaxed. Most surgeries are NOT performed under anesthesia and you will be able to respond to the doctor, speak, and move throughout the procedure (though you should refrain from doing the latter). Your heart rate will be monitored the entire time, and the doctor will continually remind you not to move if you are getting even the least bit fidgety. You will also be able to see what is going on during the entire procedure but don’t worry about seeing the instrumentation, everything will just look generally blurry to you. Because you can talk during the procedure, it can be interesting to hear patients describe what they are seeing. One woman kept talking about trees, and afterwards she told me that she could see the surgeon and his attendants while he was operating, but they were so blurry they looked like big trees.
3) Only ONE eye is operated on at a time. I know it would seem so easy to get both of your cataracts removed in one fail swoop, but having a healing time between operations is very important. As discussed in previous posts, the risk of complications from surgery are minimal, but if something were to happen that damages vision, it is better to have your other eye protected and undisturbed. Generally several weeks to 1 month passes between surgeries on each eye.
4) Not only is cataract removal one of the most commonly performed surgeries in America, it is also one of the fastest. The actual time of surgery is typically around 10 minutes! It is incredible how quickly the process can be performed with today’s techniques. Here is a little breakdown of the procedure:
--A small incision is made into the cornea (no bleeding and no suture will be required afterwards) where the instruments to remove the lens are inserted.
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| A small (typically around 2.5 mm) incision is made in the cornea to allow entry. Because the cornea is avascular, the wound will not bleed. Due to the small size of the entry used in current procedures, no suturing is needed to close the wound. |
--The back surface (endothelium) of the cornea is protected with a material called viscoelastic that is inserted through the corneal entry point. Viscoelastic greatly reduces the risk of swelling after surgery (and thus the immediate visual outcome).
--The pupil is dilated prior to surgery so that the surgeon has good visibility of the cataractous lens. If you are taking Flomax, this medication is typically discontinued several weeks before surgery to prevent the iris (colored part of the eye) from not retaining a good dilation and thus reducing visibility for the surgeon. This is commonly called “Floppy Iris Syndrome”
--The lens sits in a little sack (called the capsule or capsular bag) that is suspended behind the iris by string-like zonules. To get to the lens, the surgeon peels away some of the anterior capsular bag, and then uses an instrument called a phacoemulsifier to break up the cataract into small pieces. The phacoemulsifier also has a vacuum-like function that sucks up these cloudy cataract pieces, leaving a nice, clear, and empty capsular bag.
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| Peeling the anterior capsule away to get to the cataract. The surgeon must be careful to not make a hole too large in the capsule because it is needed intact to hold the intraocular lens implant! |
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| Phacoemulsification allows the surgeon to "vacuum" out the cloudy lens. All of the yellowed (or browned) cataract pieces are removed, leaving a clear and empty capsular bag in place. |
--Once the entirety of the cataract is removed, the surgeon inserts the small intraocular lens implant that will act as your new lens. The power has been carefully crafted to minimize your prescription or need for glasses post-surgically. When it is inserted into the eye, the lens is rolled-up to make it as small as possible (which allows such a small incision in the cornea). Once it enters the capsular bag, the lens implant will unfurl and the surgeon will rotate it into place via the arm-like haptics. The lens implant is placed securely into the capsular bag that once held your natural lens, which ensures stability of the implant after surgery.
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| An initraocular lens implant with "arm-like" haptics that the surgeon uses to manipulate the implant into the capsular bag. |
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| A successful cataract surgery where the intraocular lens implant rests inside the capsular bag that once held your cataractous lens. |
After surgery antibiotic drops are instilled to prevent infection, and the eye is patched for protection. Either later on that day or the following day (depending on your surgeon) you will return for the first of several post-op appointments. We’ll address those in the next post of our series!
NOTE: All pictures today are from jirehdesign
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