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Cataract Surgery
Cataract Surgery
A cataract is a painless clouding of the lens of the eye. Cataracts generally develop over a long period of time, gradually worsening the eyesight. They can eventually lead to blindness. Cataract surgery removes the cataract and can greatly improve vision.

Why have cataract surgeries?

Cataracts cloud the lens in the eye and may reduce your vision. For some people, this loss in vision is mild enough to get along fine with glasses or contact lenses. The time to consider treatment is when your vision has become noticeably worse and this is interfering with your everyday activities such as work and hobbies.
Surgical removal of your cataract is the only way to restore or maintain your vision.

The most common cataract operation is known as phacoemulsification. In this operation, the lens is broken down into tiny pieces which are removed through a small incision in the eye. The lens is replaced with an artificial one.

What are the alternatives?

So far, no medication or diet has been found to slow down the growth of cataracts, and there is no medication that can clear a clouded lens.
Wearing glasses may improve vision for people with the early stages of cataract development, but your cataract will probably get worse over time so this will provide only a temporary solution.

Left untreated, the lens will eventually become so clouded that it is impossible to see any detail at all, although some light will always be distinguishable.
What happens before cataract surgery?

Your surgeon will discuss how to prepare for your operation. He or she will also discuss your options for the type of artificial lens replacement you will have fitted.

What should I expect in hospital?

Cataracts typically occur in both eyes, but they are usually treated one at a time, to allow the first eye to recover. There is usually an interval of several weeks or months between each operation.

Your exact length of stay in hospital will depend on the type of surgery you are having.
Phacoemulsification is most often performed as a day-case, without the need for an overnight stay in hospital.

Before surgery you will talk to your surgeon about the operation and you will be asked to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead. This is a good time to ask any unanswered questions about the operation.

Your surgeon will examine your eye. Drops will be placed in your eye to dilate (widen) your pupil. This makes it easier for your surgeon to see the lens inside your eye. It will not be possible to see out of your eye as it is being treated, but you may be aware of light and movement.
The operation

The operation usually lasts around 15 to 20 minutes.

Cataract surgery is usually done under a local anesthetic which numbs the area but you will be awake. If needed, your anesthetist can also give you an injection of a sedative, which will make you feel relaxed and possibly drowsy. Less commonly, the operation is done under a general anesthetic. This means that you will be asleep throughout the procedure and will feel no pain.

During the operation, you will lie in a reclined position in a special chair. The surgeon will work with very fine instruments while looking at your eye through a microscope.
Once the anesthetic has taken effect, your surgeon will make a tiny incision on the surface of your eye. This incision is usually so small that no stitches are needed.

Your surgeon will use ultrasound energy to break up the cloudy lens (cataract), which can then be removed through a small tube. The lens sits inside a sac of thin tissue called a capsule. This is kept in place to support an artificial replacement lens, which will be inserted through the same incision.

An artificial lens (the intraocular lens) will be put into your eye after the cataract is removed. It is folded to help insert it through the tiny incision. The intraocular lens will be unfolded once it is in your eye. The lens is made from plastic or silicone and remains permanently in your eye.
After the operation

After the operation, your eye is likely to be covered with a protective pad. You will need to wear this for a few hours.

Your operation will usually be a day-case and you will be able to go home once you have made a full recovery from the anesthetic. It is a good idea to have a friend or relative stay with you for the first 24 hours (especially if it's your only good eye that has been treated).

Sensation usually returns to the eye within a few hours. Improved vision is usually noticed within a few days, although complete healing may take several months.
Before discharge, you will be given eye drops to help prevent infection and promote healing. Your surgeon will also give you advice about how long to use eye drops and, if applicable, when you can resume driving.
You will be given a 24-hour contact telephone number for the hospital and a follow-up appointment will be made. Most surgeons see their patients again within one to three weeks of the operation.

It may be helpful to wear sunglasses or a hat when you leave the hospital as your eye may be sensitive to the sun.
Recovering from cataract surgery

Take it easy for the first two or three days after the operation. If you have questions about what you can and can't do, ask your surgeon or nurse for guidance.

You can resume normal activities such as moving around and bending down, but be careful because it's hard to judge distances with one eye covered.

There are some important things to remember while recovering from cataract surgery.

  • Try not to touch or rub your eye.
  • Keep soap and shampoo out of your eyes (it's sensible to avoid washing your hair for the first few days).
  • In the first few weeks after the operation, avoid heavy lifting or strenuous exercise as this can increase the pressure in your eye and could put a strain on your healing scar.
  • If you suffer more than mild pain, or you experience loss of vision or increasing redness of your eye, you should contact your hospital for advice.
Deciding to have a cataract removed

Cataract surgery is a commonly performed and generally safe surgical procedure. For most people, the benefits in terms of improved vision are greater than any disadvantages. However, in order to make a well-informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.
Side-effects are the unwanted but mostly temporary effects of a successful procedure. For cataract surgery, side-effects include:

  • an itchy or sticky eye and blurry vision for a few days after the operation
  • aching of the eye, which generally settles down within a few days
  • bruising of the eyelid or eye, which will heal normally

Complications are unexpected problems that can occur during or after the procedure. Most people are not affected. The main complications of any operation are bleeding during or soon after the procedure, infection and an abnormal reaction to the anesthetic. In a small number of cases, complications can lead to reduced vision or blindness.
Specific complications of cataract surgery are rare but can include the following.

  • After phacoemulsification, the lens casing that is left in the eye to support the implant may thicken and become cloudy. This is called posterior capsular opacification and begins gradually, usually months or years after the operation. It results in reduced vision similar to a cataract. A relatively simple laser treatment can be used to correct it.
  • The lens capsule may tear, which can result in reduced vision.
  • A bit of the lens with the cataract may be displaced into the back of the eye, requiring another operation to remove it.
  • You may have bleeding inside your eye.
  • The implant may dislocate, requiring a further operation.
  • Your retina may be damaged during the operation, which could make you blind in that eye, but this is rare.
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