Cataract Surgery – Types and procedure

Cataract surgery is easy in concept (the opaque natural lens is replaced with artificial lens), but actually performing this surgery is challenging as we’re working under a surgical microscope with delicate ocular structures.

Three approaches to cataract surgery are generally used:

1. Phacoemulsification, involves making an incision in the side of the cornea, the clear outer covering of the eye, and inserting a tiny probe into the eye. The probe emits ultrasound waves that soften and break-up the lens so it can be removed by suction.

2. Micro Incision Cataract Surgery
Similar to Phaco but can be done through <2mm (1.8mm) incision.

3. Extracapsular surgery (Manual Phaco) requires a somewhat larger incision in the cornea and the lens core is removed in one piece.

There are many steps to cataract extraction

Essentially, we can break down the cataract surgery into a few steps:

1. Entering the eye: The main surgical entry site can be performed several ways. We can enter the eye by cutting through the cornea, or through the sclera. The size of the wound depends on the type of surgery. It’s 2.8-3.2 mm in Phacoemulsication technique & 6-7 mm in manual suture less technique.

2. Capsulorhexis: To get the lens out, we need to tear a hole in the anterior capsule of the lens.

3. Phacoemulsification: We use an instrument called the Phacohand piece to carve up the lensnucleus. This machine oscillates at ultrasonic speeds and allows us togroove ridges into the lens. After grooving, the lens can be broken into piecesand eaten up one-by-one. The term laser cataract surgery is a misnomer. The cataract is broken into small pieces using ultrasonic energy. In manual Phaco technique, the lens nucleus(central hard part) is removed in one piece from the eye.

4. Cortical removal: After removing the inner nucleus, we remove the residual cortex (the Soft part) of the lens. The back membrane of the lens called the posterior capsule is left in place to support the lens.

5. Lens Insertion: After removing the cataractous lens, an artificial lens called intraocular lens (IOL) is implanted inside the eye. We usually use a foldable lens that can be injected directly into the bag. Rigid lens is inserted in to the capsular bag in manual Phaco technique.

The intraocular lens may be nonfoldable (Rigid) OR foldable, when a lens is implanted inside the eye, glasses of minor power are required for distance after surgery. However glasses for near vision are usually required.

With the recent advancements in accommodative and multifocal lenses, the requirement of near glasses is also being minimized and it may be possible to do most of our daily routine activity without the aid of glasses.

After surgery is completed, your doctor may place a shield over your eye. After a short stay in the outpatient recovery area, you will be ready to go home.

Advantages of phaco/MICS

1. Surgery can be done at early stage of cataract and the patient need not wait for the cataract to mature.

2. Smaller incision: Increased safety. Helps in faster healing, early resumption of normal activity.

3. No sutures
   - No irritation
   - No watering
   - No need for suture removal
   - Early return to work
   - No need for hospital stay
   - Better quality of vision and early recovery of good vision

Following Surgery

You will need to:

*Use the eye drops as prescribed

*Be careful not to rub or press on your eye

*Avoid strenuous activities until your eye specialist tells you to resume them

*Ask your doctor when you can begin driving

*Wear eyeglasses or an eye shield, as advised by your doctor

You can continue most normal daily activities.