Professor Pearce Liverpool Ophthalmologist and Retinal Expert
A cataract is when the lens inside the eye becomes cloudy causing loss of vision.
This can reduce your vision both in the distance and for reading. Sometimes it may also cause ‘glare’ around bright lights, which may be worse at night.
Also known as Phacoemulsification and Intraocular Lens Implant Surgery this is surgical removal of the lens of the eye and its replacement with a man made artificial lens
After local anaesthetic is given in the anaesthetic room, you are wheeled through into theatre.
They eye is cleaned with surgical disinfectant.
An adhesive drape, with hole for the operated eye, is placed onto your face. A tube blowing fresh air is inserted underneath this drape so that you will not be short of air.
You will need to lie completely still and as flat as possible for thirty minutes.
A tiny two millimetre incision is made into the cornea of the eye.
The lens is removed piecemeal using a phacoemulsifying needle inside the eye. This is a needle that oscillates at ultrasonic frequencies allowing it to cut the hard lens into pieces.
An intraocular lens is inserted into the eye. This lens is permanent and lasts forever.
Distance vision and reading vision should be clearer, although you may still need glasses or contact lenses to achieve the best results.
In most cases the focusing after surgery is for distance meaning that you may need glasses for distance but you will definitely need them for reading.
Colours should be brighter and, if you had it pre operatively, you should see a reduction in glare.
Keeping up to date with your spectacles, using a light to help reading or even magnifiers can all be tried to help with reading if not proceeding with surgery
If you do not proceed with cataract surgery you should expect a gradual deterioration in vision. This may be over many years.
Leaving the cataract in place does not damage the eye.
The cataract does not have to ripen: the operation can be done at any time.
Before the operation you will be seen in the clinic by your consultant
He will ask you about your problem. He/she will also ask about other medical problems you have and medications you take (bring a list or the tablets themselves with you).
The consultant will examine your eyes in clinic. He will determine if your visual loss is due to the cataract.
If you are to proceed with surgery the operation will be discussed in detail. This will include any risks or possible complications of the operation and the method of anaesthesia.
You will be asked to read and sign a consent form after having the opportunity to ask any questions.
A week or two before surgery you will also see a preoperative assessment nurse who will take a swab from your nose, throat and groin. This is to exclude MRSA. MRSA is an antibiotic resistant bacteria that many of us carry on our skin. This does not make you unwell but can cause serious infections at the time of surgery. If you are positive, a short course of treatment usually rids you of the MRSA and surgery can then proceed.
Biometry measurements of your eye will be performed by your consultant or a technician. This usually takes place at the time of initial consultation but sometimes on a separate day. These measurements take a few minutes and enable your consultant to select the correct lens implant for your operation.
What should I do about my medication?
If you take warfarin, this should be checked 1 week before and on the day of surgery. As long as it is within your normal therapeutic range we will proceed with operation.
Other medication should be taken as usual.
Bleeding may occur spontaneously inside the eye during surgery. This may cause permanent loss of vision
Removal of the lens is a very delicate procedure. In some cases part of the capsule holding the lens may tear. If so, an extra procedure called a vitrectomy may be required. This occurs in approximately 1 in 100 cases.
If the capsule tears some of the lens may fall into the vitreous jelly at the back of the eye. If this happens you would need further vitrectomy surgery by a specialist retinal surgeon at a different hospital on a different day. The incidence of this is approximately 1 in 500.
Infection: This can occur inside they eye after surgery. It presents with pain, redness of the eye and loss of vision. It is very rare – approximately 1 in 1000 cataract operations become infected. If you suspect it has happened after surgery you should contact your surgeon or the hospital urgently. If in doubt you should go to an accident and emergency department. It can cause permanent loss of vision.
Bleeding: This may occur spontaneously inside the eye during or after surgery and cause permanent loss of vision. It can also occur as a complication of local anaesthetic injection causing a penetrating injury of the eye or bleeding around the eye – orbital haemorrhage / haematoma.
Retinal detachment: This rare condition is more common after cataract surgery but the incidence is still very low (1 in 10,000). This risk however does increase significantly if there are other complications, such as needing a vitrectomy at the time of cataract surgery. Also, if you are highly short-sighted you are already at increased risk of retinal detachment and the cataract surgery could add to this risk. Retinal detachment requires surgery by a specialist retinal surgeon in another hospital and can cause permanent loss of vision.
Retinal oedema: Following the operation some people develop fluid swelling in the retina. This can reduce vision. In most cases it is temporary and resolves without treatment. In some however either eye drop medication or injections of medication next to the eye are required. The cure rate is very high.
Corneal failure: The cornea is the clear dome at the front of the eye. The operation takes place inside the eye, underneath the cornea. Mild corneal oedema is not uncommon after surgery. This usually settles spontaneously. In rare cases the cornea does not improve and fails. If this happens, further surgery would be needed to improve the vision.
Loss of vision: The most serious causes of this are bleeding, infection, retinal detachment and fluid swelling in the retina, corneal failure as already discussed.
Incorrect Lens Implant: Despite very careful measurements of your eyes, it is possible for a lens to be implanted into your eye at the time of cataract surgery that does not produce the focus we expected. This is usually mild and correctable with glasses or contact lenses. If it is significant, further surgery to remove and replace the lens implant may be required.
Further surgery: This may take the form of a vitrectomy by your consultant at the same time as your cataract surgery. In which case you may be completely unaware that it has been carried out. The only difference would be a procedure that takes forty minutes instead of twenty.
A more extensive vitrectomy would be required in the rare event of lens matter being dropped into the vitreous jelly of the eye or retinal detachment surgery.
In rare cases it is not possible to insert a lens implant on the same day as removal of the cataract. If so, a further operation would be required to complete the process and insert a lens implant.
In addition, if the wrong lens has been implanted, further surgery may be required to replace it.
Lastly, if the cornea of the eye fails after cataract surgery, corneal graft surgery can be performed at a later date to improve the vision.
Bruising on the surface of the eye or around the eyelids may occur due to the operation or the local anaesthetic. This usually resolves within two weeks
Allergic reaction to any of the medications used during or after the operation is a rare complication. It resolves with allergy treatment and cessation of the allergenic drug.
Raised eye pressure: Temporarily after surgery the pressure inside the eye may increase. This can be painful but subsides spontaneously in most cases. If pain persists after surgery, you should see an eye specialist without delay.
Benign visual symptoms: After surgery, the improved vision you will experience, may enable you to see imperfections within your eye that were there before but hidden from view. Often described as ‘floaters’ there is no treatment for this but most people find it settles with time.
Some people experience glare or reflections from the edge of the lens implant. This is not common and not treatable but usually settles with time spontaneously
What type of anaesthesia will I have?
Three types of anaesthesia are used for this procedure: local anaesthetic alone; local anaesthetic with intravenous sedation; general anaesthesia.
Subtenons Local anaesthetic involves an injection next to the eye without a sharp needle. It is similar to dental anaesthesia. Initially the injection is painful but after 10 – 15 seconds the eye becomes numb. This will not only reduce eye movements but also fully anaesthetise the eye.
The vast majority of patients have simple local anaesthetic for this operation
Sedation with local anaesthetic means that you are breathing for yourself, don’t have a breathing tube inserted but you are very relaxed and sleepy. Often patients don’t remember the operation or the local anaesthetic injection.
General means you are completely asleep with a breathing tube inserted.
You should have the opportunity to discuss the risks of anaesthesia with your surgeon or anaesthetist prior to surgery.
What should I expect after surgery?
After surgery you may experience some pain. Simple paracetamol is usually enough to control this.
It is not unusual to experience some mild pain within the first 12 hours after surgery. This usually starts to improve once the eye drops are started.
Your vision will be blurred initially but usually starts to improve within the first 48 hours. If you experience a drop in vision after surgery you should contact the hospital where you had the surgery and speak to a doctor
The legal standard for driving is that you can read a number plate in daylight at 20.5 metres. Also you need to be able to read 6/12 on a Snellen chart (the vision test you have when you see an optometrist or ophthalmologist). As long as you meet these requirements you may return to driving.
You will need to put drops in your eye 4 times a day for a month following surgery. If you don’t think you can do this you should arrange for a friend, relative or carer to do this for you. If you do not have this help a district nurse will need to be arranged.
It is best to wait until both eyes have been operated on before obtaining new spectacles. You should wait at least 4 weeks after surgery before obtaining new spectacles. If only having one eye operated on you may go for glasses after 4 weeks. If having 2 eyes operated on you may see your optometrist/optician in between operations to have the lens removed from the operated eye if your vision is difficult through your old lens
If proceeding to surgery with both eyes, you will be seen in clinic following the first operation. If all has gone well you will then be listed for the second eye surgery.
You may return to normal activities after 48 hours of surgery. You should avoid heavy straining or any form of activity where the eye could receive direct trauma for at least 10 days.
In approximately 1 person in 30, scar tissue grows around the lens implant. This will seem as though the cataract is growing back causing blurring of vision. The cataract cannot grow back and this problem is easily treated with a simple out patient laser treatment. If you think you have this problem, see your optometrist and they will refer you if necessary.
What to do in an Emergency?
Call Spire Liverpool Ward
0151 522 1801
0151 522 1802
See your GP
Attend a local accident and emergency department informing them that you have very recently had cataract surgery.
Post operative Instructions
If an eye pad is placed it should remain until the next morning when you may remove it.
Keep the clear plastic eye shield and wear it every night for the first 10 days
Clean around the eye using boiled water that has cooled down or sterile water sachets. Do this twice a day for 10 days using cotton wool balls.
Put in the post operative eye drops as instructed. Pred-Forte 4 times a day for 4 weeks
Do not allow shower or bath water into the eye for 10 days – you may still bath and shower, just be careful with the eye.
Do not swim in public baths for 10 days
If you are using other eye drops for another problem you should still use them. Please obtain a completely new bottle to use after surgery to avoid infection
If you experience deterioration in vision, pain or redness of the eye you should seek the opinion of an eye doctor without delay, even if out of normal working hours.
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