Cataract Surgery

Lens Replacement

Why do I need a Lens Replacement?

Lens Replacement is a procedure that resolves multiple refractive conditions like presbyopia / hyperopia / myopia / astigmatism along with cataract as well.

However, a patient can undergo Lens replacement even if one does not have cataract, in which case it is termed as “Presbyopic Lens Replacement or PRELEX or even Clear Lens Extraction”..

Lens Replacement in cataract surgery: This is the best and only way to treat cataracts effectively. In order to restore vision the cataract affected natural lens would to be replaced with IOL (Intra Ocular lens). Intraocular lenses are artificial replacement lenses that are foldable, flexible and are implanted though the incisions made during the surgery after the removal of the natural lens.

Lens Implantation during a cataract surgery through phacoemulsification technique is performed without any stitches resulting in speedy healing and reducing the risk of complications. The procedure completes in few minutes.

Your life style and visual needs are considered while choosing the right lens. Accurate IOL calculations are essential for proper lens implantation. You would be advised on which type of lens is most suitable for you after assessment of your candidature for lens replacement is satisfactory.

Clear lens Extraction Surgery is useful for patients for whom LASIK treatment is not suitable [usually belong to an older age group]. Cataract surgery is a daycare procedure and lens implantation is performed one eye at a time. An interval is maintained between eyes to avoid infection. There are various types of IOLs according to the suitability and type e.g. monofocal, multifocal and toric lens.

Monofocal IOLs: A type of traditional lens to resolve your distance vision although you may need glasses for near vision.

Lens replacement for correcting Presbyopia: Presbyopic IOLs like Multifocal IOLs (to focus distance as well as near) and accommodating IOLs (designed to move the eye muscles in order to adjust the right focus) are used during the cataract surgery to resolve Presbyopia. It eliminates or reduces the need of glasses for distance and near vision.

Lens replacement for correcting astigmatism: Toric IOLs resolve astigmatism as well. Toric IOLs replace limbal relaxing incisions in the cornea to change its shape.

Lens Replacement Recovery: Lens Replacement recovery time is very quick and eye restores to normal vision rapidly although initially after surgery vision is slightly blurred.

Medication (eye drops) to safeguard infection [antibiotics] and inflammation [anti inflammatory] are instilled in the hospital as well as the person accompanying you would be explained and trained on its usage in order to continue the same at home.
You are advised to follow the instructions regarding the follow up visits after the surgery.
Eyes would be rechecked after the cataract surgery recovery for further correction in case required.

Shroff Eye Hospital facilitates your relatives to watch the live procedure telecast in the viewing area in the facility. Post surgery, you will be in a recovery area for a short time and then shifted to your allotted day bed. You are under observation in the post operative period, monitoring of the vital signs are also done. You would be discharged after post operative doctor’s check up and confirmation.

You would be sent home with a detailed list of instructions and medications. All post operative eye drops are provided by us for the immediate post operative period.

Our endeavour is to ensure you get the best possible treatment. Your eyes are important to us.

Lower your Cataract Surgery Risks Even Further

If a cataract surgery is advised, then delay or avoiding surgery is the biggest risk. Why? Because you could simply lose your vision and in certain cases such loss of vision is irreversible. As you know, surgery is the only logical solution to treat cataracts effectively; the real need is to take a decision at the right time. When you take a decision for surgery, half the battle is already won.

The phacoemulsification procedure for cataract removal is usually a satisfying surgical experience, using implants or (IOL’s) Intra Ocular lenses, which improves vision.

It is by far one of the safest and most common surgeries in modern times.

But how can one reduce surgery risks even further?

BEFORE CATARACT SURGERY

I] Choose the right hospital

One which is well equipped to handle any type of eye related issues, even if emergencies or complications arise.
One that utilizes latest technology and expertise.
A hospital that has excellent treatment plans to choose from and medical care in the best of facilities.

II] Choose the right surgeon

With good surgical expertise and experience. Learn as much as you can about him/her before you visit the clinic. You must strike a good rapport on your visit, such that you should be comfortable to ask any questions that concerns you, no matter how silly you think it may be.

III] Choose the right surgical procedure:

When you have made a wise selection of the hospital and surgeon, the right surgical procedure easily follows through. Your doctor will help you in narrowing down your treatment plans

Iv] Choose to undergo Routine Eye examinations:

It’s like having a regular maintenance contract for your eye. Helps to rule out abnormalities and treat eye diseases effectively at the right time or even prevent them before you see the signs and symptoms. The first eye examination begins at birth, then at regular intervals. When you undergo cataract surgery, it should continue even after surgery.

V] Choose to be in good overall health:

Not just eye care, a complete health care is vital. Exercise, nutritious diet, protection of eyes from trauma and UV rays by appropriate eye wear when outdoors for prolonged periods.

VI] Choose healthy lifestyle changes:

Incidence of High Blood Pressure and Diabetes could aggravate diseases like cataract and could further lead to complications. Smoking and alcohol increases risk of co morbidity. Hence due care should be taken at all times.

VII] Choose to know your vision needs:

Knowing what is going on with your body is very essential to help the treating ophthalmologists identify vision issues and advise the suitable solutions.

VIII] Choose to attend to any decrease in vision or other symptoms:

If you tend to ignore them, no other person or doctor can help you. You are the best person to first report them.

IX] Choose medication for other disorders when necessary:

Treat lower urinary tract symptoms, dental focus, as simple as they sound, it could turn out to be a focus of infection during your cataract surgery. Some medications need to be reported to the doctor, do not hide facts from them. For e.g. studies have indicated that Tamsulosin (Flomax) could cause IFIS (Intraoperative floppy iris syndrome).

AFTER CATARACT SURGERY

Safe guard against risk of infection and inflammation
- Observation of instructions for medication as prescribed.
- Timely consultation and follow up check up.
- Follow guidelines on eye protection and eye care.
- Taking precautions against infection like instilling eye drops in the right technique.
- Avoid rubbing the eye.
- After surgery biannual consultations or annual consultations will help you.
- Keep free from dust, allergens and unhygienic conditions.
It is advisable to opt for cataract surgery in the second eye after the first eye recovers at a specific gap to avoid infection. This usually is about 7 days or more.
Trust your doctor and the team: This increases your self confidence for the surgery and helps you to deal with your vision issues in a better way.

Assuring you of our best support and treatment.

Numbing the Eye

With modern surgical techniques, cataract surgery is quite painless and without stitches. The process begins with the dilation of the eyes.

Dilation: In this process, dilating drops are instilled to enlarge the pupil and expose the cataract. Once the eye is dilated, it blurs your vision for some time thereafter it restores back to normal.

After dilation, the eyes are numbed to begin the surgical process.

Before numbing:

Before the surgery, a patch test is done to determine any sensitivity or allergy to the anesthetic agent being used.

What is numbing the eye?

Numbing is the process in which pain is eliminated in the eye before the surgery by anesthetizing the eye with the use of anesthetics. It could be in the form or topical eye drops, ointments or injections.

In the earlier days numbing was done by general anesthesia. This further progressed to injection behind the eyeball. Nowadays most common method of numbing in a cataract surgery is by using topical anesthetic eye drops in most of all cases. In certain cases anesthetic injection is given if essential. Numbing may sting for a few seconds. Only the eye would be numb and you would be awake during the entire surgery. After the eye is numb, an eyelid holder is placed on the affected eye to prevent blinking during the surgical period. If the cataract surgery is under general anesthesia (as in case for children) overnight fasting as instructed to be followed.

Advantages of Numbing through Topical anesthetic eye drops:

Easy to administer
For Painless surgery
Facilitates stillness during surgery and minimizes discomfort.
Block the pain signals at the nerve ending in our eyes, thus enabling us to withstand pain without realizing it.
Quick recovery
Eliminates risk and side effects associated with injection.

What to expect when your eyes are numbed?

The eyes are kept open during the entire surgery with the help of an eye lid holder. This does not hurt, but feels like a gentle stretching of the eyelids. The numbing eye drops take away the sensation of wanting to close the eyes or the blink reflex. Hence, it is quite comfortable to keep the eyes open without feeling the urge to blink, though the surgery.

Ensure that you are still and refrain from any head movement for successful instillation of the topical anesthetic eye drops. In case you have cough or other illnesses that could cause movement during surgery need to be intimated. If fasting is advised or restriction to a particular food is advised, kindly follow as instructed. After initial stinging sensation you begin to face painlessness and lack of sensation till the numbing effect wanes off. Topical anesthetic eye drops are administered in the affected eye as per the requirement. Some medicines may interact with certain topical anesthetic eye drops. The cataract surgery is performed under a close observation on your vitals with an anesthetist stand by for additional support if needed.

Do inform our anesthetist for any of the below conditions.

General Health reasons: In case of any health problems, infectious diseases, past operations, serious illnesses.
Dental conditions: False teeth, caps, loose teeth or other dental problems.
Any medical problems needing regular treatment.
In case of intake of any herbal/ayurvedic medicines.
Allergies or intolerances of any type especially to medicines.

Am I a candidate for Topical anesthetic eye drops?

Those who suffer from chronic pain and alcoholics may have varied doses for Topical anesthetic eye drops and in certain cases it would not be administered.

Before your cataract surgery, the type of anesthesia to be administered is usually pre-determined. Pro Paracaine eye drops are commonly administered topical anesthetic eye drops. The choice of anesthetic depends mainly on the surgical procedure adopted, your eye condition and general health.

Possible Short-Term Side Effects from Cataract Surgery

Cataract surgery is considered to be the safest and most commonly performed surgery worldwide and has a very high success rate. Just like every surgery there also lies an inevitable undesired element of side effects. Most people have faced no side effects. However, one should be alert regarding the same, because if treatment is ignored it may turn serious. Normally the side effects are short term and easily treatable.

The knowledge of the possible short term side effects, should they arise, helps in better understanding and preparation to combat the same. Let us understand some of the common possible issues due to cataract surgery that goes beyond what is desired.

Side effects from Medication: These relate to any side effects observed before, during or after surgery due to administration of medicine/eye drops even anesthesia for cataract surgery. These need to be immediately reported. You would be advised accordingly in case medicine needs to be reduced in dosage or discontinued completely.

Some of the ancillary effects: Small incision cataract surgery (Phacoemulsification) itself has reduced the risk to side effects. However in rare case the conditions listed below could occur in some cases.

Inflammation: Ie.g Uveitis in rare cases. This is associated with redness, tearing and light sensitivity. Sometimes, eye lids swell up and there is mild to moderate pain. This usually occurs when the post surgery eye drops are suddenly stopped and if there is any underlying cause for inflammation, such as a dental or gum infection. Oral anti inflammatory eye drops for inflammation is prescribed.
Bleeding: With small incision surgery there is almost no bleeding during surgery. Moreover cornea does not have blood vessels. However, in rare cases bleeding may occur in back of the eye (vitreous).
Mild pain and discomfort: Usually just after surgery a mild discomfort is common which gradually reduces or responds to any simple pain killers.
Sensitivity to bright light: The temporary side effect of light sensitivity is common for few days, which is why dark protective glasses or good sun wear is advised when outdoors.
Redness: Mild redness in some cases which is expected to reduce within a day or two.
Eye Pressure variations: Variation in the intraocular pressure could arise in some cases.

Other side effects after cataract surgery that affect the eye:

These could result due to the presence of other health conditions like diabetes and hypertension.
Caused due to other eye diseases like age-related macular degeneration or glaucoma.
Caused due to medications from previous eye surgeries.

Measure to minimize the side effects: Shroff Eye Hospital ensures that cataract surgery is performed with minimal side effects.

Understanding of overall health condition while treating cataracts.
Regular check up and consultation is an opportunity to share the information about the medications taken and understanding of other prevailing health conditions.
Use of latest technology and expertise.
Constant monitoring of eye pressure, body pressure and sugar levels at various intervals and follow ups.
Surgery is performed only if you are fit for the surgery and right candidate for the same.
Patients are taught and trained on eye care methods right from instilling eye drops before surgery to various processes till the complete healing of the eye.
Zero Infection goal: Surgeries are performed with highest rate of sanitization to avoid any infection of any kind. Oral antibiotics and eye drops to prevent infection is prescribed in various stages. Proper eye care and effective use of eye drops after surgery prevents infection.
Due precautions are taken to maximize success rate and minimize side effects from cataract surgery.

Practicing with your New Lenses

IOL technology, being a widely developing and highly researched field has given rise to a wide range of designs and types of IOLs to resolve vision problems. IOL’s today are designed to not just treat your cataract but also to improve your lifestyle.

Visual outcome from IOLs:

Enhanced vision is the aim of a cataract surgery. Most patients experience enhanced vision after cataract surgery.

The process of healing:

It is important to note that the vision gets stabilized when the eyes recover from the surgery and any minor issues faced by you resolve with time. Those who have any other eye problems like glaucoma, retinal issues, corneal issues etc and also systemic disorders like diabetes or high blood pressure, it is important to know that healing differs on case to case basis. What to expect in your case should be discussed with the treating surgeon.

Consultation post surgery is aimed at keeping a check on infection or any other complications. As regards need for spectacles, this also depends upon the type of lens used. Some patients may need glasses only for reading, driving at night, while others may not require glasses at all. Some IOLs acts as a UV barrier to protect your eyes from ultra violet rays, which help those patients who are at a higher risk of macular issues in the retina.

IOLs for Children: Children with congenital cataract or any other type of cataract are treated with the same surgery per se as in adults ie. phacoemulsification, however lenses [IOLs] may be advised at a later age.

What are the key areas of change with new IOLs?

Colour vision: Initially some may see bright colours and have difficulty in facing bright light. However, subsequently it settles down with improved colour vision.
Vision correction: Depending on your vision requirement, the presbyopia, myopia or astigmatism is corrected by the IOL best suited for you. The new advanced IOL’s have the advantage of correcting distance, intermediate and near vision.
Spectacle Independence: Glasses would not be required in certain cases. Use of premium IOLs could reduce the need of glasses. Standard Monofocal IOL helps those who are happy to wear glasses after cataract surgery.

Points to note:

Precautions to be taken with new IOL’s: Unlike contact lenses, IOL’s being a permanent implant, due care needs to be taken.
Complications after IOL implant are very rare e.g. Infections, inflammations etc. Rarely variations in post operative power calculations may need correction as no IOL is perfect.
Safe guard your eye against any eye trauma and UV rays.
Avoid eye rubbing.
Visit the ophthalmologist as advised and definitely annually to ensure good health of your eyes.

How to achieve success with the newly implanted IOL?

Shroff Eye hospital utilizes various ways to enable you to have best accommodation with your new IOL’s after cataract surgery.

Post-operative eye check up and advise.
Determine the level of adjustment with the new vision.
Monitoring the reading with fonts of various sizes and reading from distances. This is recorded and observed to understand progress.
Suggestion of corrective remedies to adjust to the new vision requirement.
Identifies if any issue exists and recommends medications if necessary like checking of the ocular surface for conditions like dry eyes.
Vision issues mentioned are checked with the actual prevailing vision conditions so as to rule out any case of neural adaptationor sensory adaptation.
Eye Exercises according to your vision needs.

In case you find any difficulties in vision like flashes, glare, blurred vision, poor quality of vision, halos, pain, do let us know. In rare cases, if posterior capsular opacification is found then YAG laser capsulotomy is considered.

Rare Complications from Cataract Surgery

Let’s preview and understand the rare complications from cataract surgery.

Complications are classified as below:

Pre operative like local anesthesia side effect or allergic conjunctivitis.
Intra operative like posterior capsular tear.
Post operative conditions.

Post operative rare complications could occur either immediately after cataract surgery or after a long gap may be months or years after surgery.

Post operative complication indicators:

Floaters
Elevated eye pressure
Redness
Pain
Swelling
Loss of vision
Bleeding
Eye watering

Early post operative rare complications:

Hyphema
Iris Prolapse
Flat anterior chamber
Post Operative Anterior Uveitis
Toxic Anterior Segment Syndrome

Late Post operative complications:

PCO (Posterior Capsule Opacity): This is commonly known as secondary cataract occurring within months or years after cataract surgery. After cataract surgery normally after a day the vision improves but in case you notice that you eyes are still hazy and vision is not clear. This could be an indication for PCO due to the thickening of the lens capsule. In such cases do consult and have your eyes checked in order to confirm the issue and get effective treatment. YAG laser capsulotomy is a painless procedure to resolve the same within minutes.

Rare complications include:

Retinal detachment: The patient experiences floaters, curtain like loss of vision. Floaters could occur due to posterior vitreous detachment.
Dislocated Intraocular lenses: Intraocular lens are placed inside the capsular bag which could rapture or break. It could happen due various reasons like zonular dialysis. Intraocular lenses need to be repositioned back to have clear vision. In such cases you may notice double vision.
Cystoid Macular edema: This is caused mainly due to accumulation of fluid in the macula. Anti inflammatory eye drops are prescribed to reduce the swelling of the retina.
Endophthalmitis: It is an infection and it presents generally as red eye, pain and loss of vision.

Precautions and points to note:

It is advisable to consult early if any symptoms or vision difficulties crop up, so that healing would be faster and treatment would be more effective. In case of delay it could lead to further complications and could also result in loss of vision.
An annual checkup is advisable even if there are no symptoms of complication.
A proper pre evaluation before surgery and good after surgical care prevents complications.
Those patients who already have other eye diseases along with cataract are more prone to the risk of complications after surgery e.g. diabetic retinopathy. Post operative eye trauma can also cause complication. Hence due attention needs to be given.
Medication and corrective surgery corrections help to treat complications. E.g. Vitectomy is done in case complications arise due to retained lens material.

Why are complications with phacoemulsification very rare?

Modern cataract surgery involves small incision, no stitches- so less infection and faster healing.
Use of advanced technology.
Use of latest surgical methods.

Modern cataract surgeries are performed by phacoemulsification under local anesthesia (eye drops). This reduces risk and complications and is generally highly successful.

The Pre-Operative Office Visit

The pre-operative hospital visit is the next step after deciding on the cataract surgery in order to plan your surgery to maximize surgical outcome.

Why is a pre-operative office visit necessary?

This instills a level of confidence and preparedness for your cataract surgery.
Ensures an affirmation of your interest for the surgery.
A complete pre-operative assessment prior to the cataract surgery to ascertain your fitness for the surgery.
Opportunity to understand the diagnosis and the type of procedure advised.
To have a proper understanding on the entire surgical process and utilize the opportunity to clarify your doubts.

What to expect during your the pre –operative office visit?

Pre Operative Tests: The tests are common for all cataract patients while some tests could be specific as per your health condition to avoid any risk. All the pre-operative tests are conducted in the hospital.
Testing specific for the Intra ocular lens Implant called ‘A Scan’ is done by our optometrist to determine the powerr calculation of the intraocular lenses to be implanted. Depending on your needs, lifestyle and eye condition the type of lens could be decided with our guidance.
Laboratory tests and ECG normally lasting for20 mins approx. could be easily conducted in our in-house laboratory in the same hospital itself.
Fitness from our anaesthetist or your physician is required in case Blood Sugar etc are high or any reports are abnormal.
Medication:
You would be recommended to continue all medications for systemic conditions such as Thyroid Disorder, Hypertension, Heart Disease, Diabetes etc
Pre surgery antibiotics and some dilating eye drops to be used on the day of the surgery will also be prescribed to you, once you are found fit for the surgery with normal blood tests and ECG.
Pre – operative consultation:
This provides an opportunity to answer your queries about your cataract surgery and the precautions that need to be taken for the surgery.
Discuss on the financial responsibilities, pre-operative instructions and desirable post operative expectation.
You would be provided a hard copy on the details of the pre-operative instructions for planning your cataract surgery along with the consent form for cataract surgery. The form needed to be duly signed and accepted after understanding the risks, benefits and alternatives of the recommended type of cataract procedure.

How to make the best of the pre-operative office visit?

For clarity and better understanding at times you have be asked the questions on your health condition in detail or specific to a particular illness like diabetes or hypertension. Advisable to carry previous illness records and details of medications in use in case required. In some cases certain medications that may affect the surgery would be asked to discontinue on case to case basis.
Successful one to one communication is a key to utilize the purpose of the visit.
Advisable to be accompanied by spouse/close relative/friend for a pre-operative visit. This helps in ensuring that the instructions and recommendations are righty noted.
Correct method and proper administration of the eye drops prescribed.
Maintain good general health before and after the cataract surgery.
In case of any reasons you are unable to make the pre operative visit or you are suffering from cough, fever, BP etc., do let our office know so that we would assist in rescheduling the same.

WE ENSURE YOU HAVE AN ENRICHED AND SATISYING PRE-OPERATIVE VISIT FOR A SUCCESSFUL CATARACT SURGERY.

Deciding when to have a Cataract Surgery

After completion of your initial eye examination and consultation with us, we guide you in your decision on when you need to have a cataract surgery. Cataract surgery being an elective procedure, the time for the procedure is mutually discussed; however the final decision lies with you.

Difficult to take a decision?

Our painless surgical procedures and extensive use of advanced technology helps in faster post operative recovery.
Understanding the symptoms, risks and treatment of cataract helps in taking the decision for cataract surgery.
With a wide array of intraocular lenses to choose from, it could be a difficult decision. Our advise during consultation helps you to make the right choice depends on your need, life style and eye condition.
With the expertise of our well experienced surgeons you could have an enhanced surgical experience.

A common myth regarding cataracts is that cataracts need to be mature enough for surgery. This may not be required with the latest advances in cataract surgery. Moreover cataracts are likely to harden as stages advance leading to more complications during surgical removal and also higher risk of other issues like glaucoma or other age related complications etc.

Symptoms and Indication:

Deterioration of vision may not always be an indicator for cataract surgery. For example: Although vision may be 20/20 still cataract surgery may be required. Some for work conditions that require fine vision, even glare could affect their vision.eg. Pilot, Drivers etc. Nevertheless any symptoms of cataract like blurred vision, halos or glare etc. should not be ignored. Intervention and treatment at right time is important.

Decreased vision and quality of life:

Cataracts disrupt your quality of life. Cataracts need treatment anyway; the only treatment being a surgery. There is no advantage of postponing treatment because delay can worsen the cataract. Moreover as age progresses other aliments like diabetes or heart related issues could make surgery complicated and risky. The risks of accidents would be much higher without treatment. Furthermore you are restrained from doing the work that you want to do because of the decrease in vision. In case of cataracts that cannot be operated upon or those that do not need immediate surgical intervention, our surgeon would advise other options and the roadmap of treatment.

If both the eyes require surgery, it is advisable to maintain a time gap between the surgeries before proceeding with the second eye. Usually a week’s gap is acceptable. This is to avoid infection and giving time to the first eye to heal comfortably. During your consultation you could get your doubts clarified in order to have a proper understanding of your treatment process.

Get rid of glasses: Decrease in vision is often corrected with corrective glasses. Today, cataract surgery can aid in getting rid of glasses as well. According to the type of lens used, one can opt for lenses which give you an advantage of being able to see near, intermediate and distant vision clearly, without need of glasses. These are multifocal or accommodative lenses. This enables you to get rid of cataract as well as be least dependent on glasses.

As the symptoms and eye conditions differ from each eye, the treatment options and guidance from eye specialists is vital.

Consultation at the right time would help you to take the right decision on your cataract surgery.

YAG Laser Capsulotomy Risks

Posterior capsule opacification is a complication after cataract surgery. Nd: YAG laser capsulotomy treatment is done to correct this complication which improves vision, contrast sensitivity and reduce the glare. The occurrence of PCO makes the lens opaque. In this procedure a YAG laser is used to create a minute hole in the posterior position of the lens capsule in order to let the light rays pass through for clear vision. It is a safe and effective procedure; nevertheless it also has certain risk factors.

Risks of YAG laser capsulotomy:

Elevation of IOP (Intraocular Pressure): This is a commonly observed risk after the YAG laser capsulotomy. Certain types of glaucoma if present, could elevate IOP. Acute conditions could cause loss of light perception vision. Preventive medication is administered before and after the procedure to control the IOP(Intraocular pressure).
Floaters: Floaters are normally experienced and it settles down after some time.
Cystoid Masular Edema : It is the swelling of the center of the retina occurring after the laser capsulotomy. This built up of fluid cause the blurring of vision.
Retinal detachment: The nerve layer gets detached at the back of the eye. It may occur a year after the capsulotomy. The occurrence is less common after laser capsulotomy. The experience of flashing lights or vision like dark curtain over the eye mainly affecting the side vision from unspecific direction.
IOL Damage (IOL Pitting): Lenses made of acrylic material create more damage compared to silicone lenses. The choice of IOL design and type is another factor to this complication. Factors that influence the risk to IOL damage are the inherent resistance of IOL to damage by laser, energy used, IOL position etc.
IOL Displacement: In some cases the IOL could get displaced into the eyes vitreous as in case of larger /rigid implant or in case of posterior capsule rapture during the initial cataract surgery.
Endophthalmitis: Uveitis and loss of vision is experienced in some cases.
Corneal edema: A mild bruising response in the retina is experienced. Corneal edema leads to reduction visual clarityfor a short duration.
Re-formation of Elschnig’s pearls: This risk is found at the opening of the capsulotomy. This generally resolves without treatment in most cases.
Other complications: Rarely occurring is corneal endothelial cell loss, Iritis (inflammation of iris). Glaucoma etc.

The follow up checkups and medication routine after surgery are beneficial to keep a check on the eye conditions. It is advisable to report any sign or symptom of excessive pain in the eyes, redness, floaters, vision and get treated and corrected immediately. As observed in any other surgical procedures, Nd:YAG laser capsulotomy treatment also has risks that are easily correctable. These differ according to your eye condition. Serious complications are normally very rare.

In case of any discomfort as mentioned above specifically in terms of vision loss, pain or blurring, it is advisable to immediately report and get it treated as soon as possible.

Anesthesia during Cataract Surgery

Anesthesia is an integral part of many surgeries. It was also an essential part of cataract surgeries done in earlier times. However, today Cataract surgery has metamorphosed greatly. From using General anesthesia and keeping patients in the hospital for several days, the surgery changed to using local anesthesia in the form of injections, and today it has so evolved that we perform most cataract surgeries under topical anesthesia (just using eye drops).

Modern cataract surgeries with advanced laser treatments have resulted in faster surgeries with smaller incisions, thereby involving the least need of anesthesia. Presently, during cataract surgery topical eye drops are administered by most skilled surgeons. However other kinds of anesthesia are also used in some cases, only if it is essential.

Let us understand more about this.

Major goals for administration of anesthesia for successful cataract surgery:

To avoid pain during the surgery.
To restrict movements of the eye during the surgery as required.
Maintain safety of patient and optimize surgical outcome.
To regulate the intraocular pressure.
To facilitate quick recovery.

Selection of right anesthetic for cataract surgery depends on:

The type of surgery performed.
Patient’s health condition.
The surgeon’s expertise.
The time taken for surgery etc.

Kinds of anesthesia for cataract surgery depend on:

Age of the patient and tolerance.
The type of cataract surgery.
Ocular co-morbidity like corneal opacity etc.

Types of anesthesia:

Regional or Local anesthesia: It may be administrated with a sedative followed by a tiny injection generally on the top and underneath the eye. This is done to prevent blinking and restrict eye movements during the surgery. Intracameral Lidocaine / Lignocaine (local) is used commonly and Pro Paracaine eye drops are used as the anesthesia eye drops (topical) .
General anesthesia: Health condition should be supportive and intake of food or drink should be avoided as instructed by the Doctor. Continuous monitoring of the progress on the blood pressure, heart beat rate and breathing are done during the procedure by an General anesthesia is mainly reserved for Pediatric patients and some adult patients (when uncooperative). Vomiting, drowsiness, nausea after general anesthesia is rare but gradually wanes off.
Techniques in general anesthesia for cataract surgery:

Blocks:

Peribulbar blocks- In this type a needle is inserted close to the eyeball for administering a local anesthetic agent like Lignocaine.
Retrobulbar blocks- In this type a needle is inserted behind the eyeball for administering a local anesthetic agent like Lignocaine.

(Hyaluronidase for ophthalmic blocks is used at times to enhance the speed of action of the local anesthetic)

Topical anesthesia– This is mainly administered as eye drops to block the afferent nerves of the cornea and the conjunctiva. It is most suitable for clear corneal incisions. It is advantageous in shorter surgeries and has fewer side effects. This type of anesthesia helps you to experience the benefit the cataract surgery at a faster rate and is the type of safe anesthesia used at Shroff Eye, Mumbai.

Risks: Modern anesthesia is generally safe, although not completely risk free. The risk factor varies according to the anesthetic used alongside other factors. Few of them are noted below but are rare and mostly associated with block- type anesthesia.

Globe perforation.
Damage to optic nerve.
Retrobulbar hemorrhage.
Ocular muscle injury.

Considerations:

Any problems encountered by you during any previous surgeries or allergy to drugs etc. should be informed to the doctor before the procedure.
Other prescription medications being taken should also be discussed prior to surgery to avoid any drug interactions.
Your co-operation to remain calm and anxiety free during the cataract surgical process will help you immensely.

At Shroff Eye, we manage your cataract surgery in the safest and most helpful way for you and allow you to return home with a pleasant surgical experience.