Cataracts of the eye > Cataract surgery procedure

Nowadays there are not any medications or eye drops which could eliminate cataract and improve vision. A surgical procedure is the only option for restoring vision. In this type of procedure opaque intraocular lens is removed and substituted by artificial lens.

When to undergo cataract surgery?

Decrease in the visual sharpness is the principal reason for cataract surgery. Cataract surgery is always recommended when cataract decreases the quality of patient´s vision to such a degree that it bothers him in personal and work life.

Decrease in the central visual sharpness is discovered with the help of optotypes. However, recently the attention has turned to other examinations because a patient can feel subjective problems even when he has fine central visual sharpness.

Cataract itself is often discovered during standard eye examination when a patient visits ophthalmologist or optical stores with the need to change his diopters because he does not see properly.

How is cataract surgery performed?

Nowadays in routine clinical practice, cataract surgery is performed in local anesthesia which consists in applying drops to the cornea and conjunctiva thus resulting in desensitized eye. Sometimes local anesthesia is combined with intravenous application of tranquillizers. The application of local anesthesia has enabled to perform this surgical procedure under ambulatory conditions and patients return home on the day of the procedure.

Surgical techniques can be principally divided into intracapsular and extracapsular. When the whole lens is removed together with its capsule it is the intracapsular technique and when the capsule is preserved it is the extracapsular technique. Nowadays the intracapsular extraction is not commonly used. At the moment facoemulsification done by sonography is the most commonly used technique.

Cataract surgery procedure - facoemulsification

Facoemulsification is the extracapsular extraction when the lens nucleus is divided into small parts and is aspirated out with the help of cannula which is controlled by sonography. This technique has the advantage of performing whole surgery through one tiny incision which decreases the amount of postoperative complications, speeds up restoration of vision and shortens duration of the surgery.

There are two basic surgical approaches:

• so-called sclerocorneal tunnel incision
• corneal incision

After injecting the so-called viscoelastic material an opening is made in the front lens capsule. Then hydrodissection of the lens follows - by injecting the fluid under the front capsule we separate the lens nucleus form the cortex which will permit the rotation of the nucleus. With the help of facoemulsification cannula the nucleus is divided into smaller parts in the capsular bag which are emulsified by sonography and aspirated out. The nucleus rotates and is divided by facoemulsification cannula and also by second tool, which is called irrigation-aspiration cannula, the lens cortex is aspirated out. Viscoelastic material is injected for safer implantation of the artificial intraocular lens. The lens is inserted into transparent lens capsule which stays in the eye.

The artificial lens substitutes refractive power of removed human lens and enables the patient to see sharply after this surgery. Moreover, choosing refractive power of the artificial lens permits to remove preoperative refractive disorder. Implantation of soft intraocular lens (silicon, acrylate) is performed by injector or special tweezers. After insertion of the artificial intraocular lens viscoelastic material is rinsed out of the front capsule.

The advantage of tiny corneal incision lies in its self-closure without any need to stitch it.

Cataract surgery procedure itself is very quick and it often does not last for more than 20 minutes.

Restoration of vision after cataract surgery

Vision is restored very quickly after the surgery. A patient recovers his good vision usually on the second day after the surgery. In some cases after the surgery vision can be temporarily blurry. Vision usually clears up after a couple of days.

Vision is usually stabilized after 2 to 4 weeks after the surgery. After this period of time it is possible to prescribe new eyeglasses. After the surgery most of patients see more sharply to the distance but they have to use eyeglasses when reading or working.

Duration of incapacity for work depends on the type of occupation and the state of vision of the other eye. It usually takes days, rarely weeks.

Nowadays cataract is a very common disease and patients do not need to be afraid of anything because current technology, surgical techniques and surgeon´s experience have made cataract surgery one of the safest and most successful surgeries.