Cataract Surgery: Indications and Complications

Your eye has a transparent lens that helps you focus light on your retina, hence allowing you to see. Sometimes, due to deposition of proteins in the lens, it may become opaque and lead to the blurring of vision. This condition is called a cataract. A cataract surgery is a procedure for removing the diseased lens and replacing it with an artificial lens, hence improving vision.

Procedure

Cataract surgery is a short procedure requiring about an hour. Before the surgery, you will have to undergo a few tests to determine the size of your eye, which will help the doctor decide the power of the artificial lens to be implanted. To do so your doctor will order a painless Ultrasonogram of your eye. Your doctor might also ask you to stop taking medications that may increase the risk of bleeding a few days before the surgery. Your doctor will ask you to refrain from eating or drinking anything a night before your surgery.

Before the surgery, your ophthalmologist will put eye drops into your eye to ensure that the pupil stays dilated. Local anesthesia in the form of injection around your eye will be given to ensure that your eye doesn’t move during the procedure. There are many ways of performing a cataract surgery.

• Phacoemulsification: your surgeon will make a small incision at the edge of your cornea and insert a thin probe through it. After cutting open the anterior part of the capsule that holds the lens this probe produces ultrasound waves which cause the lens to break down. The broken pieces of the lens are removed by the same probe by creating vacuum. The posterior part of the capsule is left intact. An artificial lens is implanted in the empty space created. The probe is then removed. Generally, no sutures are required after this procedure. The wound is self-healing.
• Femtosecond laser-assisted surgery: this procedure is similar to phacoemulsification other than the fact that laser is used to break down the lens in place of the ultrasound waves.
• Extracapsular cataract extraction: less frequently used procedure; this requires a larger incision and hence has a greater recovery time.

There are many types of lenses available. Discuss with your doctor to decide upon the best option based on the cost and functioning. Most of the lenses are made of acrylic, silicone or plastic. The types of lenses are:

• Monofocal: this lens is most commonly covered by the insurance companies. This lens can be set for near, intermediate or far vision. Most people choose to have the lens set to far distance and use reading glasses for near vision
• Multifocal: like the bifocal lenses this lens can help you see far and near objects properly.
• Accomodative: these lenses have only one focus but can respond to eye muscle movements and shift focus accordingly
• Toric: if you have astigmatism you will be suggested to opt for this lens.

Indications for Cataract Surgery

The surgery for the removal of lens is suggested when there is:

• visual loss because of opacification
• displacement of lens from its normal position
• defect in the shape of the lens
• lens induced complication like glaucoma.

Complications of Cataract Surgery

Complications following the surgery can be:

• Haemorrhage at the site of injection for anesthesia
• Inflammation 
• Infection
• Detachment of implanted lens
• Drooping of eyelid
• Detachment of retina
• Glaucoma
• Secondary cataract: this is caused due to opacification of the posterior capsule that was left behind in the surgery. This condition can be corrected very easily by a simple outpatient procedure called yttrium-aluminum garnet laser capsulotomy.

If you experience visionless, redness and pain in the eye despite medications you should contact your doctor.

Recovery

After the surgery, your vision will gradually start to improve as your eye adjusts to the new lens. Your doctor might ask you to wear an eye patch for a few days after the surgery. Your doctor will schedule a meeting with you a few days, a week and about a month after the surgery to monitor your healing. A few eyes drops may be prescribed to prevent infection and control the inflammation inside the eye

Resources: 

• American Academy of Ophthalmology.