Cataract Surgical Techniques

Several techniques are used for removing cataracts.

Phacoemulsification: In this method a tiny instrument is inserted through a very small incision. The instrument uses ultrasound vibrations to break the cataract into fine pieces, which are gently suctioned out. The new lens is then inserted into the eye. Usually no stitches are required to close the incision. This minimal surgery allows faster and safer healing, hastening your return to normal activity.

 Small Incision Cataract Surgery (SICS): This is a new technique where the cataract is removed manually through a small incision. The small incision heals fast, enabling you to recover quickly.

Extracapsular Extraction: Here the lens is removed in a single piece through a relatively larger incision. It is replaced with an artificial lens and the incision is closed with fine stitches. The surgeon may opt for this technique in cases where the cataract is very advanced. The recovery period is longer here. Your doctor will select the method of surgery that is most suitable for your case.



Planning for Surgery
It is not necessary for the cataract to mature fully or for the vision to become totally cloudy before scheduling surgery. You and your ophthalmologist should jointly decide on the time for surgery. Be sure to inform your doctor about any medications or herbal remedies that you may be using.

At the Institute our counselors will help you to understand the pre-operative procedures and obtain an estimate of the expenditure involved. Prior to your surgery, you will need to undergo some routine medical and blood tests. If you wear glasses or contact lenses bring them so that your prescription can be checked. An A-scan will help the doctor to determine the power of the new lens to be implanted in your eye.

It is good to wash your face thoroughly with soap and water before coming for surgery. You will be advised to use some eye drops. Please follow the instructions carefully as these drops help dilate your eye. If your eye is not properly dilated, surgery may be delayed. You may also be advised not to eat or drink anything for a few hours prior to surgery. You can bring only one attendant; children below 15 years are not allowed unless they are patients.

Though the success rate for cataract surgery is almost 98%, sometimes there may be complications. Most of these complications are minor and can be rectified. Your doctor will advise you about any specific issues related to your case.

The Surgery
In the operating room, the area around your eye will be cleaned thoroughly. Sterile drapes will be placed around your head and face, with only the eye exposed. Usually a local anesthetic in the form of an injection is administered next to the eye. Sometimes doctors may have to perform the surgery under general anesthesia. An oxygen tube will be placed near you nose so that you do not feel suffocated.

The actual surgery lasts about 30 minutes. You will be relaxed and awake but feel no pain. The nerves in your eye will be completely numbed so you will not be able to see or move your eye. Generally, there is very little bleeding.

Care after Surgery

After surgery a bandage or shield will be placed over your eye.

You will be advised to rest till you are ready to leave.
You should wear protective glasses or an eye shield in the day and an eye patch at night to avoid accidental injury. The doctor will advise you when you can discontinue them. You can bathe carefully from below your neck but do not wet the operated eye for 15 days. You may gently clean the eyelids with a piece of cotton boiled in water or a sterilized tissue.

Some important Tips

  • Do not rub the operated eye.
  • Do not use any eye cosmetics until the doctor allows it.
  • Do not wash your hair until the doctor says you can.
  • Shave carefully, soap or water should not enter the eye.
  • Avoid any vigorous activity.
  • Do not lift heavy things.
  • Do not bend so that your head is lower than your waist.
  • Avoid driving till your vision improves.
  • Avoid sleeping on the operated side.
  • No sexual intercourse until permitted by the doctor.
  • Avoid alcoholic beverages.
  • Watch television for short periods only.

Please follow the advice of the patient counsellor about medication and follow-up visits.

Be alert for Problems
If you have any of these symptoms that last more than 24 hours, inform the Institute or an ophthalmologist immediately:

  • Any sudden change in vision or blurring of vision
  • Increase in sensitivity to light or seeing flashes of pain
  • Increase in redness
  • Swelling of the eyelid or bleeding
  • Nausea or vomiting
  • White or cloudy cornea or pupil
  • Persistent discomfort or pain – if the pain is severe, do not delay, contact us immediately.

Surgery of the Interior of the Eyeball with vitrectomy

What is Vitrectomy?
This is a very delicate operation performed with an operating microscope and special needle-sized instruments. The most common indication for this operation is removal of the vitreous, which has lost its transparency and, therefore, has become an obstacle to the incoming light. In this surgery most of the non-transparent vitreous is removed and replaced with a clear solution. Vitrectomy may also be used to remove the pulling forces of the vitreous, which may have led to detachment of the retina. This operation may also be used to remove blood clots, infectious material, cataract, foreign bodies, and abnormal membranes from the interior of the eyeball. Sometimes it is done for diagnostic purposes for diseases of unknown origin. Occasionally it may be necessary to inject air, gas, or silicone oil into the eye after removing the vitreous gel.

How is the operation performed?

The surgery may be done under general anaesthesia (sound asleep) or under local anaesthesia (you are awake but feel no pain). The operation takes two to four hours. Usually one operation is sufficient, occasionally additional surgery may be required. The eyelashes are cut but they always grow back. Most patients stay in hospital for one or two days; longer hospitalization may sometimes be necessary. A face-down position for sleeping may be suggested for several days. The operated eye will be bandaged for one day. Occasionally both eyes may need to be bandaged to ensure complete ocular rest.

What may I do after the operation?
For the first two weeks you should rest at home. Travelling should be avoided except to see the doctor. If gas has been injected into the eye, you should avoid air travel for several weeks until specifically authorized by the doctor. Postoperative instructions will be given to you at the time of discharge and these should be strictly followed. Most patients are able to return to their routine in four weeks.

What are the chances of success?
The vision improves to some degree in 90% of simple vitrectomy cases. In difficult cases however, improvement is seen in approximately 60% of the cases while in others it may remain the same or even decrease. The final degree of clarity of vision is usually not evident for about three months. How much vision a patient will ultimately have is difficult to predict in individual cases. Patients are usually able to see large objects but fine vision and reading vision may not improve.

What are the side effects and possible complications of surgery?
Blurred vision, pain in the eye, redness and swelling, mucus discharge and enlaged pupil and double vision are usually the temporary side effects and they clear up in a few weeks. Usually there are no complications, but some patients may have problems such as recurrent bleeding, infection, or elevated pressure in the eye. Rarely, a retinal detachment or cataract may develop requiring further surgery, either during or after the vitrectomy operation. Very rarely a complication may lead to the loss of all vision. To find out about anesthesia related complications, one may consult and anesthetist.

Instructions for Patients who have had Surgery of the Retina or Vitreous

The following precautions should be observed for three weeks:

  • Do not lift anything that weighs more than five kilograms.
  • Do not bend over so that your head is below your waist.
  • Avoid sleeping on the operated side, unless you are instructed to do so
  • Avoid sexual intercourse.
  • Avoid alcoholic beverages.
  • Do not rub the operated eye.
  • You may watch television sparingly.
  • You may gently rub the eyelids with cotton or a clean tissue moistened with warm water. Do not bathe the eyeball. Eye bandage
  • You may remove the eye patch on your doctor’s advice (usually after one day).
  • Always wear either protective glasses or an ‘eye shield’ to avoid accidental injury. Medication
  • You may bathe carefully from below your neck and shave, but do not get the eyeball wet for at least two weeks. You may carefully clean the forehead and cheek with a wet cloth.
  • Always wear either protective glasses or an ‘eye shield’ to avoid accidental injury. Medication
  • Avoid vigorous activity.
  • No automobile trips except to visit the doctor.

Follow the instructions that are given to you when you leave the hospital.

Follow-up appointment

Please adhere to the follow-up appointment date given to you at the time of discharge. In case of doubt, contact us. Some discharge from the eye is to be expected. This should normally show gradual improvement, but increasing discharge or pain or decreasing vision should be reported to the doctor immediately. You may call us for any other concerns that you have.
Instructions for Patients who have had Surgery of the Retina or Vitreous Special Face-Down orders

  1. Certain retinal detachments require the placement of a bubble of sterile gas in the interior of the eyeball. When you observe a face-down position this gas rises toward the ceiling and pushes the retina back into place. The gas will be absorbed by the eye within a few weeks.
  2. You will be asked to lie on your side while in the recovery room.
  3. After moving to your ward bed, you will be placed in position (A) or (B). (A) Place a pillow under the chest and a rolled-up towel (or small blanket) under the forehead. (B) Lie on your side with your face turned toward the mattress. NOTE: The long axis of the head should always be parallel to the floor.
  4. You may lie on your back for 3 – 4 minutes for changing of the eye bandage, putting eye drops or for the doctor’s examination.
  5. For the first 10 days after surgery, you have a choice of five positions: (A) Prone (as illustrated) (B) On side (as illustrated) (C) Sitting with elbows on knees. (D) Sitting with forehead on table edge, with small pillow (as illustrated). (E) Walking in the house with the long axis of head parallel to the floor.
  6. Eat facing down, drink beverages with a straw.