Currently, this type of surgery is carried out on an outpatient basis, so that the patient can go home just a few hours after the operation has been performed. Furthermore, with the modern technologies used to eliminate the cataract problem, no type of eye bandage is provided, although it is necessary to follow the instructions given by the doctor so that there is a complete and rapid recovery.
Cataract surgery is considered to be an effective and safe operation, however, since it is still a surgical operation, it is not free from risks and complications.
(this explains why most cases of cataracts are found in elderly patients); trauma; taking certain types of medications; infections; etc.
For more information, we recommend reading the dedicated article: Cataract.
The surgical procedure for the treatment of cataracts involves the removal of the opacified lens and the insertion of a new intraocular lens (IOL - IntraOcular Lens) - also known as an artificial lens - which will perform the activity once performed by the natural lens.
, myopia, astigmatism, etc. This is possible thanks to the enormous progress made by research in the field of IOLs (intraocular lenses). Currently, in fact, different types of intraocular lenses are available, which can be used to treat the most varied disorders of sight and which - in agreement with your ophthalmologist - can be positioned in place of the damaged lens during cataract surgery.Curiosity
Cataract surgery is one of the most performed surgical operations in the world. According to the World Health Organization (WHO), over 20 million cataract surgeries were conducted in 2017, of which 600,000 in Italy alone.
, fundus examination, anterior segment eye examination, etc.). In this context, moreover, the specialist will also ascertain the general state of health of the patient and may prescribe the execution of additional investigations (for example, blood tests) in order to determine the presence of any contraindications to the intervention of cataracts or the presence of any risk factors.
Choice of intraocular lens
The complete eye examination and additional investigations carried out by the specialist are also necessary to evaluate which type of artificial lens should be inserted in the eye to replace the damaged lens.
Currently, there are really many intraocular lenses available, designed to treat the most varied visual disturbances. Among these, we mention only a few:
- Monofocal intraocular lenses: these are the "classic" lenses that are positioned in place of the opacified lens to solve the problem of cataracts. They are not used to solve other types of visual problems.
- Toric intraocular lenses: they are high quality IOLs that can be used for the correction of astigmatism, farsightedness or myopia.
- Multifocal intraocular lenses: IOLs are useful for the correction of presbyopia, eliminating or reducing the need to wear glasses after cataract surgery.
- Accommodating intraocular lenses: These are flexible IOLs that, once in place, can move slightly allowing objects to be focused at different distances. They are also useful for correcting presbyopia, although they appear to be less effective than the aforementioned multifocal IOLs.
Based on the patient's requests, the problems that afflict him and the general state of health and his eyes, the specialist doctor can decide what type of IOL to use. In fact, it is not always possible to replace the damaged lens with IOLs capable of correcting visual problems and defects as well as cataracts.
Anesthesia
Before starting with the actual cataract surgery, of course, you need to perform anesthesia.
With the techniques currently used, general anesthesia is no longer required, therefore, one proceeds with the administration of local anesthetic drugs.
In most cases, anesthesia is administered locally topically through the use of a suitable medicated eye drops containing, in fact, an anesthetic drug. Sometimes, however, the physician may find it necessary to administer anesthesia by retrobulbar or peribulbar injection (parenteral administration). In both cases, the patient is awake and conscious, but does not feel any pain.
In addition to the anesthetic, it is possible that other drugs necessary to allow the operation to be carried out may also be administered.
Traditional Technique: Phacoemulsification and IOL Insertion
The "traditional" technique currently used to perform cataract surgery is that of phacoemulsification, followed by the insertion of the IOL.
Without going into particularly complicated technical details, it is possible to summarize the "traditional" cataract surgery in the following points:
- Corneal incision;
- Anterior capsulotomy: in this phase, the surgeon creates a "circular opening on the anterior capsule of the lens. This" opening is necessary to allow the insertion of the instruments that will deal with the destruction, then the removal, of the damaged lens.
Did you know that ...
The lens capsule is the contiguous membrane that surrounds it. With cataract surgery, it is not replaced. However, over time, the capsule may also become opaque, thus giving rise to the so-called secondary cataract.
- Fragmentation of the lens with phacoemulsification: to fragment the opacified lens, a special instrument equipped with a probe and capable of emitting high-frequency ultrasounds, the phacoemulsifier, is used. While fragmentation occurs, thanks to an automatic irrigation and suction system, the surgeon constantly removes the crushed material.
- Implantation of the most suitable intraocular lens for the patient.
The success of cataract surgery, therefore, is closely related to the dexterity and experience of the specialized surgeon.
Femtosecond laser or Femtolaser
Relatively recently, the use of the femtosecond laser - or femtolaser - for cataract surgery has been introduced.
Thanks to the use of the laser, guided by a computer, it is possible to standardize some phases of the operation which - in the "traditional" method - are entrusted exclusively to the manual skill and experience of the surgeon. This manual skill, of course, can vary from specialist to specialist.
However, it should be noted that cataract surgery supported by the use of the femtosecond laser is not performed everywhere and, moreover, it is not always possible. For example, the use of this type of laser is generally not recommended in the presence of advanced cataracts, in the presence of irregularities or opacity of the cornea as well as in the case of poor pupil dilation.
Did you know that ...
Although some studies have shown that the use of laser in cataract surgery can improve the accuracy and precision of some steps, it has not been shown that its use can improve or accelerate recovery from surgery.
Duration of the Intervention
The surgery itself generally has a short duration (15-20 minutes), however, the time spent in the clinic is longer, as it includes preparation for the surgery and a short observation period at the end of the procedure.
Did you know that ...
If it is necessary to perform the cataract surgery in both eyes, in the vast majority of cases, the specialist prefers to treat only one eye at a time, leaving an interval of at least 2-4 weeks between one operation and the other.
, swelling and temporary blurring of vision. Increased sensitivity to light and increased lacrimation are also very common side effects. Finally, discomfort, itching and / or pain may also occur.
In the event of these effects, although generally self-limiting and temporary, it is always advisable to inform the specialist.
Risks and Complications
Among the main risks and complications that could be encountered when undergoing cataract surgery, we remember:
- Transient increase in eye pressure (quite common)
- Hemorrhages;
- Eye infections;
- Damage to other ocular structures during the operation (eg, retina);
- Dislocation of the new implant (in other words, the intraocular lens moves from where it was inserted).
Generally, the day after the operation, the patient is invited to make the first check-up immediately. In this phase, the doctor will prescribe appropriate medicated eye drops (for example, antibiotic eye drops) which must be applied to the affected eye in the manner, with the frequency and for the duration (even several weeks) indicated by it.
The next follow-up visit is usually done 15-20 days after the operation. This time interval, however, may vary from one patient to another and will be determined by the doctor on a case-by-case basis.
Total recovery from cataract surgery usually occurs within 8 weeks, although there may still be some patient-to-patient variability.
Useful Tips
After the operation and after the first check-up visit, the doctor will provide the patient with all the information about the drug therapy to be taken and the behaviors to be followed in order to ensure a rapid and correct recovery. In general, it is recommended to:
- Protect your eyes from sunlight and artificial lights (especially if very intense) by wearing sunglasses. In some cases, the specialist may prescribe special post-operative glasses;
- Protect your eye from splashing water while washing;
- Avoid swimming, going to the pool, the sea, etc .;
- Avoid intense sporting activities or any other activity that could stress the eye during the recovery phase;
- Avoid strenuous activities (such as lifting very heavy objects);
- Avoid activities that could cause dust, dirt and / or other contaminants to enter the eye;
- Avoid rubbing your eyes with your hands, especially if they are dirty.
Further indications and recommendations could be provided by the specialist in the post-operative phase and / or during follow-up visits.
Eyeglasses after Cataract Surgery
Unless an intraocular lens has been inserted into the eye to correct pre-existing vision defects, it may be necessary to wear eyeglasses after cataract surgery.
If the patient will have to use eyeglasses even after the operation, it will be necessary to wait about 30-40 days before being able to prescribe them, naturally after an adequate eye examination.
;Furthermore, the surgical treatment of cataracts is also not recommended for those on drug therapy with hormones and / or psychotropic drugs.
Despite this, each case should be evaluated individually by the specialist who will be able to advise the patient on the treatments that best suit him.
