What are the surgical options, and which one is the best?
A variety of options are extra capsular (non-phaco) surgery through lens insert, Phacoemulsification with a non-foldable or foldable lens insert. The finest procedure for nearly all patients is stitch-less Phacoemulsification with a foldable intraocular lens. However, for some selected patients, an alternative method may be more appropriate. It is a painless procedure done under local anesthesia without or with an injection, using a very small cut. Through this small cut, the tip of the instrument is introduced into the eye. This tip uses localized high frequency waves to crack the cataract into very minute fragments and pieces, which are then sucked out in a controlled manner through the same tip. A thin shell or 'capsule' is left behind after cleaning up of the entire dense cataract.
What are the advantages of Phacoemulsification over extracapsular (non-phaco) surgery?
A foldable IOL is then inserted through the same little incision and is supported on this capsule. The cut required for Phacoemulsification is small (<3mm) and the wound construction is such that it is self-sealing. Therefore a surgery, in which a foldable lens has been inserted through the small 3 mm wound, generally does not need any stitch. The surgeries in which the wound has been enlarged (5 or 5.5 mm) to put a non-foldable lens is likely to require one stitch, because the cut is larger depending upon the type of lens. In a non-phaco surgery the cut required is larger (10-12 mm) and requires stitches for closing. This larger cut takes 6-8 weeks to cure. Moreover, the stitches can source distortion of the normal curvature of the clear part of eye cornea and thus lead to astigmatism and blurred sight because of this. In contrast, Phacoemulsification need smaller cut of only 3 mm, which cure faster with least distortion and leads to early visual recovery and return to work. In nearly all of the patients, the surgery is generally done under local anesthesia. Mostly it is performed after putting just anesthetic drops, and without any injection. However, in some cases, mainly in anxious patients, local anesthesia in injection form may be given. Its a small surgery of 15 to 20 minutes and patient can go home after ½-1 hour. So only a short stay is needed. You require use eye drops for about four weeks. It is advisable not to rubbing or splash water on your open eye for at least two weeks. The sandy conditions are avoided for the similar duration. Use of cosmetics in and around eyes should also be avoided for 4 weeks. There is no limit in reading, watching TV, walking or eating any type of food. Most of the patients can resume office work within a week after the surgery.
Will I need glasses after surgery?
Yes, you will require glasses, which are generally prescribed two weeks after the surgery. The power required is generally very small and is different for distance and near sight. Cataract surgery is one of the most successful surgeries. Over 90% of patients operated for cataract gain a useful sight. But like any other surgery, problems may increase occasionally if not taken proper post-operative care, in the form of infection, swelling of the eye, dislocation of the natural or artificial lens, swelling in the retina (cystoids macular edema), retinal detachment, etc. Most of these complications can be managed well if they are detected in the early period of time. Hence a good post-operative follow up must be maintained and in case of any strange pain, decreased sight or other symptoms, the doctor must be consulted immediately. In some patients, in the months following surgery, the membrane behind the new lens can get thickened leading to blurred sight. This is referred to as capsular opacity or 'after cataract', and can be treated easily by laser as an out-patient procedure.
