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How is cataract surgery performed?
Cataract surgery is a way to replace the cloudy lens with a
crystal clear lens, thereby restoring vision. In modern
techniques, the posterior capsule of the natural lens is left in
place to support the man-made replacement lens that is
implanted at the time of surgery.
There are three different ways of performing this surgery:
- In extracapsular surgery the nucleus of the lens is taken out
in one piece through a very large incision, and the softer parts
of the lens are then aspirated. The man-made lens is then
placed in the eye. This technique always requires many sutures(about 10 sutures is typical), a needle injection behind the
eyeball for anesthesia, significant bleeding, and months of
recovery. This is the original technique of surgery that has been
around for decades, and it’s still performed by some
ophthalmologists because it’s technically easier to learn. Be
warned that this type of surgery typically creates a lot of
astigmatism and you may never be able to see 20/20 without
powerful glasses.
- In phacoemulsification the hard nucleus is broken up by
ultrasonic fragmentation (using sound waves) within the eye,
and can then be aspirated. The man-made lens is then placed
in the eye. This allows a somewhat smaller incision to be used.
Phacoemulsification has gained in popularity in recent years,
and is now a more common form of cataract removal in the
United States. This procedure has been used for approximately
15-20 years, although recent advances and refinements have
made it safer and more effective than previously. This is
typically performed using needle-injection anesthesia, one or
two sutures, and less bleeding. The recovery time until the
vision stabilizes is reduced to approximately 2 months. This
surgery can cause an increase in the astigmatism and may
require that you wear glasses full-time to correct your vision
after the surgery.
- Clear-corneal phacoemulsification is a more advanced
version of the last technique mentioned. In this technique, as
performed by me, no needles are used, and the painful
anesthetic injection behind the eyeball is not given. Instead the
eye is numbed with eye-drops and the patient is given a mild
intra-venous relaxing medication by the anesthesiologist. The
incision in the eye is ultra-small, approximately 1/8th of an inch
or less, and it is made with an actual gem-quality diamond.
This creates such a tiny and fine incision, that it is self-sealing,
and no stitches are required. The man-made lens is one of the
top-of-the line models that can be folded or compressed during
insertion, and then opened once inside the eye. The name "clear-corneal" refers to the incision, which is made at the edge
of the clear tissue named the cornea. Due to the location of this
incision, there is typically no bleeding (not even one drop), and
the day after the surgery, the eye won't be red at all. The recovery for this surgery is very quick, with good vision within a
day or two. When combined with astigmatism management,
the pre-existing astigmatism can be lessened and further postoperative
astigmatism can be prevented.
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