Cataract surgery

Before cataract surgery

A full ophthalmic examination is performed before the appointment to a cataract surgery, including the biometry, which is the measurements and calculation of the power of the IOL implant. A pupil dilation is mandatory, which will make the vision blurred for a few hours, during which driving is not recommended. If other eye disease is suspected or present, further testing may be required.

Prior to cataract surgery, a laboratory testing, an ECG and a medical evaluation should be performed. The latter is issued by your primary care physician, internal medicine doctor or anesthesiologist after reviewing your history, medications and current tests, so that there is no internal medical contraindication to performing the cataract surgery under local anesthesia (rarely under general anesthesia). A list of the medications you take regularly is also needed.

On the day of cataract surgery but before the surgery you should eat, drink and take your medication in the same way as usual, unless the procedure is performed under anesthesia. Do not use any makeup around the eyes.

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Cataract surgery

The only known effective treatment for a developed cataract is cataract surgery, which involves the almost complete removal of the lens of the eye and implanting an artificial lens in its place.

The technique of cataract surgery is constantly evolving, but it’s most important step has remained unchanged for decades: through small (1-3 mm) corneal wounds and with the aid of an ultrasound device we break the lens into small pieces and aspirate them out, while keeping most of the lens capsule in place. After cataract removal, an intraocular artificial lens (IOL) is implanted in the eye in this capsular bag. The diopter of the IOL is determined during the biometry, which consists of a very accurate measurements of the eye and individualized calculations for that specific IOL implant. Usually we calculate in a manner so that the patient should not wear glasses for distance, but other options are possible too. The use of a modern biometer, the experience of the examiner and the use of modern calculation formulas are important, as this is the only way to reduce the acceptable margin of error to close to zero.

It is worth noted that a default artificial intraocular lens only corrects the regular, spherical diopter, but if there are any cylindrical diopter than this requires another type of calculation and a cylindrical or toric intraocular lens, with a slightly different implantation technique, which is not routinely learned by most of the surgeons.

Another type of intraocular lens is the multifocal IOL, which can provide sharp vision at far, mid-range and near distances. Multifocal intraocular lenses are in many cases a very good solution for independence from the glasses, but there are also contraindications and disadvantages, so we need to decide carefully and prudently on their use.

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After cataract surgery

You should use one or more eye drops after cataract surgery, usually for 2 weeks, but sometimes for up to 4-6 weeks (for example when diabetes is associated). You will usually need to instill it several times a day for the first week, less often afterwards, as instructed by your doctor.

For a few days after cataract surgery:

  • do not rub, squeeze or wipe your eyes,
  • water or dirt should not go into the eye,
  • do not force or do strenuous physical work or sports.

In the first week, your vision may not be perfect yet, your eyes may be a little redder, a stinging sensation often occurs as well as tearing and photosensitivity. However, if your vision deteriorates compared to the first day after surgery and if your eyes becomes redder and you have any pain or other complaints then you should have an examination immediately.

Cataracts surgery follow-ups

Routinely a follow-up examination is performed at day one, at first week and after an additional 1 month after cataract surgery. Usually the vision will became good during the first week and after that the majority of the ophthalmic restrictions will be lifted, however the complete recovery usually takes 4-6 weeks.