Cataract Surgery

 

Cataract Surgery

Femtosecond Laser Assisted Cataract Surgery and IOL Insertion
There are two steps to this state of the art procedure

  • Laser
  • Microsurgical removal of the cataract and IOL insertion

1. Laser

You will be comfortably positioned, lying back with a rest to support your head. Numbing drops (topical anaesthesia) will be placed on your eye. You will be asked to look at a light to align the eye. The laser needs to establish a link with your eye (docking) to begin real time microscopic measurements to guide the laser beam.
The surgeon programs the laser to

  • Create two incisions of precise dimensions
  • Create a perfectly circular opening in the anterior (front) capsule of the cataract of a precise diameter
  • Divide the cataract into small pieces.

2. Microsurgical removal of the cataract and IOL insertion

You will be transferred into the operating theatre. If you have astigmatism, then alignment marks will be made on the surface of the eye with ink.

The Anaesthetist (Specialist Anaesthetic Doctor) will place more numbing drops (topical anaesthesia) on your eye. He will gain access to a vein in your arm. At his discretion, relaxing medication can be given. You will remain awake and will hear Dr Chau, the Anaesthetist and the theatre staff talking. Dr Chau and his team will communicate to you as appropriate throughout surgery. Dr Chau may ask you to look at the microscope light, to align the eye.

Antiseptic and a sterile drape will be placed on the eye. The drape is lifted off your face, creating a tent. Oxygen is provided to you under the drape. The other eye is covered.
Surgery is performed under a high powered microscope specifically designed for microsurgery inside the eye. As the cataract has already been divided into small pieces by laser, removal by the traditional Phacoemulsification probe is much more gentle and rapid.
The IOL is folded and injected into the transparent residual sac (capsular bag) of the cataract, where it unfolds. The IOL is then securely fixated with the human eye. The very precise small incisions made by laser, self-seal and do not require sutures.

Topical Anaesthesia

Topical anaesthesia involves using eye drops to numb the front surface of the eye, giving a full anaesthetic effect for (1) Laser (2) Microsurgical Cataract removal and IOL insertion.
Before laser is applied, Dr Chau will ask you to look at a ring of lights to dock the laser to your eye. You may feel Dr Chau touching around the eye. This is normal.

For Micro surgical Cataract removal, a tiny volume of supplementary anaesthesia is infused into the eye with a blunt cannula to block out sensations that can occur when positive pressure is applied to keep the eye inflated for microsurgical cataract removal. The Anaesthetic Doctor will monitor you very carefully during cataract removal. He will constantly measure your pulse and blood pressure. His role is to ensure that you are relaxed and comfortable. He will give relaxing medication through a vein in your arm if he feels that this is necessary.

One of the advantages of topical anaesthesia is that NO EYEPAD is needed after surgery. Although the operated eye can be used immediately after surgery, full recovery if vision may take days or even longer.

Phacoemulsification and IOL Surgery For Patients Who Are Unsuitable For Laser Assisted Cataract Surgery.

The laser step (1) is omitted. You are transferred directly into the Operating Theatre. The anaesthetist will instil eye drops (Topical Anaesthesia). He will obtain access to a vein in your arm. At his discretion, relaxing medication can be given.

Antiseptic and a sterile drape will be placed on the eye. The drape is lifted off your face, creating a tent. Oxygen is provided to you under the drape. The other eye is covered.
Surgery is performed under high powered microscope. The two corneal incisions are made with disposable blades. A tiny volume of supplementary anaesthesia is infused into the eye.

Dr Chau will ask you to look at the microscope light to align the eye. The anterior (front capsule of the cataract is punctured with micro forceps. The same forceps are used to create the circular opening n the anterior (front) capsule.

As the cataract is not pre divided into smaller pieces by laser, more energy is required from the Phacoemulsification probe to break up the cataract and remove it. Manual techniques to crack or fracture the cataract are used.

The intraocular lens is folded and injected into transparent residual sac (capsular bag) where it unfolds.

Restrictions on your activities after surgery

  • There are no restrictions on bending or stooping, sneezing or coughing
  • You can read and watch TV as much as you like.  Your old glasses will not be of the correct prescription for the eye that has just had surgery, but may be useful to focus the other eye for reading.  Using old glasses will not harm the operated eye
  • If you were driving a motor car before your operation, you can usually return to driving after the first post operative visit to Dr Chau.  Please enquire.
  • Avoid very strenuous activities, such as sports and situations where high pressure might be applied to the eye such as being accidentally hit in the eye
  • Avoid wearing make-up, gardening and swimming for 2 weeks after surgery, as well as any other situations where germs may be introduced into your eye.
  • DO NOT RUB THE EYE.

Post-Operative Eye Drops

A prescription for the following:

  1. Maxidex – Anti inflammatory
  2. Chlorsig– Antibiotic

will be provided when you book in for surgery. Please ensure you bring these drops with you on the day of your operation unopened.            

  • The order of the drops does not matter
  • Leave 5 minutes between the 1st and 2nd drop (refer to separate instruction sheet).
  • During the DAY - an eye pad is not necessary
  • During the NIGHT - an eye shield when sleeping is optional to prevent accidentally rubbing the eye (if you are restless at night)

Lubricating eyedrops are also advised after surgery if you experience mild irritation or a gritty sensation.

What will happen later on?

An improvement in vision may often be noticed in the first few hours to days after surgery.  As we are all individuals, healing time varies from one individual to the next. 

To ensure adequate healing of the eye, after-surgery assessments are scheduled.  These appointments are very important and must not be missed or altered. The purpose is to ensure that there is no problem after surgery such as: excessive inflammation, infection or any other problem which could jeopardise full recovery of vision and the health of your eye.

These assessments are:

  1. The day following surgery  at Dr Chau’s rooms
  2. At 1 week following surgery with your Optometrist or at Dr Chau’s rooms and
  3. At 4 weeks following surgery with your Optometrist or at Dr Chau’s rooms

Your Optometrist may send an account to Dr Chau for the 1 week assessment.  This involves no extra cost to you.  It is a legal requirement that we inform you of this arrangement.  If you have any questions regarding this, please speak to the staff at The Eye Surgery and Laser Centre.

What will happen to my glasses after cataract surgery?

Thick glasses or contact lenses are not necessary due to the implantation of an intraocular lens (IOL).  Corrective reading glasses might be needed as the IOL has a fixed focus.  Sometimes distance glasses are necessary for driving and watching TV.

Your Optometrist will discuss with you when it is most appropriate to prescribe new glasses.  Typically this is approximately 3-4 weeks after surgery.

Patients who are currently employed will generally require at least 1-2 days away from work. This however may vary from one person to the next.

In Conclusion

An important contributing factor to successful treatment of cataract is a well-informed patient.  Whether you have cataract yourself, or have a close family member or friend who has cataract, this information is provided to help you make an informed decision about cataract treatment. 

The patient’s experience is more pleasant nowadays, and there is much less disruption to day to day activities compared with the past.  Increasing Surgeon experience and newer techniques have shortened the duration of surgery, and accelerated the rate of recovery.  Despite this cataract surgery has always and is still regarded as major eye surgery.

If the decision has been made to proceed with cataract and intraocular lens implant surgery, we hope that there is sufficient detail in this information booklet to answer most of your questions.  Please also refer to the Informed consent document prior to surgery.

If you have any further questions about Cataract surgery, the Vision Day Surgery Centre, Aftercare or any other aspect of your care, please do not hesitate to ask any member of our team.