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CATARACT SURGERY: PROCESS & RISKS

WHAT IS CATARACT??

A cataract refers to the clouding of the eye’s natural lens which lies behind the iris and the pupil. It is the principle cause of blindness in the world and is most common in people of age 40 years and above.

There are 3 types of cataract:

  • SUBCAPSULAR CATARACT: This type of cataract occurs at the back of the eye. It is most common in people with diabetes or those taking high doses of steroid medication.
  • NUCLEAR CATARACT: This type of cataract occurs in the deep central zone of the lens. It occurs due to aging.
  • CORTICAL CATARACT: This type of cataract begins in the periphery of the lens and slowly spreads towards the centre of the lens. It affects the cortex of the lens, which is the part of the lens that surrounds the central zone.

CATARACT- IS IT BECAUSE OF YOUR FAMILY, LIFE STYLE OR JUST BAD KARMA??

Our eye lens works very much like the camera, focusing light onto the retina for clear vision. It also adjusts the eye’s focus enabling us to view the things both close up and far away. The eye lens is made of water and certain other proteins that let light to pass through it. With aging, some of the protein may clump together and cloud up over a small area. With time, the clouding up becomes larger and larger making it harder to see. This condition is called cataract.

Nobody is pretty sure why the eye lens changes with age resulting in the cataract. Researchers have eventually found out other risk factors that may lead to cataract. Some of which are:

  • UV radiation from the sun and other sources
  • Diabetes
  • Obesity
  • Hypertension
  • Smoking
  • Medicines used to control cholesterol
  • Alcohol consumption
  • Family history

 

There’s no concrete proof on what could reduce the risk of cataract. There is no harm in practicing a healthy lifestyle that consists of a diet rich in nutrients, vitamins, minerals, antioxidants and omega 3 fatty acids. Regular exercise and sound sleep also add on to your quality of life.

Though it seems to be terrific, it is something we needn’t worry a lot about! The advancements in the field of medicine have made it possible to cure the patients of cataract with help of surgeries.

CATARACT SURGERY:

Cataract surgery is the process of removing the natural lens of the eye (crystalline lens) which is affected by cataract. During the cataract surgery, the patient’s cloudy lens is removed and is replaced with synthetic lens ensuring lens’s transparency. The synthetic lens replaced is otherwise called as INTRAOCULAR LENS (IOL). The cataract surgery is performed by an ophthalmologist.

There is two commonly preferred type of surgery for cataract. They are:

  • PHACOEMULSIFICATION
  • MANUAL SMALL INCISION CATARACT SURGERY (MSICS):

Phacoemulsification is the most commonly preferred method for cataract surgery. It involves the use of ultrasonic energy to emulsify the cataract lens. It comprises of 6 steps:

  • ANAESTHETIC: Using topical aesthetic eye drops or subtenon injection, the eye is numbed.
  • CORNEAL INCISION: two cuts are made at the margins of the clear cornea that allows insertion of instruments into the eye.
  • CAPSULORHEXIS: With help of needle or a pair of forceps, a circular hole is made in the capsule in which the lens is placed.
  • PHACOEMULSIFICATION: Ultrasonic energy is used to emulsify the lens into a liquid. The resulting emulsion is then “sucked away”.
  • IRRIGATION & ASPIRATION: The cortex, which is the outer layer of the cataract is sucked away. The fluid removed is continuously replaced with saline solution to prevent a collapse of the structure.
  • LENS INSERTION: A plastic, foldable lens is placed in the capsule which contains the natural lens. Along with this, an antibiotic is also injected into the eye to reduce the risk of infection.

Finally, salt water is injected into the corneal wounds, which cause the area to swell and seal the incision.

MANUAL SMALL INCISION CATARACT SURGERY (MSICS): This technique is evolved from ECCE. The word “small” in the title refers to the wound being smaller than an ECCE, although it is larger than a PHACO wound.

HOW LONG DOES IT TAKE TO PERFORM A CATARACT?

If it is an uncomplicated surgery, then it will not take more than 10 minutes. Since the patient will be given an aesthetic while performing the surgery, it might take about 30 minutes to recover from the sedation.

HOW TO PREPARE YOURSELF FOR THE CATARACT SURGERY?

Before undergoing a cataract surgery you may be asked to do the following:

  • A week before the surgery, the doctor may take certain painless tests using ultrasonic energy to determine the size and shape of your eye.
  • You may be advised to stop certain medications at the time of your surgery as that might increase the risk of bleeding during the procedure.
  • You will be advised to use antibiotic eye drops to reduce the risk of infection.
  • You will be instructed to fast for 12 hours before your surgery.

 

 

RISKS AND COMPLICATIONS OF THE SURGERY:

A person suffering from cataract alone may not have many complications, but those who have other eye conditions such as uveitis, high myopia (severe short-sightedness)

Less than 10% of the people have greater chances of developing PCO, within two to three years after the cataract surgery.

 POSTERIOR CAPSULE OPACIFICATION (PCO): it is the condition in which the lens capsule thickens thereby causing cloudy vision. This isn’t the cataract developing again, it is the skin or membrane growing over the artificial lens

Other complications are less common but to list a few, they are:

During the operation:

  • inability to remove all of the cataracts
  • tearing of the lens capsule
  • bleeding inside the eye
  • a bit of the cataract dropping into the back of the eye
  • damage to other parts of the eye, such as the transparent outer layer of the eye (cornea)

After the operation:

  • swelling or inflammation of the eye
  • swelling and redness (inflammation) in the eye
  • swelling of the retina- where the fluid builds up between the layers of the retina at the back of the eye. This may sometimes affect the vision.
  • Swelling of the cornea- where the fluid builds up in the cornea at the front of the eye; it usually clears itself.
  • retinal detachment – a rare complication where the retina (the layer of nerve cells inside the back of the eye) becomes separated from the inner wall of the eye
  • infection in the eye – such as endophthalmitis (a rare bacterial infection)

 

It is important to seek medical advice if you experience any increasing pain in the eye or loss of vision or redness after the surgery. It is possible to treat these complications with further surgery.

There is also a small risk around 1 in 1000 may experience permanent damage to the eye resulting in loss of vision. However, the majority of the people lead a happy life with improved vision after the surgery.

 

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