Cataract surgery


When should cataract be operated?

Most ophthalmologists recommend cataract surgery if it begins to interfere with quality of life or everyday activities such as reading or driving at night.

  1. If the cataract is monolateral, there is no hurry to remove it, as it usually does not harm the eye.
  2. If the cataract is bilateral, the patient’s vision could be significantly impaired and there may be a more urgent need for treatment.

In children with congenital cataracts, some ophthalmologists recommend performing the operation within the first 4 months of life to prevent the irreversible development of weak vision.
If you do not decide to have cataract surgery, the ophthalmologist must regularly monitor the development of cataracts.

Anesthesia for cataract surgery

Today, this operation can be performed under local anesthesia. A few numbing drops are applied to the eye.
After a few minutes, the patient no longer perceives pain.
When this type of anesthesia is applied, the patient retains control of the eyelid muscles and at the end of the operation he can close the eye independently.

What are the risks of cataract surgery?

Like any surgical procedure, cataract surgery carries risks such as infection or bleeding.

After surgery:

  • keep your eye clean,
  • wash hands,
  • take the prescribed medication to minimize the risk of infection.

A severe infection can lead to loss of vision.
Cataract surgery slightly increases the risk of retinal detachment.
Other disorders of the eye, such as severe myopia, can increase the risk of retinal detachment after cataract surgery.
A sign of retinal detachment is the sudden increase in flashes of light or floating bodies in front of the eye.
The floating bodies are “spots” that seem to float in the field of vision.

If you notice a sudden flicker or flash, you should consult an ophthalmologist immediately.
Retinal detachment is a medical emergency. If necessary, you should go to an emergency room or hospital.

Is cataract surgery effective?

Removal of a cataract is one of the most common, safe and effective surgeries.
There are no basic contraindications, but if the patient has a cough, the procedure should be postponed until recovery.

In about 90% of cases, vision improves in people who have cataract surgery.

How much does cataract surgery cost?

  • As a rule, statutory health insurance companies cover the costs of surgery with a standard lens (monofocal lens).
  • Private health insurance companies usually cover the full costs of cataract surgery with premium lens (multifocal lens).

If the legally insured patient opts for a premium lens, the share to the standard lens is credited by the insurance company and only the difference is due as own contribution.
The costs for the implantation of a multifocal lens including follow-up examinations are approximately between € 600 and € 3,000 per eye, depending on the lens type.

In any case, you should clarify the financial requirements with the health insurance company before the procedure!

Preparation for surgery

A week or two before the surgical procedure, the doctor will conduct some examinations.
These preliminary examinations include:

  • Biometrics: Measurement of corneal curvature, size and shape of the eye.
  • Endothelial microscopy: examination of the corneal endothelium with a special microscope.
  • Studies of the retina: computerized optical tomography and fluorangiography.

This information is used by the doctor to choose the right artificial lens.

The patient must remain fasting from 12 hours before surgery.

With the new techniques, anticoagulation therapy (e.g. Coumadin) does not have to be interrupted because:

  • the cornea is not supplied with blood;
  • the anesthesia is topical and no injection is made;
  • the incision is very small.

Cataract Surgery Description

In the eye clinic or hospital, eye drops are administered to dilate the pupil.
The area around the eye is washed and cleaned.
An anesthetic is injected to numb the nerves in and around the eye.

1. Phacoemulsification without sutures. The surgeon makes two tiny incisions and a small incision (1.8-2 mm) in the cornea (transparent curved surface covering the front part of the eye).

  • Through this incision (called a tunnel), the instruments are inserted to suck in the lens and insert the new lens.
  • The cut is carried out in such a way that a valve is created in which the internal pressure is greater than the external pressure, allowing closing without a seam.
  • With an instrument (cystotoma), a small round incision is made in the capsule surrounding the lens; this process is very delicate, because a capsule rupture must be avoided at all costs.
  • The lesion of the capsule means a complication of the procedure and the lens may lack support.
  • The surgeon injects water to separate the capsule from the lens.
  • Then a small phacoemulsifier is introduced into the eye. This instrument emits ultrasonic waves that soften and crush the lens, which is then removed by aspiration.
  • After that, an artificial lens is inserted into the patient’s capsular bag.
  • The lens is inserted with a so-called injector, even if it is larger than the incision.

Most cataract surgeries today are performed by phacoemulsification.
In a few days, vision is fully restored.

2. Extracapsular extraction operation. The doctor makes an approximately 1 cm long incision in the cornea and removes the cloudy core of the lens in a single operation. The rest of the lens is sucked out.
After the natural lens has been removed, it is usually inserted through an artificial lens called an intraocular lens (IOL).
The IOL is a clear plastic lens that requires no care and becomes an integral part of the eye. The light is clearly focused on the retina and improves vision.
You can’t feel or see the new lens.
Some people cannot tolerate the onset of an IOL.
You may have another eye disease or there may be problems during surgery.
For these patients, the doctor may recommend contact lenses or glasses with high magnification.

3. The newest method is the femtosecond laser, which does not require an incision to treat the cataracts.

  • The laser emits high-frequency pulses that can be applied to the tissue in question with great precision.
  • Anesthesia is performed locally by eye drops.
  • The laser beams open the outer sac of the lens and divide the cataract into four parts.
  • Then an artificial lens is inserted by means of an ultrasonic cannula.

Femtosecond laser surgery is also used to correct:

Not all patients are suitable for this procedure, it is estimated that the percentage of operable patients accounts for about 60% of candidates.

After the operation, the eye must be protected by a bandage for a day.
Most people return home on the same day of cataract surgery (outpatient treatment).
An accompanying person is required who can take the patient home.

How long does cataract surgery take?
The procedure takes about 20-30 minutes. Inpatient admission is not required, the patient is discharged home the same day.

Healing process and convalescence after cataract surgery

Postoperative symptoms include:

After a day or two, the discomfort should pass, but in some cases it lasts about 10-15 days. For a few days after surgery, the doctor may prescribe eye drops that will speed healing and reduce the risk of infection.

Precautions include:

  • Wear eye protection or sunglasses for the first two days.
  • Friction and pressure on the eye or sleeping on the side of the operated eye should be avoided for at least two weeks.
  • Do not lift heavy objects (for two weeks).
  • Do not drive in the first week.
  • Avoid make-up for 15 days.

You may:

  • walk
  • climbing stairs,
  • showering (keeping the operated eyes closed),
  • do light housework.

In most cases, recovery takes 2 days to 2 weeks.
The doctor makes appointments for examinations to monitor progress.

Complications of cataract surgery

If the procedure is not successful (failed), some complications may occur, such as:

  • Rupture of the posterior lens capsule and dispersion of cataract fragments in the eye
  • Detachment of the retina (very rare)
  • Inappropriate positioning of the lens

Problems after surgery are rare, but can occur. These problems are:

If the doctor intervenes immediately, these problems can usually be treated successfully.
Sometimes the tissue surrounding the IOL clouds and can obscure vision.
This disorder is called a post-cataract.

Postoperative complications: Capsular contracture may develop after a few months or years after cataract surgery.
Posterior capsular opacity, which can lead to impaired vision for weeks or months after cataract removal, is treated with a laser. The doctor creates a small hole in the tissue of the eye behind the lens.
This outpatient procedure is called capsulotomy with the YAG laser.
It is painless and rarely causes increased eye pressure or other eye problems.

In rare cases, cataract surgery has led to potentially serious consequences for vision, such as a common eye infection known as endophthalmitis.
People who suffer from severe complications often have other conditions such as diabetes or high blood pressure (arterial hypertension).

When does normal vision return?

It is possible to quickly return to everyday activities; vision may be blurred for a day if there are no copplications.
At the beginning, halos can be seen around the lights, but usually after about two weeks.
The lens used is clear, in contrast to the natural lens, which can have a yellowish/brownish color.
It may also be necessary to wear new glasses or contact lenses after recovery (after about 2 weeks).

Recovery and results

The statistics used to describe OP results are based on a comprehensive analysis of 90 studies conducted between 1979 and 1991.
These data show that a high percentage of patients have achieved good results.
In addition, the technologies and intraocular lenses used in cataract surgery have improved significantly over the last decade.

For example, patients who also suffer from macular degeneration can be fitted with a double intraocular lens that focuses the light rays on a healthy side of the retina.

The latest studies show that almost 96% of cataract-topped eyes that
had no problems before surgery (for example, other eye diseases) achieve a remote visual acuity of at least 10/20, which is sufficient to drive with glasses or contact lenses.
If all eyes are taken into account, including those with pre-existing other types of eye diseases as cataracts, almost 90 percent of patients can show a good result.
Less than 2 percent of eyes experienced complications from cataract surgery.

Can cataracts be prevented?

Since the exact cause of cataracts is uncertain, there is no way to prevent it.
The cataracts and other conditions, such as glaucoma, often occur in the elderly. It is therefore important to examine the eyes regularly.
This is especially important if there are already risk factors or a family history of eye problems.
Adults should have an eye exam at least every two years and annually if they are over 50 years old.
People with a problematic history of the eyes or with other conditions that increase the risk of an eye disorder (such as diabetes) should see the ophthalmologist more often.

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