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How Cataract Surgery is Performed?

How Cataract Surgery is Performed?

What is Cataract?

Cataract is the condition where the natural lens inside the eye loses its transparency and becomes clouded, resulting in impaired vision. Vision cannot be corrected with glasses in a cataract-affected eye. Surgery is the only treatment for cataracts.

In cataract surgery, the damaged natural lens of the patient is dissolved and removed, and an artificial lens is placed in its position. The average lifespan of the human lens is 65 - 70 years. Therefore, most individuals reaching the age of 65 - 70 need to undergo cataract surgery.

What method is used for cataract surgery?

Although cataract surgery has been performed for thousands of years, it has greatly advanced in recent years, with its success and outcomes reaching a very high level. In modern cataract surgery, the clouded natural lens inside the eye is dissolved by entering the eye through a 2.2-millimeter hole using highly advanced devices. Afterwards, a high-tech foldable plastic lens is placed inside the eye through this small hole.

The method used for cataract surgery is commonly referred to as sutureless laser cataract surgery, with its medical term being phacoemulsification. Certain stages of phacoemulsification, the most modern method for cataract surgery, can be automated using another laser system.

What are the Preparations for Cataract Surgery?

Cataract surgery, which involves replacing an important part of the eye, the lens, requires serious and meticulous preparation. Firstly, a detailed eye examination is performed before the surgery to determine the level of vision, the type of cataract, any macular disease in the eye, retina problems, eye pressure, glaucoma, or any other similar problems.

With precise instruments, measurements are taken from the eye to calculate the power of the artificial intraocular lens (IOL) that will be placed in the eye during the surgery. During these calculations, if the patient has astigmatism, the type of lens to be used should be converted to a toric lens, which is called an astigmatic lens.

Selection of Lens in Cataract Surgery

After completing the eye examination and taking all measurements, if the patient has any eye diseases, the doctor determines the type of lens to be implanted because not every lens is suitable for every eye. If there are no problems with the eye, then a decision needs to be made among single focus, multifocal, and extended focus smart intraocular lenses as described on the intraocular lenses page. At this point, the most important factor is selecting a lens that is compatible with the patient's lifestyle.

Professor Doctor Ahmet Akman has been lecturing to his younger colleagues for many years to teach which lens is better for which patient through conferences he has given both nationally and internationally.

The compatibility of the lens to be implanted with the patient's lifestyle is the most important factor for having good quality vision in the future. For example, implanting a trifocal multifocal lens to a person who drives at night can make driving very difficult, causing the person to lose their job and greatly reducing their quality of life.

After the examination in our clinic, Professor Ahmet Akman explains the advantages and disadvantages of different intraocular lens types to his patients and decisions about the intraocular lens types are made in collaboration with the patient. After the examinations are completed and the type of intraocular lens is decided, the next step is to start the patient on eye drops to be used for 2 days before the surgery and, if the patient is using blood thinners, they have to consult their doctor to stop them for 3 days.

What Happens on the Day of Cataract Surgery?

On the day of cataract surgery, after the patient is admitted to the hospital, eye drops to dilate the pupil and sedative medications are started during the rest in the comfortable room. This period lasts about 1 hour during which both the patient's pupil dilates and the sedative medications take effect. If the patient has any special problems with their eyes, some iv fluids or similar medications are given to complete the preparations.

Then the patient is taken to the operating room, where the eye is sterilized with special solutions and prepared for the procedure, which will take about 10-15 minutes. The patient's eye is numbed with eye drops. After covering with a sterile drape, a device is placed to prevent the eyelids from closing, and the surgery begins with the patient lying comfortably on their back with their eyelids open and their eyes numbed.

How is Cataract Surgery Performed?

During the cataract surgery procedure, the operating microscope is positioned over the patient's eye, and they are instructed to look into the light within the microscope. Following this, a painless, needle-free incision of 2.2 millimeters is made.

Protective medications are administered into the eye to ensure that no damage occurs during the surgery. It is crucial that these medications are of high quality and FDA-approved, as inadequate or low-quality medications may lead to serious eye problems in later years, even necessitating corneal transplant surgery, also known as eye transplant.

Subsequently, a window is opened in the anterior capsule of the cataract, and using our advanced technology devices, we enter the eye and dissolve the cataract. The interior of the eye is thoroughly cleaned, and any remaining cataract residues are vacuumed out using another device. Next, the lens is placed into the eye using our specialized electric injector system utilized in our clinic. The lens unfolds and settles into place within the eye. If a toric intraocular lens (IOL) for astigmatism correction is used, adjustments are made. Then, the medications administered into the eye are cleared using vacuum.

The final step involves closing the surgical incisions with suturless technique and administering antibiotics into the eye. The patient is then taken to their room with only a transparent protective band without bandaging the eye. A nice meal is served to the patient, and after finishing their meal, they are discharged home approximately within the first hour of the surgery.

Post-Cataract Surgery

We recommend our discharged patients to instill an eye drop every hour until bedtime and until their morning examination appointment. It is considered entirely normal to experience slight stinging and blurry vision since the eye is not bandaged as it was before, leading to a small amount of discomfort.

When the pupil becomes normal again, approximately within 24-48 hours, the vison satrts to clear. The stinging is typically attributed to the medications used to clean and sterilize the area around the eye before surgery and generally subsides by the following morning after the surgery.

On the day after cataract surgery, we need to see our patient briefly for their first follow-up examination in our clinic. If no issues are observed, the patient is briefed on a medication regimen that will last for approximately 5 weeks.

One month after cataract surgery, the final examination is conducted, and any medications related to the surgery are discontinued. If glasses are needed, they are prescribed based on the type of lens used during the surgery; however, if smart lenses were utilized, there might not be a need for glasses. This check-up is not mandatory for patients living abroad or out of town.

During this period, some discomfort may still be experienced. In areas with dry and dusty climates, especially in the Central Anatolia region, slight stinging may occur around the first month after the surgery due to dry eye conditions. If the patient experiences such a problem, artificial tear drops are recommended.

What Problems Can Occur After Cataract Surgery?

Even if cataract surgery proceeds smoothly and everything goes well, the following problems may still arise. Firstly, there may be a sensation of burning and stinging in the eye; cataract surgery is a serious procedure in which the eye's an important part is replaced, and many drops are used during this period, so experiencing mild burning or stinging within the first month is considered normal. While most patients do not feel this, if a patient experiences such sensations after the surgery, additional tear supplements are provided.

Another common issue that patients typically perceive as a problem is seeing black spots floating in the eye. Seventy percent of the interior of our eye is filled with a gel-like substance called vitreous. From around the age of fifty, this gel begins to shrink and become threadlike, similar to the wrinkles in our skin, causing some areas to lose transparency. This gel-like substance cannot be easily removed with a simple operation. Patients whose vision was poor before cataract surgery tend to forget these floating objects because their brains do not register them.

Vision After Cataract Surgery

After cataract surgery, patients may begin to notice the black spots and a slight haze in their vision as it opens up to 100% and becomes very clear. In fact, this indicates the success of the cataract surgery; the eye can see so well that it even perceives the floating objects within it. These floaters become less noticeable and eventually disappear within 1-2 months as they settle downward. Additionally, our brains eventually ignore them, just like we don't notice the sound of the refrigerator in our homes if we don't actively listen for it.

Patients who receive single-focus lenses must wear glasses for reading. Some patients may complain that they can see distant objects very well after the surgery but have difficulty seeing up close.

If a patient with single-focus lenses read small print without glasses, it indicates that the calculation for distance vision might not have been accurate. If we have adjusted the single-focus lens correctly during the surgery and have not encountered any surprises during the healing process, the patient does not need to wear glasses for distance vision. However, they wiil need reading glasses for near vision.

Alternatively, we can change the lens power to achieve near vision without glasses with single-focus lenses, but in this case, glasses may be required for distance vision. If a glasses-free life is desired, we can use smart lenses, also known as multifocal lenses, if the patient's eye is suitable. With smart lenses, it is possible to see both near and far without glasses.

Cataract surgery is the most commonly performed and successful surgery in the world!

In conclusion, cataract surgery is the most commonly performed, safest, and most successful surgery in the world.

Thanks to technological advancements, vision correction and glasses-free vision can now be achieved after surgery. However, it should not be forgotten that cataract surgery is a very serious procedure, and problems that arise when it is not performed in a hospital that adheres to all cleanliness and safety precautions, with quality materials, quality lenses, and an experienced doctor, th,is propblems may not be fully resolved and could result in poor vision for life.

Therefore, when choosing a center for cataract surgery, patients should prioritize factors such as doctor experience, the equipment used, and not focus solely on advertisements and various financial differences.

With our experience of approximately 50,000 patients and the successful results seen in patient testimonials, we have been striving to make our patients happy and successful. We continue to treat each patient as if they were our own family member and carefully evaluate them to maintain our success and keep our patients satisfied.

Update Date: 18.07.2023
Ahmet Akman M.D.
Prof. Dr. Ahmet Akman
Göz Hastalıkları Uzmanı, Katarakt, Glokom ve Ön Segment Cerrahisi
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