Mother lode Cataract Surgery Posts

Cataracts develop when the eye’s lens becomes partially or completely cloudy. The three main causes of cataracts are aging, inflammation, and steroid use.

What primary signs and symptoms can cataracts development bring on?

When the lens is cloudy, you might notice that bright lights glare more and that your vision is blurrier. Additionally, you might notice that your optometrist warned you that your eyeglass prescription might vary more than usual.

The best way to treat cataracts.

The most common form of treatment for cataracts is straightforward cataracts surgery, which is frequently carried out as a day-case procedure under local anesthesia.

What is involved in cataracts surgery?

The natural lens in your eye will be removed during cataracts surgery, and a custom-made artificial lens will be inserted in its place.

Cataract surgery is a common, simple surgical procedure that usually takes 30 to 45 minutes to complete. The same day as their cataracts surgery, patients may return home.

When this is required, there is often 6-12 weeks interval between the two operations.

What occurs prior to having cataracts surgery?

Prior to having cataracts surgery, the patient must be sent to a qualified ophthalmologist for an eye examination to measure their eyes (biometry). Patients may need ultrasound scans to confirm certain eye measurements and getting an OCT scan to check the retina’s health before surgery is also typical.

What advantages does cataracts surgery have?

The primary advantages of having cataracts surgery include the following:

• increasing color saturation
• decreasing glare
• enhancing eyesight
• decreasing need on glasses.

What dangers come with having cataracts surgery?

The following are the primary dangers of cataracts surgery:

• There is a 1 in 1000 chance that an infection or retinal detachment may cause irreversible vision loss.
• A one in one hundred chance of needing many procedures but eventually having satisfactory visual results.
• A 10% chance of needing a YAG capsulotomy, a simple and short treatment, to “polish” the lens 6–12 months after the operation.

Which kind of lenses are inserted?

Monofocal lenses are the norm. Patients are therefore left with clear eyesight at a certain distance. Typically, patients ask for distant vision without glasses or with only a mild prescription. Reading a book or using a phone will necessitate reading glasses for them.

Patients who are myopic (short-sighted) may want to be left short-sighted. This implies that following surgery, they will be able to read without glasses but will still need them to see far away.

A toric lens, which lessens astigmatism and simplifies glasses prescriptions, may be helpful for patients with substantial astigmatism. You may talk about this during your consultation.

Extracapsular Cataract Extraction (ECCE)

The natural lens of the eye is removed during extracapsular cataracts extraction, but the rear of the capsule that holds the lens in place is left untouched. The incision is far less invasive than the intracapsular operation (which removed the lens and whole capsule), but it is still longer than the later-developed phacoemulsification. (6) The ECCE method entails making a tiny incision close to the exterior border of the cornea and then entering the eye via this aperture. 

Then, a tiny circular rip, or “capsulorrhexis,” is used to delicately open the front of the lens capsule, which retains the lens in place. The lens’s hard nucleus is then carefully retrieved using specialized instruments and pressure. The surgeon next removes the cortex of the soft lens using suction. The empty lens capsule is filled with viscoelastic material to keep it in shape while the intraocular lens is being implanted; this substance is then withdrawn after the IOL has been properly put. 

The undamaged rear of the lens capsule helps to securely maintain the freshly implanted intraocular lens since it is still within the eye. Two to three stitches are then used to secure and guard the wound. Although extracapsular cataracts extraction is less often utilized than phacoemulsification nowadays, it is nevertheless beneficial for removing severely advanced cataracts that are difficult to remove with phaco or in individuals with several eye conditions that might be made worse by phaco. Because the cataracts is removed in one piece with ECCE, the visual recovery is often slower than via phaco, and the incision is bigger, which may be more uncomfortable. 

Phacoemulsification

An improvement on extracapsular cataracts extraction is phacoemulsification. Charles Kelman first developed the method in the 1960s. It was found that a cataracts might be broken up before removal using an ultrasonic tip (instead of removing it in one singular piece). Although learning phacoemulsification might be challenging for medical professionals, surgeons have increasingly mastered the procedure thanks to its astounding success rates. 

Phacoemulsification has been improved and developed by surgeons throughout time, making it even lower risk and more efficient. Technology advancements like the foldable IOL, for instance, have improved results by enabling surgeons to make smaller incisions. (9) The surgeon anesthetizes the area around the eye before completing the procedure. 

An incision is made on the side of the cornea after pressure is applied to stop any bleeding. The temporal region has been shown to be the least invasive spot to make the incision in recent years. To lessen shock in the intraocular matter, viscoelastic fluid is introduced via the surgical site. A small, circular incision is created in the tissue around the cataracts to execute capsulorhexis. A water stream is used to remove the cataracts from the cortex, then an ultrasound-infused sharp needle is inserted into the cornea. The cataracts is emulsified by this and suctioned out (starting with the central nucleus because this is the densest part). A small hole at the tip of the phaco probe is used to extract the cataracts as it is being emulsified. The posterior capsule is kept in place to stabilize the intraocular lens after it has been inserted while the cortex is removed.

The incision is much smaller in this procedure because the IOL can be folded before being inserted. Depending on the size and density of the cataracts that has to be removed, the precise surgical techniques may vary. There are several emulsification strategies, and the surgeon might focus on various regions of the nucleus at various periods. The cataracts may either be surgically removed in portions or continuously sliced. Because of ongoing technological advancements, smaller incisions are becoming necessary. (10) Cataract Surgery with a Small Incision (SICS)

Although phacoemulsification is by far the most often performed operation in the industrialized world, non-phaco minor incision surgery is frequently performed by ophthalmologists in impoverished nations and, when performed properly, is just as successful. There are three crucial components to this “sutureless non-phaco cataracts surgery.” Low danger of astigmatism development is provided by the procedure’s tiny, self-sealing incision. To remove the lens nucleus, the incision must be large enough to accommodate the complete structure. In order to avoid damaging the cornea and posterior lens capsule, the nucleus must first be prepped within the eye for extraction. Manual SICS compared to phaco has a number of benefits since it uses less resources, may be used to treat almost any kind of cataracts, and needs less training. 

Artists eye diseases

It is fascinating to look at the changes that eye disorders bring about in how individuals see the world in order to better comprehend the impact of these conditions. Famous painters Degas and Monet’s final works have been criticized for being “strangely harsh and gaudy” and completely inconsistent with their customary artistic personas. Their artworks provide us insight into the manner in which eye disorders may significantly distort and obstruct vision since these modifications resulted from eye ailments. Images of a “near acuity test card” were altered in a research by Michael Marmor to simulate the impact of the artists’ eye ailments. Photographs of items the artists observed and painted in real life were altered using techniques including “Gaussian blur, brunescence, darkening, blur, and filter settings.”

More to read: Can I exercise after cataracts surgery?

Diabetes is a systemic illness that is growing more common, and many cataracts surgery patients also have diabetic eye disease, which makes the process more challenging. Although cataracts surgery may still provide excellent results, the risk of complications and long-term vision limitations in these patients is increased. If careful preoperative planning, careful attention to detail during phacoemulsification, and careful postoperative treatment are used, diabetic patients may have excellent vision following cataracts surgery.

Preoperative evaluation is crucial.

With a higher focus on the presence and severity of diabetic eye disease, our diabetic cataracts patients go through the same preoperative evaluation as the rest of our cataracts surgery patients. Patients with diabetes are more likely than non-diabetics to develop cataracts earlier in life and may also be more prone to developing posterior subcapsular cataracts. The extent of the cataracts surgery should be commensurate with the patients’ reported visual impairment and visual acuity, which is a crucial factor to take into account. If a patient reports having severe vision problems but the test only shows mild cataracts, the retina should be extensively inspected to rule out any other potential causes of vision loss.

Existence of harmful neovascularization is one of the key differences between background diabetic retinopathy and proliferative diabetic retinopathy. Proliferative diabetic retinopathy is less frequent than background diabetic retinopathy, however it may happen in either group. Numerous problems, including as vitreous hemorrhage, tractional retinal detachment, and neovascular glaucoma, are brought on by the growth of these new blood vessels. 

Macular edema, one of the most prevalent causes of central vision loss in diabetes patients, may affect diabetics at any stage of the retinopathy spectrum. A thorough dilated fundus examination may find many of these diseases, but other methods, such as optical coherence tomography or fluorescein angiography, can find more subtle abnormalities.

Before thinking about cataracts surgery as a therapy option, diabetic ocular condition should be fully treated. This requires a multi-pronged approach, with targeted macular laser therapy acting as the main treatment for clinically significant macular edema and argon laser panretinal photocoagulation serving as the primary treatment for proliferative retinopathy. Anti-VEGF drugs and steroids are routinely administered intravitreally as an alternative ocular treatment option. Establishing strict control of the systemic blood glucose level, which will be reflected in the hemoglobin A1c level, should be the main objective.

The anterior part of the eye may also be negatively impacted by poorly controlled diabetes, including neovascularization of the iris and angle, which commonly leads to neovascular glaucoma. Since a sustained increase in intraocular pressure (IOP) may result in irreparable damage to the optic nerves and serious vision loss, vigorous neovascular glaucoma treatment must be prioritized above cataracts surgery. 

Working with a retinal colleague is usually the best course of action for managing these challenging patients.

Surgery technique and aftercare

Once diabetic retinopathy has improved and the macula has dried up, cataracts surgery can be scheduled. Monofocal lens implants, toric intraocular lenses, and occasionally accommodating IOLs will be placed first during cataracts surgery. When there is a history of macular lesions present or when there is a significant risk of developing macular disease, multifocal intraocular lenses (IOLs) should not be used. The authors state that silicone intraocular lenses (IOLs) may be an appropriate choice for patients with well-controlled diabetes and moderate retinopathy, whereas acrylic intraocular lenses (IOLs) are preferred in patients who are anticipated to require a future vitrectomy for proliferative diabetic retinopathy.

Cataract surgery may be made less traumatic by using less phaco energy, circulating less fluid through the eye, and minimizing contact with the iris. In order to get the best outcomes possible while doing cataracts surgery on diabetic patients, it is essential to adopt an effective surgical technique. An experienced surgeon, as opposed to a new surgeon, should do the cataracts surgery on these complex patients. Patients with diabetes frequently have impaired pupillary dilation due to their diabetes, especially when they have active rubeosis or even retracted neovascularization. 

Stretching the pupils should be avoided since they run the risk of rupturing and causing intraocular bleeding. At the time of cataracts surgery, triamcinolone or anti-VEGF medications may occasionally be injected intravitreally. In diabetics with tractional retinal detachments or non-clearing vitreous hemorrhages, a pars plana vitrectomy may be combined with cataracts surgery. This is carried out together with a vitreoretinal colleague.

In eyes with severe diabetic retinopathy, cataracts surgery may result in the development and worsening of the disease, which will have a detrimental effect on vision. The likelihood of retinopathy developing after cataracts surgery is lower in eyes with just mild diabetes changes than in other eyes. Because early cataracts surgery is linked with fewer complications and a quicker return to clear vision after the treatment, it is generally helpful for diabetic individuals.

Macular edema may be prevented and treated using topical steroids and nonsteroidal anti-inflammatory medications (NSAIDs), which are administered postoperatively to reduce inflammation. Before stopping the topical medications, macular thickness may be measured over time at postoperative visits. Patients should try to keep their systemic blood glucose levels under control throughout the recovery phase to aid in the mending process. 

Both prolonged postoperative inflammation and the development of posterior capsular opacification may be more likely in diabetics. Even after a masterfully performed cataracts surgery, a patient’s diabetic retinopathy may develop in the postoperative term. As a result, patients should be regularly monitored with serial dilated funduscopic examinations and referred to retinal colleagues as needed.

Diabetic patients with extensive cataracts provide unique surgical challenges, and diabetic patients with substantial cataracts may be more susceptible to postoperative complications. The good news is that these individuals may do exceptionally well and regain fantastic vision, just like our other cataracts patients do, with careful pre-treatment of diabetic retinopathy, less invasive surgical methods, and appropriate medications after a cataracts operation.

Final thoughts

It is more difficult to do cataract surgery on people who also have diabetic eye disease since diabetes is a systemic disease that is becoming increasingly prevalent. Although cataracts surgery may still provide great outcomes, these individuals are at a higher risk for problems and long-term visual impairments. Diabetic individuals may have great eyesight after cataract surgery if thorough preoperative planning, meticulous attention to detail during phacoemulsification, and appropriate postoperative care are performed.