MANSAROVAR EYE HOSPITAL, LUCKNOW, INDIA.
Phones: 91-522-224292/228655/201717
Fax: 91-522-239259
E-Mail:
CATARACT AND INTRA-OCULAR LENS IMPLANTATION
WHAT IS A CATARACT ?
The construction of our eye is very similar to that of a
camera. Both have the same components inside them. Just like
the camera our eye contains a 'LENS' whose function is to focus
the rays of light entering the eye so that we may be able to see
clearly. When this lens of our eye which normally is totally
transparent, becomes cloudy and loses its transparency, a
'CATARACT' is said to have formed.
WHAT ARE THE SYMPTOMS ?
When the lens instead of focusing the light starts
obstructing it then the main effect will naturally be the
BLURRING OF VISION and this is the main symptom of
cataract. The vision becomes progressively blurred
as the cataract matures and a stage comes when the
patient cannot see anything except light. The other symptoms
of cataract are excessive feeling of GLARE , DOUBLE-VISION,
DIFFICULTY IN READING in normal room lights and the blunting
of color perception. There is never any pain, irritation, headache
or redness.
WHY DOES CATARACT FORM ?
The development of cataract is a part of the normal
human aging process and can be compared to the graying of
hair with age. As we grow older the lens of our eye gradually
becomes less transparent and even totally opaque leading to
complete loss of vision in the affected eye. By the age of 60
years a majority of the population has some degree of cataract.
The development of cataract is a very slow process and takes
anything from a few months to a few years.It may even stop
progressing after a certain stage, but these changes cannot
be predicted.
Cataract can also form due to injury, due to metabolic
diseases like diabetes, due to the prolonged use of drugs
called steroids and some local eye diseases like iritis.
Cataract can rarely even be congenital i.e. present since birth !
CAN WE PREVENT CATARACT ?
Much research has been going on in this area,
but till date no medicine is available that can be used to
prevent cataract from developing. Many expensive medicines
are available in the market claiming to have an effect on the
development and progress of cataract but none of them has
been scientifically proven to have any effect whatsoever on
cataract. Although we cannot prevent or halt the growth of cataract
we can still see better inspite of cataract if we go to a qualified
person and get glasses tested. Glasses help to focus the rays
of light entering the eye and to some effect can temporarily
neutralize the effect of cataract. These glasses may need
frequent re-testing as the cataract progresses, but they
are helpful till the cataract matures sufficiently for operation.
WHEN SHOULD OPERATION BE DONE ?
Except for a few rare situations, cataract is not an
emergency and enough time is available to the patient to plan
his operation. The choice of when to get operated is the
patient's depending on his visual disability and need.
IT IS NO LONGER NECESSARY, AS IN THE PAST,
FOR THE CATARACT TO BE FULLY MATURE OR 'RIPE'
BEFORE IT IS OPERATED. Modern surgical techniques
have revolutionized the operation of cataract and made it
extremely safe. It is now possible to perform the operation
at any stage of the cataract with equally good results. In fact
allowing the cataract to become fully mature is now not preferred
as it can lead to more complications during surgery than an
immature cataract.
Taking these considerations into account it is
recommended that surgery be performed as soon as the
clouded lens begins to interfere significantly with the person's
comfort and normal daily activities.
WHICH IS THE BEST SEASON FOR OPERATION ?
All seasons are ideal for cataract surgery. There is
a big misconception among the people in India that cataract
operation should only be done in the winter months. The results
of surgery are equally good all through the year. Therefore
while deciding about operation no thought should be given
to the season.
WHAT CAN BE EXPECTED FROM CATARACT SURGERY ?
The results of modern cataract microsurgery
techniques are extremely good and in a vast majority of
cases normal eye-sight is restored completely. The
complication rates are negligible and post-operative discomfort
is minimal.. It is due to these reasons that we can confidently
advise patients to undergo early surgery and regain good vision.
In case the patient is suffering from some other
eye disease like glaucoma, diabetic retinopathy or other retinal
diseases all of which cause a reduction in vision then after
cataract surgery only that part of the vision will be regained
that had been lost due to the cataract. The vision that has
been lost due to the other eye disease that was concurrently
present will not recover after cataract operation. Inspite of this
it may be wise to undergo cataract surgery because after
the removal of cataract it may be possible to treat the other
conditions better than would be possible in the presence of
cataract.
WHAT ARE THE MODERN SURGICAL TECHNIQUES ?
In the modern method operation is done using an
operating microscope by which the structures of the eye are
magnified 10 times . This allows the surgeon to operate very
precisely causing least amount of trauma to the delicate tissues
of the eye. This in turn leads to less pain and discomfort
post-operatively and faster recovery.
EXTRA-CAPSULAR CATARACT EXTRACTION (ECCE) is the most
common method in use today. The surgeon makes a 10 to 12 mm
long incision in front of the eye and removes the front part of the
lens 'capsule' and the whole 'nucleus'. The back part of the
capsule which is a thin transparent membrane is left behind .
The wound is closed using 7 to 10 very fine stitches that don't
need to be removed later. The very latest technique which gives
the best results is called 'PHACO-EMULSIFICATION' and is
available only at a few highly advanced centers in the country
including this hospital.
INTRA-OCULAR LENS IMPLANTATION :
An intra-ocular lens (IOL) is an artificial lens made of
special non-reactive plastic that is placed inside the eye during
the ECCE or phako-emulsification cataract operation. Intra-ocular
lens implantation is now a standard procedure and millions of
lenses have been implanted world-wide in the last 20 years.
In the west more than 99% cataract patients get an IOL implanted
in their eyes. An IOL offers significant advantages to the patient.
In the modern method the IOL is inserted in the 'posterior chamber'
of the eye i.e. it is placed at the very spot in the eye from where the
cataractous lens of the patient is removed. This is vastly superior
to the old technique of putting the lens in the 'anterior chamber' as
is still being practiced by some. The anterior chamber lenses do
not do well in the long-term and the patient can completely lose his
sight after a few years.
After a simple cataract operation in which the cloudy
lens has been removed, the patient's eye does not have any lens
in it so his vision after the operation remains very blurred as the rays
of light are not being focused at-all. The obstruction which was
present in the form of cataract has been removed , but no alternative
has been provided in order to focus the rays of light. He is able
to see only after he has been prescribed his 'cataract glasses'
6-8 weeks after the operation.These cataract glasses are very
thick due to their high plus power and the patient takes
5-6 months to get adjusted to them. Moreover he becomes
totally dependent on his glasses because his vision without
them is so poor that he cannot walk even a few steps and he
cannot recognize people even at very close distances.
Reading or doing any fine work without these thick glasses is
absolutely out of the question. Even newspaper headlines
cannot be seen clearly.
ADVANTAGES OF IOL :
1. Between 60 - 80 % of the person's normal eyesight is
restored even without glasses. He can easily read headlines without glasses. All routine house-hold works can be done without glasses.
2. Only low power glasses needed for reading and precise vision.
3. Difficulty in judging distances ( false orientation ) that occurs after conventional operation due to thick glasses does not occur.
4. A wide field of vision is maintained after IOL implantation,
5. Patient can use both, the operated eye and the un-operated
eye together without any double vision as occurs after conventional operation : 'binocular vision' is maintained.
6. The IOL cannot get displaced by rubbing or washing the eye.
It lasts for the patient's life-time. It never needs replacement. It cannot break inside the eye no matter what the patient does.
WHAT IS PHAKO-EMULSIFICATION AND STITCH-LESS CATARACT SURGERY :
This is science's latest gift to humanity by which cataract
surgery has become even safer and the post-operative recovery
even faster. In this technique the cataract is removed from the eye
through a much smaller incision by first dissolving it inside the eye.
This is made possible with the use of a very sophisticated
computer-controlled machine that produces very high frequency
sound waves which are used to break-up and dissolve the lens
in the eye. This dissolved lens is then sucked out through a
3.5 mm long incision. A limitation of this procedure is that it cannot
be done in fully mature, hard cataracts. It is ideal for immature cataracts.
A special type of IOL is then inserted through this incision.
Because the incision is so small no stitches are required in
this method and the patient gets back 70 - 90 % of his vision the
very next day. Post-operative restrictions and precautions are
minimal.. This latest technique is available in this hospital .
WHAT IS 'YAG LASER CAPSULOTOMY' ?
Following the cataract operation ( with or without IOL )
the 'posterior capsule' that has been left behind may, after a few
months or few years, start becoming cloudy. When this happens
the vision becomes blurred as if the cataract is developing again.
This condition is called 'after-cataract' and is quite common,
occurring in 60-70 % patients at some time or the other after
operation. For useful vision to be restored a small opening has
to be made in the center of the capsule. This can be done by
two methods : operative method and LASER method. The laser
method is superior because it is faster , painless, does not involve
injections, tablets etc. and you can go home immediately with full sight restored. The laser used is called a YAG laser and the procedure
is called a 'capsulotomy'. This laser is available in this hospital
to take care of this problem whenever it arises.
PREPARATION FOR SURGERY :
Once you have made the decision to get operated
special tests will be done to determine the exact power of the
IOL to be implanted. You will be prescribed eye drops to be put
in the eye for e few days before the operation so that the eye
becomes free of all infections. You will have to deposit some
advance for the operation and a confirmed date will then be given
to you along with a list of pre-operative instructions. You will have
to report to the hospital at the time given to you and a room will be
provided to you when you come. Only two relatives will be allowed
to be with you. No children will be allowed.
HOSPITAL STAY :
No real need of hospitalization is there and the operation
can be done on OPD basis. Those who have their own conveyance
and live locally can go home 3 hours after the operation. A room with
attached bath is provided to all. .You however, have to come back
the next morning to get the eye examined and to get advice
regarding the medicines etc. Those who find it inconvenient to
go and return the next morning are provided a room with attached
bath for the night stay.
OPERATION :
The operationis done under local anesthesia only
andthe patient is fully conscious during the operation. The surgery
takes approximately one hour. There is no pain during the operation.
POST-OPERATIVE CARE :
Immediately after the operationthe patient should rest in bed
for a few hours. Patient can walk to the bathroom if needed.
A set of post-operative instructions are given at the time of discharge. These are to be followed after reaching home.
The patient is called for periodic follow-up and the dates
are given at the time of discharge.Complete recovery will take
6-8 weeks for ECCE (with or without IOL ) and 2-3 weeks if for phako-emulsification. At the end of this period final glasses will be
prescribed .
It is very usual for the glass power to change 4-6 months
after the operation especially in the ECCE group
( not so with phako) sothe patient may have to come
back for re-testing of glasses.
WHAT ABOUT COMPLICATIONS ?
Regardless of the care, expertise and
sophisticated instrumentation, there exists the chance
of complications in any surgical procedure.Luckily complications
are rare and when they do occur they can usually be tackled
in such a way as to not affect the final result. However,
unexpected and serious complications like infection,
hemorrhage and retinal-detachment can occur and cause
permanent decrease in vision. It is necessary that you have
knowledge of these possibilities.
CONSENT FOR SURGERY :
On the day of admission you will be asked to sign a
consent form indicating that you understand your diagnosis, the
surgery that you are about to undergo and the possibility of
complications.If you do not understand please ask the doctor to
clear your doubts.
This information brochure is part of informed consent for
cataract operation ( ECCE or phako-emulsification ) with or
without intra-ocular lens implantation.
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