Cataract Surgery - Types, Precautions, Complications, Recovery

Most modern cataract surgeries involve replacing your cloudy lens with the intraocular lens (IOL). It is a flexible lens placed into your eye through smaller incisions. There are different types of intraocular lenses, which include:-

Monofocal IOLs: These are the most common IOLs used for close, medium, or long-range distance vision. With these lenses, you might be able to see things far away but need glasses for close vision. 

Multifocal IOLs: These IOLs help you see things at different distances, i.e., they allow for both far and close focus simultaneously. 

Accommodating IOLs: These flexible IOLs are more like your natural lens that focuses at different distances. 

Toric IOLs: These lenses help correct astigmatism (an imperfection in the eye’s curvature). 

Here’s how cataract surgery is performed:-

Step 1: Numbing Your Eyes

The surgeon will numb your eyes with either eye drops or an injection. He/she may also give you medication to relax. You will be awake throughout the surgery, seeing the light and movement during the procedure. But you won’t be able to see what the doctor is doing in your eye. 

Step 2: Cataract Removal

The surgeon uses a special microscope to examine your eyes. He/she makes tiny incisions using a blade or a laser near the edge of your cornea. Using these incisions, the surgeon reaches your lens. He or she will then use ultrasound waves to break up the cloudy lens and remove it. Finally, the surgeon places the new lens into place. 

Step 3: Placing a Shield

The surgeon does not need to use stitches to close the incision. These self-sealing, tiny incisions close by themselves. The surgeon will place a shield, such as an eye patch, over your eye to protect it during the healing process. 

Types of Cataract Surgery

Phacoemulsification: The surgeon makes a two to a three-millimetre long incision in the front of the eye. He/she then uses an ultrasonic probe to break the cataract and remove the fragments with suction. The lens is then inserted through the incision, and the incision does not need sutures to heal. 

Manual Extracapsular Cataract Surgery (MECS): The surgeon uses a nine to thirteen-millimetre long incision to replace the lens with IOL. It has a higher risk of complications as compared with phacoemulsification. 

Manual Small Incision Cataract Surgery (MSICS): The surgeon makes a smaller V-shaped incision narrower on the outside (6.5 to 7 mm) and wider on the inside (11 mm) of the eye. 

Femtosecond Laser-Assisted Cataract Surgery (FLACS): The surgeon uses a laser to make the incision in the eye instead of a manual incision. The procedure can be used to correct astigmatism. 

Intracapsular Cataract Surgery: An older procedure that involves making a larger incision to remove the entire lens and lens capsule from the eye. Doctors rarely perform this procedure as it has a high risk of complications. 

1. Your doctor will advise you for a pre-anaesthetic checkup. 
2. He/she will perform an ultrasound to measure your eye and determine the correct focusing power for your IOL. 
3. The provider will ask you about the medications you take, and you might be informed to not take some of those before the surgery. 
4. The doctor may prescribe eye drops to prevent swelling and infection during and after the surgery. 
5. You may also be instructed to not eat or drink anything 12 hours before the surgery. 
6. Finally, the doctor will briefly explain the procedure, estimated cost, and insurance formalities.

1. On the day of the surgery, the staff will ask you to sign the consent formalities. 
2. Someone from the team will inform you about the change of clothes and removal of jewellery. 
3. The team will record your last meal and give you medication to relax. 
4. After monitoring your vitals, the team will shift you to the OT room. 

1. In the OT room, you will be made to relax on the operating table.
2. The surgeon will numb your eye with drops or an injection. 
3. He/she will make a tiny cut through your cornea to reach your lens
4. Then the surgeon will use ultrasound waves to break the lens and remove it. 
5. Finally, he or she will place the IOL into its place. 
6. Your surgeon will place a shield over your eye.
7. The team will monitor your vitals throughout the procedure. 
8. The entire procedure takes less than 20-30 minutes. 

1. After the procedure, the staff will shift you to the recovery room for 15-30 minutes. 
2. As it is an outpatient procedure, you can go home the same day (within about 30 minutes after the surgery).
3. The doctor will restrict you from driving immediately after the surgery. Thus, you will need to ask a friend or family member to drive you home. 
4. You can remove the eye shield the next day after the surgery, but you may need to wear it while sleeping.
5. The doctor will prescribe special eye drops to be used for about four weeks after the surgery. 
6. Avoid getting water and soap in your eye.
7. Do not rub or press your eye.
8. Wear sunglasses when outdoors to protect your eyes from sunlight.
9. You should avoid engaging in strenuous activities until your provider gives you the all-clear. 
10. Avoid wearing mascara for a week or two.
11. Do not swim for about two weeks after the surgery. 
12. It can take up to four to eight weeks to fully recover from lens replacement surgery. 

First Follow-Up Appointment

The first follow-up appointment is generally scheduled for the day after the surgery. During the visit, the doctor will ensure that there are no complications or signs of infections. He/she will also review the medications and answer your queries related to the medication schedule or dosage. 

Cataract surgery is a comparatively safe procedure. But like any other surgery, it comes with some risks, including:-

1. Eye infection
2. Blurred vision or vision loss
3. Bleeding or swelling in the eye
4. Retinal detachment
5. Pain that does not improve with medicine
6. Seeing halos, dark shadows, and glares
7. Dislocation of IOL implant
8. Secondary cataract

Call your healthcare professional if you experience the following symptoms:-

1. Stickiness around the eye
2. Vision loss
3. Redness or pain that does not improve with medication
4. Seeing dark spots or squiggly lines across your vision
5. Eyelid swelling