Cataract Management
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I have been diagnosed with cataract. My daughter is getting married next month. Can the surgery wait? Cataracts usually mature slowly. The patient, in consultation with his ophthalmologist, should decide when his eye should be operated. Unless it is a Hypermature cataract, there is generally no emergency about cataract surgery. If you get the surgery done before the wedding, may be you can admire the newly-wed couple better! Today, cataract surgery is performed when the cataract is interfering with the subject's daily life and duties - it may be done even when the cataract is immature. Spectacles - The cataract increases the refractive power of the lens, making the person myopic. This can be corrected wholly or partly with appropriate glasses. Prevention -
Why should I get my cataract removed? A Cataract can become Hypermature. This means, the material inside the lens becomes liquid, milky white. It starts leaking proteins into the aqueous. This causes inflammation of the eye, pain, severe headache and glaucoma. This requires an Emergency hospital admission and surgery. Routine Cataract Surgery -Anaesthesia- Local injection for the eye or topical anaesthesia with drops. Premedications -
Procedure - The patient lies down on the operating table.
In olden days, Intracapsular cataract surgery (ICCE) was done, when the whole lens with the anterior and posterior capsule was removed. In those days, IOL was not used and thick aphakic glasses had to be used postop. These were heavy, cosmetically disfiguring and had a lot of problems, vision was never satisfactory, since everything got highly magnified with them. Cataract surgery is NEVER done by LASER. Post-operatives - The eye is kept closed, with an eye-pad for about 6-8 hours after surgery. Painkillers are given. Other medications for diabetes, hypertension are to be continued as before. Dark glasses are worn for 2-3 weeks post surgery. These keep the eye protected from dust or any mechanical injury. Eyedrops are to be instilled as advised. They consist of
Each ophthalmologist has his own regime, but the general scheme remains the same. Post Operative Visit Schedule A Follow-Up on - Day 1 2 nd Week 3 rd - 4th Week 6 th Week By sixth week, the eye has healed and any corrective glasses, that are required may be given. Glasses for near vision are usually required after cataract surgery, inspite of the IOL. This is because the IOL cannot change its refractive power like the natural lens. Post-Operative Instructions
Any complaints or sudden redness should be treated as emergency and ophthalmologist seen immediately. Complications -Every surgery is a risk, but every precaution is taken to avoid the untoward. Early -Infection- This can be mild or may be severe. Usually presents as increased redness, pain and watering. Infection involving, the whole eye called endophthalmitis. For this, antibiotics are given, in form of drops, tablets or injections into the eye. It is vision threatening. Inflammation - Mild inflammation is okay, but it can be severe especially in diabetics, and requires treatment and follow-up. Increase in intra-ocular pressure can occur, and is controlled by drops. Late complications-Infections are rare. The posterior capsule gets opacified. Sometimes, few lens fibers remain behind inspite of through cleaning and these can grow and opacify later, thus reducing vision at a later date. These are remedied by cutting the posterior capsule with Laser. Posterior capsule opacification occurs to at least a minute extent in 60% cases. CME - Cystoid macular edema. This means swelling of the center of the retina at the macula. This is not very common, except in diabetics and uveitis. IOLs are very commonly in use now and they rarely cause any complications.
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