In a previous article we explained what a cataract is and we pointed out the best time to operate, but it is worth recalling it briefly. It is necessary to operate when the decrease in vision interferes with the patient’s normal activities or when the ophthalmologist notices an increase in intraocular pressure or other complications related to the progression of the cataract.
Risks in the operation
All surgeries have some risk, especially when they are intraocular, but nowadays the results of cataract surgery are excellent and visual recovery is usually fast and satisfactory in most cases. Even so, it is important to know that success cannot be 100% guaranteed, we can only take the maximum of preventive measures so that the probability of risk is very low, and if a complication occurs, it can be solved without major consequences.
How cataract surgery is performed
The intervention is usually indicated in both eyes, even if one of them is more advanced than the other. If we only perform the operation on one eye, the signals that reach the brain are different and that makes us not see well, there is a deterioration of binocular vision, the vision in relief, so necessary in tasks of precision in the calculation of distances when we drive.
Until now one eye was performed first and after a few days the other eye but now it is beginning to recommend surgery of both eyes in the same session, is what is called: bilateral cataract surgery. This allows a faster visual adaptation and reduces the patient’s downtime, and we can do it provided that the necessary means, adapted operating rooms and specialized personnel are available, as well as the use of new antibiotics that reduce the risk of infections.
The surgical technique currently used is called phacoemulsification of the cataract, using ultrasonic energy to fragment it, although new energies are already being applied, such as the femtosecond laser, which, although very promising, is still in the improvement phase. Ultrasonic fragmentation techniques make it possible to remove the cataract through a small incision of 2 or 3 mm; in our center we have even managed to reduce the size to 1 mm, which significantly reduces surgical trauma.
A cannula is introduced which will destroy the contents of the cataract and then aspirate it, leaving the capsular bag transparent, empty and ready to place an intraocular lens inside to replace the natural one. Nowadays we have intraocular lenses with flexible materials, which allow them to be inserted through the small incision made at the beginning of the surgery. Thus, the lens unfolds inside the crystalline lens sac, replacing the natural lens. There are several types of lenses, monofocal lenses, which are like the glass of glasses for distance vision, and multifocal lenses for distance and near vision. In recent years, a new type of lens has appeared that seeks to emulate the physiological mechanism of the crystalline lens, pseudo-comfortable lenses, which provide better optical quality. The surgery is completed without the need for stitches, hydrating the small incisions and injecting a broad-spectrum antibiotic into the eye to prevent infection.
The operation lasts about ten minutes and is usually performed with topical anesthesia (anesthetic drops) and sedation to keep the patient relaxed. In most cases it is not necessary to occlude the eye at the end of the operation and the patient can see with the operated eye as soon as he/she leaves the operating room.
The visual recovery is very fast, being able to obtain a useful vision from the first hours of the intervention, however, the days after the surgery the visual capacity will improve gradually. At 2 or 3 weeks after the operation, maximum vision is usually achieved and even this time can be reduced to 1 week when bilateral surgery is performed (both eyes in one session).
Life after the postoperative period
After the operation, life can be practically normal, although at first your vision may not be perfect. During the first days you should avoid physical exercises that involve sudden or violent movements of the head. It is also very important not to rub your eyes and to avoid sleeping on your stomach during the first few days. In addition, it is advisable to wear sunglasses when going outdoors to protect the eye and avoid the glare that usually appears after surgery.
When special lenses are implanted, such as toric lenses for astigmatism or multifocal lenses to eliminate the need for distance and near glasses, some more time may be necessary to achieve stable and optimal vision. If this time is extended or involves difficulties for normal life, there are special exercises to improve this situation.