Cataract Extraction with Intraocular Lens Implantation

What is a cataract extraction with intraocular lens implantation?

A cataract extraction with intraocular lens implantation is a procedure in which an eye surgeon removes a clouded lens (cataract) from the eye and replaces it with an artificial lens (lens implant).

When is it used?

Cataracts can cause vision problems by preventing clear images from reaching the retina (the light-sensitive tissue at the back of the eye). You may choose to have cataract surgery because you need to have better vision to continue your normal activities. In the early stages of cataracts, an alternative to surgery may be to change your glasses.

Alternatives to having an intraocular lens implanted in your eye after removal of a cataract are:

• wearing contact lenses
• wearing cataract glasses.

You should ask your eye doctor about these choices.

How do I prepare for the procedure?

Plan for your care and recovery after the operation, especially if you are to have general anesthesia. Allow for time to rest and try to find people to help you with your day-to-day activities.

Follow instructions provided by your doctor. Eat a light meal, such as soup or salad, the night before the procedure. Your doctor will probably also recommend that you not eat or drink anything after midnight or the morning before the procedure. Do not even drink coffee, tea, or water.

Do not wear eye makeup on the day of the surgery. Also, tell your doctor about any kind of medications you are taking. Ask your doctor if it is okay for you to take your medications the day of surgery.

What happens during the procedure?

You will be given a local or general anesthetic to prevent pain during the operation. A local anesthetic numbs your eye while you remain awake. A general anesthetic relaxes your muscles and puts you to sleep. Most surgery is done with local anesthesia only. Sometimes the doctor will give you a sedative to help you relax.

The surgeon will make a small cut in your eye and remove the cloudy lens. The surgeon will remove the lens by either:

• Nuclear expression: A procedure in which the lens is removed in one piece.
• Phacoemulsification: A procedure in which sound waves (ultrasound) are used to break the lens into small pieces. The small pieces are then removed through a narrow hollow tube.

After the lens is removed, the surgeon will put a plastic lens in your eye. The surgeon may put one or more stitches in your eye and then put a patch over the eye.

What happens after the procedure?

You will be in the recovery area after surgery until you are ready to go home. Have someone take you home.

It's normal to feel itching, sticky eyelids, and mild discomfort for a while after cataract surgery. Some fluid discharge is also common. If you have discomfort, your doctor may suggest a nonaspirin pain reliever every 4 to 6 hours (aspirin can cause bleeding). After 1 to 2 days, the discomfort should stop.

You will have few limits on your activities after surgery. You can read and watch TV almost right away, but your vision may be blurry at first. You can do simple tasks such as ride in a car, get dressed, cook, and visit friends. Do not rub your eye or allow water or other substances to get into your eye. Avoid bumping or injuring the eye.

Your eye doctor will schedule exams to remove the patch and to check on your progress. You may need to use eyedrops to help healing or to prevent infection or inflammation. For a few days after surgery, you may also use eyedrops or take pills to control the pressure in your eye. Ask your doctor how and when to use the drops or pills and what effects they can have.

In most cases, it takes about 6 weeks for the eye to heal. You will be ready for new glasses in about 1 month. It may take a few more weeks for the sharpest vision to return.

What are the benefits of this procedure?

You can regain nearly normal vision if the rest of your eye is normal.

What are the risks of this procedure?

The risks of this procedure include:

• infection
• bleeding
• inflammation (pain, redness, swelling)
• glaucoma (higher pressure inside your eye)
• retinal detachment
• need for additional surgery
• loss of vision (rare).

There are some risks when you have general anesthesia. Discuss these risks with your doctor.

A local anesthetic may not numb the area quite enough and you may feel some minor discomfort. Also, in rare cases you may have an allergic reaction to the drug used in this type of anesthesia. Local anesthesia is considered safer than general anesthesia and is used for most cataract surgeries.

You may develop an after-cataract. When this happens, the back part of the capsule that enclosed your lens becomes cloudy and blurs the image reaching the retina at the back of your eye. The after-cataract can be treated with a laser. In a procedure called YAG capsulotomy, your doctor uses a laser beam to make a tiny hole in the clouded capsule so a clear image can reach the back of the eye. This is a painless outpatient procedure with low risk.

Ask your doctor how these risks apply to you.

When should I call the doctor?

Call the doctor immediately if:

• You have severe or worsening pain.
• You have loss of vision.
• You see flashes of light.
• You see new floaters in your vision.
• You have a lot of drainage from your eye.
• You develop a fever.