Plastic Surgery Circulatory Surgery Digestive Surgery Muscular Surgery Reproductive Surgery |
Description - Video - After Surgery The surgical procedure in phacoemulsification for removal of cataract involves a number of steps. Each step must be carefully and skillfully performed in order to achieve the desired result. The steps may be described as follows: 1- Anaesthesia, Following cataract removal (via ECCE or phacoemulsification, as described above), an intraocular lens is usually inserted. After the IOL is inserted, the surgeon checks that the incision does not leak fluid. This is a very important step, since wound leakage increases the risk of unwanted microrganisms to gain access into the eye and predispose to endophathalmitis. An antibiotic/steroid combination eye drop is put and an eye shield may be applied on the operated eye, sometimes supplemented with an eye patch. Antibiotics may be administered pre-operatively, intra-operatively, and/or post-operatively. Frequently a topical corticosteroid is used in combination with topical antibiotics postoperatively. Most cataract operations are performed under a local anaesthetic, allowing the patient to go home the same day. The use of an eye patch may be indicated, usually for about some hours, after which the patient is instructed to started using the eyedrops to control the inflammation and the antibiotics that prevent infection. Occasionally, a peripheral iridectomy may be performed to minimize the risk of pupillary block glaucoma. An opening through the iris can be fashioned manually (surgical iridectomy) or with a laser (called YAG-laser iridotomy). The laser peripheral iridotomy may be performed either prior to or following cataract surgery. The iridectomy hole is larger when done manually than when performed with a laser. When the manual surgical procedure is performed, some negative side effects may occur, such as that the opening of the iris can be seen by others (aesthetics), and the light can fall into the eye through the new hole, creating some visual disturbances . In the case of visual disturbances, the eye and brain often learn to compensate and ignore the disturbances over a couple of months. Sometimes the peripheral iris opening can heal, which means that the hole ceases to exist. This is the reason why the surgeon sometimes makes two holes, so that at least one hole is kept open. After the surgery, the patient is instructed to use anti-inflammatory and antibiotic eye drops for up to two weeks (*depending on the inflammation status of the eye and some other variables). The eye surgeon will judge, based on each patient's idiosyncrasies, the time length to use the eye drops. The eye will be pretty recovered within a week, and complete recovery should be expected in about a month. The patient should not participate in contact/extreme sports until cleared to do so by the eye surgeon. Complications after cataract surgery are relatively uncommon. Some people can develop a posterior capsular opacification (also called an after-cataract). As a physiological change expected after cataract surgery, the posterior capsular cells undergo hyperplasia and cellular migration, showing up as a thickening, opacification and clouding of the posterior lens capsule (which is left behind when the cataract was removed, for placement of the IOL). This may compromise the visual acuity and the ophthalmologist can use a device to correct this situation. It can be safe and painless corrected using a laser device (YAG laser) to make small holes in the posterior lens capsule of the crystalline. It usually is a quick outpatient procedure that uses a Nd-[[YAG laser]] (neodymium-yttrium-aluminum-garnet) to disrupt and clear the central portion of the opacified posterior lens capsule (posterior capsulotomy). This creates a clear central visual axis for improving visual acuity. In very thick opacified posterior capsules, a surgical (manual) capsulectomy is the surgical procedure performed. * Posterior capsular tear may be a complication during cataract surgery. It refers to a rupture of the posterior capsule of the natural lens. Surgical management may involve anterior vitrectomy and, occasionally, alternative planning for implanting the intraocular lens, either in the ciliary sulcus, in the anterior chamber (in front of the iris), or, less commonly, sutured to the sclera.
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