Ophthalmology and Cataract

Treatments

When the eye's original lens will becomes clouded, then it was termed as cataract. Most of the cataracts are the result of natural process of the aging. Others can be present at the birth or develop as the result of the physical, drug, or chemical injury. By performing the cataract surgery, the cloudy lens is removed or cleaned out & replaced by the clear manmade lens. Most of the cataract surgeries were performed by a technique known as phacoemulsification also known as "small cut (incision) cataract surgery." The cut (incision) will be smaller, due to the harder center section of lens was liquefied & then vacuumed out. Under the local anesthesia, doctor will perform phacoemulsification, by making a small opening on side of the cornea.

A device which sends out ultrasound vibrations is inserted into the eye & breaks the lens into small minute pieces. These fragments were then removed by the suction by a small cut in the eye. Your eye doctor may also use a laser to make the incision. The hope was that a more precise incision will additionally improve the recovery time from the cataract surgery.

After the cataract was removed, doctor generally replaces it with a new, man-made lens known as intraocular lens or IOL. This technique is called as "intraocular lens implantation." The IOL is a clear plastic, acrylic, or silicone with a optical power chosen by the doctor to help in restore the normal vision, usually minimizes the dependence on the eye glasses after surgery. This lens is permanent & needs no special care.



The IOL focuses light into the retina that helps to improve vision. Even though if natural lens is replaced with intraocular lens, you perhaps will need a new eyeglass prescription. Yet, most of the people can see fairly good at a distance without having glasses after a recent cataract surgery with the cataract lens replacement. Cataract surgery was performed as an outpatient procedure in an operating theater. So there was no hospital stay.

The actual operation was usually lasts less than a one hour. It is safe & in several ways it is desirable to be awake with low level of sedation during the operation. A sedative is given & numbing drops were introduced into the eyes. Another choice is to use a novacaine injection was placed around the eye. General anesthesia is occasionally used in the cataract surgery. Doctors generally won't remove the cataracts in both of the eyes at the same time. If you need surgery for both of the eyes, you need to be scheduled for separate surgeries, generally a few weeks after.

Small-incision cataract surgery (SICS) is also known as manual small-incision cataract surgery (MSICS) or sutureless extra-capsular cataract extraction (SECCE). It is a safe, cost-effective method with very good results.

SURGICAL TECHNIQUE

The procedure itself is wonderful when all works well. Even though every eye is different, every surgery is different, & each & every step of the procedureis as important as the one before. A good draping is required to capture the eyelashes, particularly those of the upper lid. The superior rectus suture is important: it immobilises the eye & assists with scleral tunnel ‘opening’ when extracting the nucleus. Going too deep with the needle may penetrate the eye, & going too shallow will engage the conjunctiva only. Firm scleral fixation (throughout the tunnel construction) should be maintained by using good forceps.

The scleral tunnel is very important. A very curved & ‘frown-shaped’ incision should be made initially. If the incision is too flat, this will induce a significant against-the-rule astigmatism. Use adequately sharp blades. When forming the tunnel with the crescent blade, aim to see just enough of the metal of the blade. If you cannot see any of it, you are too deep & will likely prematurely enter the anterior chamber. If you see too much, a buttonhole will form. Dealing with complications in tunnel construction may be necessary: a button hole may lead to leakage & should be undermined in a different plane or a new entry site fashioned. Premature entry into the anterior chamber will often require a suture.

The capsulotomy can be linear or continuous-curvilinear. Lots of small puncture marks are necessary for a linear capsulotomy. Aim for just above the halfway line. This will leave a good inferior portion to protect the corneal endothelium when extracting the nucleus, but also enough of a superior portion to support a sulcus-placed IOL if the posterior capsule is ruptured & cannot support an IOL.

Thorough hydro-dissection helps mobilise the nucleus. Always check that the cannula is on tightly before entering the eye. Lift the capsule slightly when injecting underneath it.

The most difficult part of the procedure is the mobilisation of the nucleus. Once you are happy that the nucleus is free in the bag, inject visco-elastic into the anterior chamber to protect the endothelium. Use the cannula, while slowly injecting visco-elastic, to dislodge the upper equator of the lens nucleus. The important point is to press backwards & slightly down within the scleral wound beyond the upper equator, such that the upper part of the nucleus actually starts to move forward rather than backwards.

Inject a good amount of visco-elastic behind the nucleus to push back the posterior capsule before inserting the vectis or fishhook needle to extract the nucleus.

Once the nucleus is removed, take great care when removing the soft cortical lens matter. Increase the magnification on the microscope for this stage, as well as for the capsulorhexis.

An injection of antibiotic into the anterior chamber (intra-cameral) should be performed at the end of the procedure (with either cefuroxime (1 mg in 0.1 ml) or moxifloxacin, but only if you can guarantee that the concentration will be correct every time. This may help to prevent postoperative endophthalmitis, but can severely damage the corneal endothelium if an incorrect dosage is injected.

CATARACT TREATMENT :
As age increases, there will be some changes occurred to the natural or original crystalline lens that may leads to the occurrence of cataract, or a loss in the clarity of the lens. Thereby the lens is no longer as flexible or much clear as it used to be, then eye cant focus light properly.

The standard cataract surgical treatment is usually performed either in a hospital or in an ambulatory surgery center. The major common form of cataract operation today is aprocess known as phacoemulsification. With the help of an operating microscope, doctor will perform a very small incision or cut in the surface of your eye in or near to the cornea. A thin ultrasound probe was also inserted into the eye which uses ultrasonic vibrations to dissolve the clouded lens. These small or tiny fragmented pieces were then suctioned out by the same ultrasound probe. Once the cataract was removed, an artificial lens is positioned into the same slender capsular bag in which the cataract occupied. This intraocular lens was useful and required to help your eye focus after the surgery.

There are 3 basic techniques for the cataract surgery :

PHACOEMULSIFICATION :
This is the most common form of cataract removal. In this most recent method, cataract surgery will be performed in less than 30 minutes & generally requires only nominal sedation and numbing drops and there will be nostitches to close the wound also no eye patch after the surgery.

EXTRACAPSULAR CATARACT SURGERY :
This procedure is also used mostly for very advanced cataracts, where the lens was too thick to dissolve into small fragments or in facilities that don’t have any phacoemulsification technology. This procedure requires larger incision by that the cataract will be removed in one piece devoid of being fragmented inside the eye. An artificial lens is positioned in a same capsular bag with the phacoemulsification procedure. This surgical procedure may require a many number of sutures to close this larger wound, & visual recovery is often slower. Extracapsular cataract extraction generally needs an injection of numbing medication surrounding the eye & an eye patch after the surgery.

INTRACAPSULAR CATARACT SURGERY :
This is a surgical procedure which requires an even larger wound when compared to the extracapsular operation, & the doctor will removes the whole lens & the surrounding capsule together. This procedure requires the intraocular lens to be positioned in a different location, in front of the iris. This procedure was occasionally used today but also it is still be useful in some certain cases of significant trauma.

After the removal of cataract by the surgery, an intraocular lens (IOL) was generally implanted into the eye, either by performing a small incision by using the foldable IOL, or by an enlarged or large incision, by using a PMMA (polymethylmethacrylate) lens.

MONOFOCAL LENS :
These lenses are most commonly implanted lenses today. These lenses will have a equal power in all the regions of the lens & will provide a high-quality vision at a single focal point (usually from a distance). They generally need only a light pair of the spectacles for the optimal distance vision correction.

TORIC LENS :
Toric lenses are having more power in exact one exact region in the lens to correct astigmatism, which may further improve unaided distance vision for so many individuals.

MULTIFOCAL LENS :
Multifocal intraocular lenses are having a variety of regions along with much power within the lens which allows the individuals to see at variety of distances, involves distance, intermediate & near.
In the past, when a doctor performed cataract surgery, the only choice is to implant a monofocal intraocular lens (IOL). This will provide a good distance vision, but won’t allow patients to see in different focal distances & did not address any of the issues related with astigmatism. Now the range of replacement lenses were available to cataract patients, each one was offering various advantages for the post-surgery vision. This is most effective lens based on the each patient’s individual preference & goals of their vision. The latest lenses will help eliminate or reduce the usage of contacts or glasses after cataract surgery of the remaining life, providing convenient, effective results of your specific vision conditions. This improvement of the vision is not only provides enhanced safety & improve a person’s normal activities & lifestyle, it will also add years of enjoyment to life.

Multifocal Replacement Lens :
The advanced technology multifocal IOL was usually referred as the “lifestyle” lens, because it was designed to restore the full range of the vision—near, far & intermediate. This is mainly helpful for the people with active lifestyles. With a multifocal IOL, it is possible to considerably reduce or completely eliminate the present dependence on glasses.

Toric Replacement Lens :
Toric IOLs is one of the best option for correcting both of the cataracts and astigmatism during the cataract surgery. In the past, patients suffering with astigmatism may experience blurred & distorted vision after the cataract surgery, because of the standard replacement lens may not correct this type condition. The toric IOL was designed to provide a quality distance of vision with reduced dependence on the eyeglasses & contact lenses.

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