Modern cataract surgery

Modern cataract surgery

• 1.
  Cataract is opacificationof natural lens in the eye. When it disturbs patient’s vision it should be removed. After proper diagnosis and medical tests for preoperative fitness, biometry is performed to decide the power of the lens(IOL) to be implanted in the eye after removal of cataract. It is believed that cataract surgery is one of the most advanced surgery in medical science. It started ages ago by Sushruta by couching where he pushed white cataracts in the posterior segment with the help of a needle, before 600 B.C. Modern Cataract surgery
• 2.
  It will beworth mentioning name if Dr Harold Ridley who thought of putting a glass designed, to be inserted in the eye after removal of opaque human lens, to eliminate necessity of thick glasses. Modern cataract surgery aims minimal anaesthesia, smallest incision, minimal surgical damage , use of modern latest generation IOL , avoidance of infection , faster recovery and best quality of vision with least dependence in glasses. We will discuss modern trends in cataract surgery. SICS ( Small incision cataract surgery) Small frown incision is taken on sclera, 5.5 mm size, cataract removal by creating positive pressure inside the eye, putting PMMA non foldable IOL ( intraocular lens ) in place of cataract. Phacoemulsification Small incision on cornea / limbus 2.2 to 2.8 mm in size Cataract is divided and aspirated by a small pencil like instrument by ultrasound technique.
• 3.
  Foldable IOL isinserted with help of injector. Here we have better control over post operative astigmatism, faster recovery, no sutures, less infection. FLACS ( Laser assisted cataract surgery) In this technique Femto laser is used to cut cornea, capsule and nucleus of cataract precisely avoiding heating of cornea that can happen in very hard cataract removal by phaco technique. Rest of the steps are same as Phaco surgery. Material used for Intraocular lenses Optic materials 1. Non Foldable IOL • Polymethyl Methacrylate(PMMA) 2. Foldable IOL • Silicone • Hydrophilic acrylic • Hydrophobic acrylic 3. Rollable/ultra-thin IOL • Hydrogel Haptic materials • Polypropylene • PMMA • Acrylic
• 4.
  IOL can bemade of various material like PMMA , Acrylic, Silicon. PMMA lenses are non foldable , requires incision of 5.5 mm for surgery. These lenses are time tested, inert, ultraviolet protective in the eye. Acrylic lenses are foldable lens available in hydrophilic and hydrophobic property. Hydrophobic lenses are better in prevention of after cataract formation. Silicon lenses are not much in use due to their opacification when silicon oil is used for retinal surgeries. Another development in IOL technology is IOL design. Monofocal lenses give good clarity at one point. They give good contrast. New monofocal IOL have aspheric surface giving better quality of vision during dull light, at night time. Yellow lenses (chromatic) are in market, they filter harmful rays entering eye, preventing retinal damage. Square edge lens design makes optic of IOL complete square edge, prevents migration of equatorial epithelial cells posteriorly thus preventing PCO(posterior capsular opacification ) We will Discuss about newer intra ocular lens implants.
• 5.
  Then came conceptof multifocality. Multifocal IOL have concentric rings on the back surface of IOL, with smooth steps. This is known as diffractive type of multifocal Lens. It gives better distant and near vision. Here there can be some loss of contrast in vision due to design. These IOL are not recommended for night drivers or skilled professional like surgeons. Latest is Trifocals, having less number of rings in optic. Less glare and haloes. They are better for computer users, as they give better intermediate vision. To compensate for astigmatism toric IOL are designed. With use of toric IOL we can reduce post operative astigmatism. Heparin coated lenses can prevent pigment deposits on IOL surface in long run.
• 6.
  Monofocal Multifocal Toric Multifocal ToricTrifocal Good distance vision Good distance and near vision Corrects for astigmatism after cataract surgery Good distance and near vision as well as correct astigmatism Provide good distance and intermediate vision Glasses required for reading
• 7.
  There are somecommon questions asked by patients frequently, 1. What is the life of lens you will use in my eye? All lenses implanted are usually for life long period . 2. Will I have to remove the lens regularly to clean them? No, this lens is implanted inside the eye. It is not required to remove or clean them .It will not give any feeling or irritation after surgery. 3. Which is the best lens for me? You should discuss best lens with your surgeon. Surgeon should know patient’s requirements and profession. There is no one best Lens for all . 4. Costlier lens is always best? Not always. If a night driver wants to go for a multifocal lens it will not be a good idea . He can opt for any good monofocal lens. 5 . Are imported lenses better than Indian lenses? Indian lenses are good. Imported lenses are manufactured by advanced technology giving better finish and quality control.
• 8.
  6 . willI need glasses after my cataract surgery? Even if we use best multifocal lens , patient may require glasses for some specific activities like doing fine work. e.g. stitching, needling, computer work . There can be development of astigmatism requiring glasses. 7. will cataract develop again after surgery? No. Cataract is your opaque natural lens, it can never develop once removed . Some times there is development of posterior capsular opacification behind lens . It requires yag laser cleaning only once. 8 . Will you remove my cataract with laser? Will there be cut on my eye? Lasers are used for putting cuts precisely. There is always a manual surgery involving cutting in even modern cataract surgery. 9 . Cataract surgery is so simple that patient can join his regular activity on next day Like any surgery cataract surgery can have some mild to serious complications . Patient has to take care and follow all the instructions given to them properly . Any problem if occurs , it should be informed to attending doctor immediately.
• 9.
  Dr Tushar D.Muni MS,FRF consulting ophthalmologist DHRUSHTI EYE CLINIC AND MICROSURGERY CENTRE Mathadi trust hospital Ubaid Guttigar D.optomety/B.optomety Consulting optometrist DHRUSHTI EYE CLINIC