Cataract
surgery today is typically performed using a microincisional procedure. To the
patient, this means minimal discomfort during or after surgery, a more speedy
recovery of vision, and reduced risk of induced astigmatism. This means less dependence
on glasses afterwards.
Below, we’ve detailed the major
steps of cataract surgery using a microincision procedure, phacoemulsification
(ultrasonic cataract removal), and a foldable lens implant. This type of procedure
is considered state-of-the-art for cataract surgery today. The procedure demonstrates
basic principles only, however, and eye surgeons use many variations of the general
theme, even from one case to another, depending on the type of cataract being
removed.
The most commonly used cataract incision is about 3 millimeters
in size – just about one-eighth of an inch! Because of the careful construction
of this incision, and its small size, the incision is generally self-sealing.
This translates to a “no-stitch” type operation.
The surgeon then creates an opening in the capsule, which
is a micro-thin membrane surrounding the cataract. This procedure, called capsulorhexus,
requires extraordinary precision since the capsule is only about four-thousandths
of a millimeter thick! This membrane is actually thinner than a red blood cell
and the surgeon must delicately remove the capsule while manipulating instruments
within the anterior chamber – a space only 3 millimeters deep!
Phacoemulsification is the aspect of the procedure in which
ultrasonic vibrations are used to break the cataract into smaller fragments. These
fragments are then aspirated from the eye using the same instrumentation.
The surgeon may elect to create grooves in the cataract,
and subsequently break the cataract into smaller pieces using the phacoemulsification
tip and a second instrument passed through a smaller “side-port” incision.
The
lateral view of the procedure shows the phacoemulsification tip being placed into
the substance of the cataract by the eye surgeon. The “phaco” aspect of the procedure
is used to remove the denser central nucleus of the cataract.
Once the denser central nucleus of the cataract has been
removed, the softer peripheral cortex of the cataract is removed using an irrigation/aspiration
handpiece. The posterior, or back side, of the lens capsule is left intact to
help support the intraocular lens (IOL) implant.
The intraocular lens is often folded and passed through
the tiny incision where it is opened (implanted) inside the “capsular bag”. In
this illustration, the lens is being inserted via an “injector”. This is an instrument
designed to help keep the incision size small while allowing implantation of a
6 millimeter lens through a 3 millimeter (or even smaller) incision!
The IOL is shown here implanted within the “capsular bag”
where it is neatly centered. The springy “arms” of the IOL, known as haptics,
hold the lens implant within the capsular bag. The IOL does not generally require
sutures to remain in good position.
This lateral view of the IOL implant shows the lens within
the “capsular bag,” which is the desired location. This position is the same as
that of the natural lens (cataract) of the eye and, therefore, is generally tolerated
best and provides the most optimal visual results. At this stage, the cataract
operation with IOL implantation is complete. Cataract
Surgery
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