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?

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

Follow your healthcare provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery. Also, your body will heal much better if you do not smoke after the surgery.

If you take aspirin, warfarin (Coumadin), or vitamin E, ask your provider if you need to stop taking this medicine before your surgery. If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This may help to avoid extra bleeding during surgery. Tell your doctor about any other medicines you are taking.

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. If you regularly take any important medicines, your provider may ask you to take them on the day of surgery with a sip of water.

Do not wear eye makeup on the day of the surgery. Follow any other instructions provided by your doctor.

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. The local anesthetic can be given to you with drops or ointment or with a shot of medicine behind the eye. 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 incision (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 an artificial lens in your eye. The surgeon may put one or more stitches in your eye to close the incision and then put a patch or shield 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 is not recommended because it 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 need to 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. Since you may have several different drops to use, be sure you have a written schedule to follow to avoid confusion.

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. In older adults, mild to severe confusion can occur. Temporary trouble with urinating is also common. 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. Very rarely, bleeding may occur when the shot of anesthetic is given, affecting your vision and making it necessary to postpone the surgery. Local anesthesia is considered safer than general anesthesia and is used for most cataract surgeries.

You may develop an after-cataract. This is not a regrowth of the cataract that was removed. When it 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 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, but you will need to see your doctor for follow-up.

Ask your doctor how these risks apply to you.

When should I call the doctor?

Call right away if:

• You have severe or worsening pain.
• You have a 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.