Small Incision Cataract Surgery

Modern small incision cataract surgery is much more than a tiny incision - it is a whole approach to cataract surgery. Taken as a whole this minimally invasive approach can lead to almost immediate recovery of vision with almost no interference in lifestyle.

OPERATION

Important components of this procedure include:-

Topical Anesthesia

The use of drops to anaesthetize the eye stops all pain but does not paralyze the eye or block vision. This eliminates all pain during the operation but allows recovery of some sight immediately. There is no need to pad the eye so a clear plastic shield is used allowing the operated eye useful vision immediately.

Small No Stitch Incision

The small incision is a carefully constructed tunnel that is self sealing. This makes the operation much safer as there is no loss of pressure control and the operation can be interrupted at any time without risk ( e.g. to allow a cough). Because of the self sealing nature of the incision there is no need to suture the incision, thus avoiding distortion and delayed visual recovery from stitch induced astigmatism, and the irritation often associated with sutures in the eye.

Phakoemulsification

This method of using ultrasound to break up the cataract allows the cataract to be sucked out once it has been emulsified. Phakoemulsification is the key to small incision cataract surgery and has driven the move to develop foldable IOLs to further reduce the incision size.

Foldable IOLs

The development of foldable IOLs has allowed the reduction in incision length from more than 5.5 mm to less than 3mm. An unsutured 3mm incision that is properly constructed is about 95% of the normal eye strength and resists rupturing about 100 times better than a 6mm incision. There is now quite a range of foldable IOLs available (see IOL Types)

ADDITIONAL COMPONENTS

• Modifying the incision type and location can reduce small amounts of astigmatism.
• Insertion of Staar Toric IOLs can reduce larger amounts of astigmatism.
• Performing small peripheral relaxing incisions in the cornea (Astigmatic Keratotomy).

RESULTS & SAFETY

Modern small incision cataract surgery is extremely safe and effective but the results can be limited by pre-existing disease in the eye. The presence of retinal problems such as Age Related Macular Degeneration or Retinal Detachment can severely reduce vision and these diseases cannot always be detected before surgery as the view of the retina is obscured by the cataract. If there is no pre-existing disease then good visual results can be expected in at least 99% of operations.

Operative complications such as hemorrhage or infection are rare occuring less than once in a thousand operations, usually they can be treated but severe infection or hemorrhage could result in total loss of vision or even loss of the eye.

After surgery about 2% of patients will develop swelling in their central retina (macula edema) which reduces central vision and delays visual recovery for about 6 weeks. This almost always recovers.

After cataract surgery with IOL insertion there may be a slight increase in the risk of suffering retinal detachment especially in very short-sighted eyes.

Development of capsular opacity (commonly called a secondary cataract) is relatively common after cataract surgery. This problem increases with time reaching about 20% by 3 years. The vision is blurred by development of an opaque membrane behind the IOL. If the vision is reduced significantly then the membrane can painlessly be vaporized by a laser with immediate recovery of vision. This laser procedure is performed sitting at a slit-lamp microscope in my consulting rooms.

PROCEDURE & RECOVERY

The operation is performed as day patient. Duration from arrival at the day surgery centre to departure for home is usually less than 2 hours. The operation itself takes about 15 minutes.

Before the operation drops are used to dilate the pupil and numb the eye.

The operation is performed under a microscope and the light is very bright. At the start most people find the light is uncomfortable but there is no pain during the operation.

At the end of the operation the eye is covered by a clear plastic protective shield. As sight starts to recover almost immediately patients can see enough to get around through the clear shield.

There is usually minor discomfort described as surface irritation , stinging and burning for a few hours, occasionally a dull ache around the eye is experienced.

The shield is removed the next morning and eyedrops commenced. The eyedrops are used for 2-3 weeks and the eye is usually fully healed by 3 weeks. Normal activities can be resumed on the first day , but it is better to avoid strenuous activity and swimming for a few days.