One of the most common eye diseases in old age is cataracts. Surgery and post-treatment today allow nearly 90 percent of patients to regain between 50 and 100 percent of their original vision. As with the eye disease cataract surgery and post-treatment exactly expire, read here.
Cataract: Operation Overview
Cataract surgery is the most commonly performed surgery on the eye. In Germany alone, about 600,000 such surgeries are performed each year, and more than 100 million worldwide.
The surgery can be performed on an outpatient basis and usually takes less than 30 minutes. The procedure is a so-called microsurgical operationthat is, it is done with a surgical microscope. This is possible in any hospital or in the practice of an ophthalmologist.
The principle of any cataract surgery is to remove the cloudy lens and through a artificial intraocular lens to replace. As a rule, however, not the entire lens is removed today. Instead, the side and rear lens capsules are usually left in the eye.
The intraocular lens must have exactly the power of the removed lens. The appropriate lens power is calculated by the physician measuring the eye length of the patient with an ultrasound machine and determining the refractive power of the cornea.
After the cataract operation, the artificial lens stays in the eye for life. So it does not have to be replaced at some point.
Cataract – Operation: When is it displayed?
When a cataract is operated depends on various factors. The patient determines the time of operation together with the attending physician.
Above all, a role in the decision plays as much as the affected person feels impaired in their daily life and in their professional life due to the deterioration in their sight. People driving a car have to have an eye test at regular intervals. From a certain impairment of vision, participation in the road is no longer possible. Also, the fear of the victim before an operation on the eye is taken into account in the decision.
If the employer presupposes a specific visual performance, for example in the case of pilots, professional drivers or athletes, surgery is often necessary at an early stage of the disease. The subjective perception of visual performance does not matter here.
If you have any other eye diseases, you should first check with your ophthalmologist what visual acuity is likely to be achieved with cataract surgery. In the following diseases is to be expected with a less good result of the operation:
- age-related macular degeneration (AMD)
- Retinal disease due to diabetes mellitus (diabetic retinopathy)
- Glaucoma (Green Star)
- Circulatory disorder of the optic nerve
At a advanced cataract the visual performance may be so dramatically worsened that one blindness threatening. In such a case, the operation should be performed even in the case of fear of surgery. Since cataract surgery is one of the most commonly performed operations ever, treating physicians have plenty of routine experience in it. In any case, the prospect of improving vision outweighs the possible side effects and complications of surgery.
One innate cataract should be operated immediately after the diagnosis. Only then is there a chance that the child can learn to see properly.
Cataract operation: Used lenses
In the cataract operation, the own lens is replaced by an artificial lens. Art lenses are available today in many different materials. They are classified according to the implantation site, the material used or their optical principles:
Differences in the place of implantation
Depending on the place of implantation, a distinction is made between anterior chamber lenses, posterior chamber lenses and iris-supported lenses:
Anterior chamber lenses (VKL) are used during the cataract operation in the anterior chamber of the eye (in front of the iris) and held there with two brackets in the chamber angle. They are only used in the so-called intracapsular cataract extraction (see below). Anterior chamber lenses are rarely used because of the risk of causing a cataract or clouding of the cornea.
Posterior chamber lenses (HKL) are inserted into the own capsular bag, which is located behind the iris. If no capsular bag is left, as with intracapsular cataract extraction, the lens is attached to the iris or dermis of the eye with two sutures.
Iris-worn lenses (irisclip lenses) are attached to the iris with small hangers. Since the cornea is often injured, such lenses are no longer used in Germany. Already implanted iris-worn lenses are often replaced by posterior chamber lenses.
Differences in material
In a cataract operation with a small incision, intraocular lenses are turned off Silicone or acrylic used because these lens materials are foldable. These artificial lenses are used in folded state in the capsule, where they then unfold themselves. An acrylic lens has a higher refractive index than a silicone lens and is therefore slightly thinner. The foldable lenses made of silicone or acrylic are used exclusively as a posterior chamber lens.
Dimensionally stable lenses Polymethylmethacrylate (PMMA, Plexiglas) On the other hand, they can be used both as anterior chamber lenses and as a posterior chamber lens. Here you need a slightly larger cut for the implantation.
Differences in the optical principles
The optical principle of a lens is understood to be the properties which determine the new “sight” of the person concerned. Physicians distinguish between monofocal lenses and multifocal lenses:
A monofocal resembles normal glasses. It has only one focal point, which means that the person concerned can see clearly either in the distance or in the vicinity. Before the operation, the patient has to decide whether he prefers to live without a “pair of glasses” but with reading glasses after surgery, or vice versa. Accordingly, the appropriate strength of the artificial lenses is selected.
Multifocal Allow good visual acuity for both distance and proximity. With over 80 percent of daily tasks, it is no longer necessary to wear glasses. However, multifocal lenses have two drawbacks due to their special design principle: contrasts are seen less sharply and the eye becomes more sensitive to glare.
Cataract: expiration of the operation
Cataract usually occurs on both sides. However, only one eye is always operated on first. Once that eye heals, the second eye’s turn comes.
A cataract surgery is mostly outpatient and under local anesthesia carried out. In most cases, the administration of suitable eye drops is sufficient for the anesthesia; Alternatively, however, a local anesthetic can be injected into the skin next to the eye to be operated on. The entire eyeball becomes so painless and can not be moved. Additionally, you can enter before surgery slight sedative receive.
As a rule, a cataract operation lasts less than 30 minutes, Throughout the operation, your circulatory system is monitored by a blood pressure monitor, by measuring oxygen saturation, or by using an ECG.
The cataract operation is one of the most frequently performed operations in Germany. All surgical methods are associated with relatively little effort. The risks are also comparatively low.
To eliminate lens opacification, there are various methods of lens implantation. Which is used in individual cases, depends on individual conditions and the stage of the disease.
1. Intracapsular Cataract Extraction (ICCE)
In this surgical procedure, the lens and capsule are removed from the eye. This requires a relatively large cut (eight to ten millimeters) through the cornea. Then the lens is frozen with a special cold stick and removed from the eye. The artificial lens can now be used either in the anterior chamber (anterior chamber lens) or in the posterior chamber (posterior chamber lens). The cut is then sewn with a fine thread.
The intracapsular cataract extraction is usually necessary only in an advanced stage of the disease.
2. Extracapsular Cataract Extraction (ECCE)
In extracapsular cataract extraction, the surgeon opens the anterior lens capsule with a cut approximately seven millimeters long and removes the lens nucleus without comminution. In the intact capsule after the artificial lens is used. This surgical method protects the cornea. Therefore, it is especially used when a far advanced cataract has already damaged the thin, innermost layer of the cornea (corneal endothelium).
3. Phacoemulsification
In phacoemulsification, the cornea is opened with a section about three millimeters wide. Then the lens nucleus is dissolved and aspirated using ultrasound or laser. In the intact envelope of the lens (capsular bag), the artificial replacement lens is used. It is folded through the tiny opening and unfolds in the capsular bag itself. Two semi-circular elastic straps on the edge of the lens ensure a secure hold in the capsular bag.
The tiny cut in phacoemulsification closes itself after surgery without any scars. Finally, the surgeon only needs to close the previously retracted conjunctiva.
Thanks to the small incision, this method of operation makes it possible to adapt new glasses and resume everyday life earlier than the others.
Cataract – Operation: What happens afterwards?
After surgery, the operated eye with a ointment Association covered. For some time, you still need to stay in the hospital or doctor’s office to monitor – if no complications occur, but you can be home after a few hours. In the following period, regular check-ups by the attending physician are necessary.
Note that you are immediately after a cataract operation do not drive yourself allowed to. So you should get picked up.
After the surgery you are allowed the same day light food and drinks to eat. Your usual drugs As a rule, you can take it as usual, but you should discuss this with your doctor first. Prior consultation is especially advisable if you need medicines for diabetes or blood thinning medication.
As long as the operated eye is covered with a bandage and the surgical wound has not healed, you should take care when showering and washing that the Eye not in contact with soap comes. Physical efforts, swimming, diving, cycling or sauna visits are to be avoided at the beginning. The same applies to activities involving a lot of dirt or dust.
Reading and watching TV You can usually return after a week.
A new glasses You can usually get adjusted four to six weeks after the cataract operation. At an earlier point in time this does not make sense, because the eye has to get used to the new lens.
Cataract surgery: risks and complications
About 97 to 99 percent of all cataract surgery is without complications. However, as with any surgical procedure, there are also risks:
capsular tear
If the posterior capsule of the lens tears during surgery, complications may occur. Behind the eye lens is the so-called glass body. It consists of a gel-like, transparent mass and presses the retina (Retina), which is in the rear eye portion, against its base. If the vitreous body substance escapes via a lens tear, a retinal detachment can occur. This risk involves about six to eight percent of intracapsular surgeries; in an extracapsular operation, capsule rupture is rare.
bacteria
Very rarely, in an intracapsular cataract operation, bacteria enter the eye and cause inflammation (endophthalmitis). The affected eye may become blind.
bleeding
During surgery, there may be an increase in pressure in the eye that can cause blood vessels to burst. Bleeding within the eye (intraocular) or within the capsule (intracapsular) is the result. However, they are very rare: in less than one percent of all cataract surgery, such bleeding occurs.
Corneal curvature
In the extracapsular surgical procedure, the incision causes a slightly greater curvature of the cornea than before surgery. In general, however, this forms back within a few weeks by itself.
When should you go to the doctor
If you notice the following symptoms some time after the operation, you should definitely go to the ophthalmologist:
- Deterioration of visual acuity
- stronger redness of the eye
- Pain on the eye
Cataract – Operation: The “After Star”
Depending on the surgical technique, a so-called after-cataract (Cataracta secundaria) can develop in 20 to 30 percent of the operated patients. In young people, this usually happens more often than in older patients. In a Nachstar it comes to the opacity of the rear portions of the remaining lens capsule. With the help of a laser or a new surgical procedure (similar to the Cataract surgery) these cloudy lens portions can be removed quickly with minimal risk. The vision improves afterwards.