Lens implantation for correction of high diopter values

Candidates

There are two types of intraocular lenses used for vision correction:

• For patients between the ages of 20 and 45, who do not yet have age-related farsightedness, i.e. whose eye lens is not cloudy, and who have a diopter higher than -10.0, the solution is to insert a phakic lens into the anterior eye chamber.
• For patients older than 45 years of age who already have age-related farsightedness, who do not have a cloudy eye lens and do not want to wear glasses, the solution is the implantation of a multifocal lens. This technique is called "clear lens extraction", with the aim of eliminating diopter and discarding glasses. After implantation, the lens will remain in the eye forever and does not need to be changed.
• For patients who have a cataract, and want to see at all distances, the solution is also the implantation of a multifocal lens. (Read more about cataract surgery here)

Procedure Description

Polyclinic Bilic Vision has been performing intraocular lens implantation surgeries for more than 15 years. Due to the many years of experience in such operations, we are among the leading ophthalmic health institutions, which can be confirmed by many satisfied patients of Polyclinic Bilić Vision.

Multifocal lens implantation surgery ("clear lens extraction") and the phakic lens implantation surgery are performed on an outpatient basis according to the so-called principle of one-day surgery. For the patient, this means that there is no bed rest after surgery and that after completing the procedure, he or she is ready to return home. No common preoperative examinations are required as the procedure is performed under local anesthesia with the application of anesthetic drops. During the operation, the patient does not feel pain, but he feels the physician touching the eye. The operation itself lasts 10-15 minutes. The surgery is completely painless, there are no sutures closing the wound, which reduces the possibility of post-operative astigmatism. It is important to note that both eyes are never operated on at the same time. There should be a one - two week gap between the surgeries of each eye.

During the multifocal lens implantation surgery we use the most modern method of ultrasound operation "clear lens extraction", the so-called phacoemulsification, or fragmentation of the lens by ultrasound and its removal by microprobe. The removed lens is replaced by an artificial one. This method of surgery is applied at the most eminent world ophthalmic clinics.

Examination

Determination of visual acuity is performed on devices that measure computer vision, curvature and corneal thickness are measured as well, and then it is subjectively checked how well the patient sees. The following tests are the eye pressure measurement, the examination under a biomicroscope during which ocular lens is checked, and under a specular microscope where the coronary endothelial state and the cell number are aslo checked to predict the success of the procedure itself.

After examining the posterior segment of the eye in the wide pupil, ultrasound measurement of the eye ball length is performed as well as other parameters required for successful phakic or multifocal implantation surgery.

Such detailed examination lasts about one hour.

The multifocal intraocular lens will not be embedded in the eye in which some damage at its posterior part - the retina or the yellow spot – is found, because then the results will not be satisfactory.

INSTRUCTIONS BEFORE THE OPERATION:

There are no strict instruction on how to prepare for the surgery, but we always advise you to:

• evening before the surgery wash your hair because postoperative recovery requires you not to bend over or make your face wet for a certain time
• put on a buttoned shirt, a cardigan or a blouse, so you do not have to take off your clothes over your head and put your recently operated eye at risk
• cook meals for the next few days because it is not advisable to expose the recently operated eye to heat and steam
• before the operation you are free to eat and take your medications (if they are regularly prescribed), meaning that it is not necessary to prepare yourself additionally for the surgery
• bring a person with you who will take you home by car or take a taxi since it is not advisable to use public transport because of the possibility of injuries and infections on a recently operated eye.

Surgical Process

PHAKIC LENS IMPLANTATION PROCEDURE:

After the drops of anesthesia begin to work, the patient is placed under the operating microscope in a lying position on his back. The operation begins with a small incision of 2.5 mm at the border between the cornea and the eye sclera. Through this hole a phakic lens is inserted into the anterior chamber of the eye in front of the iris. The lens is squeezed through the instrument in which it is rolled up, and when it is placed in the anterior chamber of the eye, the lens slowly opens and the instrument places it properly in its place. There are no sutures closing the wound, the eye is not closed with a bandage. After the procedure, you take medication treating high eye pressure and the eye pressure is checked one to two hours after the operation. Recuperation is fast, and the patient can already see well at a distance and up close.

MULTIFOCAL LENS IMPLANTATION PROCEDURE:

Once the anesthetic drops, previously dripped in the eye, start working, the patient is placed under the operating microscope in a lying position on his back. A holder is attached to keep the eyelids open. The eye is inserted through two corneal openings smaller than 3 millimeters. Such openings do not require stitches, which greatly accelerates postoperative recovery. Through the openings, the instruments are inserted to make a capsule (bag in which the lens is located) incision. The ultrasonic probe makes the lens parts fragmented and sucks them out of the eye. After removing the natural lens, the artificial lens is inserted into the eye. The diameter of the artificial lens is usually 6 millimeters so that the lens can be bended and inserted into an instrument that can be put into the eye through a 3 millimeter incision. In the eye, the artificial lens restores its original appearance. The whole procedure usually lasts 15 to 20 minutes.

After the Surgery

The course of recovery is the same for patients who have had the multifocal or phakic lens implanted.

The patient’s eye is not covered with a bandage after the surgery. He or she puts on dark and large enough sunglasses to protect the eye from external influences (wind, sun, rain, dust, artificial light, etc.). The first day after the surgery, the patient must wear sunglasses even at home, indoors, all the time. During the first two weeks after surgery, sunglasses should be worn if the patient leaves home.

It is necessary for the first couple of days to sleep with the protective cap on the eye to prevent the patient from rubbing the operated eye during sleep and to protect him or her from infection. The first follow-up examination is performed the day after surgery. Recovery is fast and patient returns to day-to-day activities within two weeks. The first results can be seen on the first day after surgery. Also, during the first few days, a slower recovery is possible if the operation was complicated. In most cases, after this operation over 90% of people achieve visual acuity above 80%. If there are some pathological conditions of the retina, visual acuity may be worse.

Immediately after the surgery you will be prescribed drops and eye ointment, which should be used according to the doctor's instructions two weeks after the procedure. Medications prevent the development of inflammation and accelerate the recovery of the eye.

There may be a slight foreign body sensation, like an eyelash in your eye. The patient's vision will be blurred for two to three days, and the eye may be sensitive to light and touch. Do not rub or press the operated eye!

During the entire recovery, watching television, reading, and computer work is allowed. These actions cannot harm the operated eye. Within the first two weeks after the surgery, you should not bend over or lift heavy objects because bending over increases the eye pressure, which is not desirable in the process of healing of a surgical incision! You can take care of your hygiene and do easier housework. It takes some time that visual acuity of the operated eye is completely recovered, so you will be able to return to your usual activities only two weeks after surgery without any risks.

Two weeks after the procedure is another check-up, and the last one four weeks after surgery, ending the regular postoperative examinations.

Possible Complications

Candidates who have had a phakic lens implanted in the anterior eye chamber must be aware that the method is not permanent and that in time, ocular lens could get cloudy due to aging of the so-called cataract, which may cause visual impairment.

For candidates who have had a multifocal lens implanted, sometimes the lens capsule (part of the natural lens that remains in the eye during surgery) may become cloudy after some time, reducing visual acuity (secondary cataract). Clouding may occur months or years after the cataract surgery. If this happens, clouding is removed with a YAG laser and is performed as a painless outpatient procedure lasting only 5 to 10 minutes, with immediate visual rehabilitation.