Cataract – surgical treatment

Who Can Have a Cataract?

How does a cataract occur?

A cataract usually occurs as a result of aging, but it can also appear at any age as a consequence of:

• diabetes
• trauma
• taking certain medications (corticosteroids)
• radiation (x-ray, ultraviolet, infrared)
• or it may be hereditary (congenital cataract).

Fifty percent of people aged between 65 and 74, and 70% of people over 75, have a cataract.

Procedure Description

For more than 15 years Polyclinic Bilić Vision has been helping its elderly patients to "see again".

Due to the long experience in cataract surgery, we are among the leading health care institutions that provide this operation, which can be confirmed by many satisfied Polyclinic Bilić Vision patients to whom we have successfully removed the cataract and restored good vision.

At the Polyclinic Bilić Vision cataract surgery is 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 the operation and, after completion of the surgery, he or she is ready to return home. Common preoperative tests are not necessary because the procedure is performed in local anesthesia using anesthetic drops. During surgery, the patient does not feel pain but feels the physician touching the eye. The operation lasts between 10 and 15 minutes. The operation is completely painless, there are no sutures, thus reducing the possibility of postoperative astigmatism.

It is important to note that both eyes are never operated on at the same time. There should be a one or two week gap between the surgeries of each eye.

We apply the most modern method of ultrasonic surgery of cataract, the so-called phacoemulsification, or fragmentation of the clouded lens by ultrasound and its microprobe removal. The removed lens is replaced by an artificial one. This method of cataract surgery is applied at the most eminent world ophthalmic clinics and at the same time, according to the success rate, it is one of the most successful operations in medicine in general.

Examination

A detailed ophthalmic examination

Cataract will be determined on the basis of ophthalmic examination by a biomicroscope. Due to the possibility of other ocular diseases that may further complicate the treatment, a complete and detailed ophthalmic examination is required.

Sometimes it is necessary to do an ultrasound examination of the eye as well because it is not possible to clearly analyze the ocular background, i.e. the eye parts that lie in the depth behind the lens, due to the strong clouding of the ocular lens.

Depending on the outcome of the examination, or the current diopter you have, the existence of astigmatism, the length of your eyeball, your needs (reading, watching television, driving, computer work, etc.) and your lifestyle, your doctor will recommend the type of intraocular lens which suits you best.

What artificial lenses are there?

Today there is a very wide range of implantable lenses that can meet the most diverse needs of patients:

• A monofocal lens improves distance vision, while near vision is worse, but not necessarily bad. A person who decides to have a monofocal intraocular lens implanted should continue using glasses for near vision, i.e. reading glasses.
• A multifocal lens is a lens that is embedded in the patient's eye and allows him or her to see far in the distance without glasses, at a medium range (computer) and to read. It is implanted in the eye during cataract surgery, and it is one of the options for removing the diopter. The multifocal lens can remove any diopter regardless of its strength, and the strength of the lens is determined before surgery, individually for each patient. After the implantation, the lens remains forever in the eye and does not need to be changed. Until recently, people had been forced to use reading glasses or glasses for distance vision after cataract surgery. By implanting a multifocal lens, a person stops depending on glasses to the greatest extent.
• Toric lens - Corneal astigmatism is a common visual impairment. In the case of patients with a cataract, this astigmatism can be corrected by inserting a toric intraocular lens (IOL). It is important to emphasize that it is possible to resolve strong astigmatism by implanting such a lens, but the patient should be well informed of all the possibilities and have realistic expectations.
• Multifocal toric lens combines the properties and effects of intraocular lenses by which diopter and astigmatism can be resolved at once and provides good visual acuity at all distances.

Preparation for cataract surgery

There are no strict instructions on how to prepare for the operation, 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.

Recovery of the eye after the operation is very fast and in several days most patients have full visual acuity.

Surgical Process

Once the droplet anesthetic in the eye begins to take effect, the patient is placed under the operating microscope in a lying position on his or her back. Measures of sterile preparation of the operating field are being carried out.

After the preparation of the operating field (disinfected with Betadine), the eye, the head and the chest part are covered with a sterile patch.

A holder is placed to keep the eyelids open. The eye is being inserted through two corneal openings smaller than 3 millimeters. Such openings do not require sutures and greatly accelerate postoperative recovery. Through the openings, the instruments are used to make an opening in the capsule (bag in which the lens is located). The ultrasonic probe crumbles the lens parts and sucks them out of the eye. After removing the natural lens, the artificial lens is embedded in the eye. The diameter of the artificial lens is usually 6 millimeters so that the lens bends and inserts into an instrument that can be introduced into the eye through a 3 millimeter incision. In the eye, the artificial lens again overtakes its original appearance.

The whole procedure usually lasts 15 to 20 minutes. The aforementioned procedure and type of anesthesia may be different in more complex cases or in the case of children.

After the Surgery

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 cataract 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.

At the last postoperative check-up, four weeks after the operation, you will be prescribed reading glasses (if you look good with the old reading glasses, you can use them without any fear until your doctor prescribes new ones). This is not the case for patients who have an implanted multifocal lens for distance, medium range and near vision.

Possible complications

Sometimes the lens capsule (part of the natural lens that remains in the eye during surgery) will become clouded after some time, reducing the visual acuity (secondary cataract). Clouding may occur months or years after the cataract surgery. If this happens, clouding is removed by YAG laser, and this is performed as a painless ambulatory procedure lasting only 5 to 10 minutes, with immediate visual rehabilitation.

Our Services

Cataract surgery includes:

• drop anesthesia, cataract surgery with an implantation of a selected intraocular lens, a medicine package containing eye drops and eye ointment, an eye shield, and three follow-up examinations (the first one is day after the operation, the second is two weeks after the operation, the third is four weeks after the operation)

Cataract surgery does not include:

• a preoperative examination during which it is determined whether the patient has a cataract or not, the measurement of the patient's lens size and sunglasses which the patient takes home after the surgery.

Become a part of the Polyclinic Bilić Vision family of satisfied patients and call today to be informed of the cataract surgery. You can make an appointment over the phone: +385 1/4678-444 or by email at info@bilicvision.hr.