Modern cataract surgery using the phacoemulsification or small incision technique is one of the miracles of modern medicine and the most commonly performed operation of any in the medical repertoire. It is done in an operating room (operating theatre) by an ophthalmologist (eye surgeon) with delicate microsurgical instruments, the most important of which is the ‘phacoemulsification probe’. After the application of a suitable anaesthetic (usually topical anaesthesia which is given by applying very strong anaesthetic eye drops) three small incisions are made on the surface of the eye. Two of these are less than 1mm wide and the other – the main incision – is barely any wider being only 2.2mm in diameter! A bulky clear viscoelastic gel is injected into the eye to preserve the shape of the front compartment – known by ophthalmologists as the ‘anterior chamber’ – of the eye so permitting the introduction of a small claw-like instrument known as a ‘capsulorhexis forceps’. The capsulorhexis forceps are used to first puncture the wrapping or capsule of the natural lens of the eye and then draw a delicate circular shape on its surface enabling the removal of a central disc of tissue from the capsule and so exposing the cloudy natural lens of the cataract beneath. Hydrodissection – the injection of water between the capsule and the cloudy lens – is then performed to free the cloudy lens from its attachment to the capsule. The eye surgeon next inserts the phacoemulsification probe – this is an extraordinarily sophisticated microscopic, ultrasonic jack hammer which vibrates thousands of times per second and effectively pulverises and liquidises the cloudy cataract material. As the phacoemulsification probe is hollow, the debris created by this technique is sucked up or aspirated through the tube of the phacoemulsification probe and led into a disposable chamber. Following complete removal of all of the cataract material (the periphery of the capsular bag often has remnants left behind which are cleaned in an intervening stage called ‘I-A’ which stands for ‘irrigation-aspiration’ further viscoelastic is injected into the eye to expand the now empty capsular region. The customised lens implant used by Eyesite surgeon Dr Simon Levy is then loaded into an injection device (which he usually describes perhaps somewhat alarmingly as a ‘shooter’ and injected through the tiny, 2.2mm main incision into the capsular bag. The reader might wish to contemplate for a moment the remarkable skill and virtuosity not just of eye surgeons but of the numerous scientists, technicians and engineers who were responsible for devising the magnificent equipment now available to the ophthalmic profession. It is quite a feat to inject a lens implant, whose maximum dimensions are generally in the region of 13mm, through a 2.2mm wide incision! In any event lens implants may be viewed as miniature contact lenses (although they are much more robust). The optical engineers and designers in companies such as Alcon, Rayner, Zeiss and Oculentis have designed the shape of the lens implants so that they are able to correct virtually every type of optical or focusing imperfection – short sight (myopia), long sight (hyperopia), astigmatism, reading glasses dependence (presbyopia) and even some types of wavefront abnormalities such as spherical aberration. This miracle of modern medicine takes only about fifteen minutes in the operating room but the impact and benefits that are derived from it will last the patient a lifetime.
The majority of patients are able to resume normal daily activities virtually immediately after the eye operation frequently without any obvious visible evidence that there has been any surgery performed.
There is of course the potential for side effects and complications as there will be with any form of medical interventions. Eyesight surgeon, Dr Simon Levy, provides his patients with a detailed booklet on cataract and cataract surgery in which more information on the causes and effects of cataract, the techniques of ultra small incision cataract surgery and customised lens implant technology, the risks and benefits of cataract surgery and the subject of secondary cataract (which is easily cured in outpatients with a laser capsultomy technique) are all discussed in more detail. To enjoy Eyesite’s premium cataract surgery services, please contact us by phone or email.
