Cataract Surgery -- Preliminary Report

Discussion in 'Laser Eye Surgery' started by Ms.Brainy, Jun 27, 2007.

  1. Ms.Brainy

    Ms.Brainy Guest

    I went with the good doc and everything was fine.

    I checked with a couple of people who know him and his record, got
    only very positive opinions.

    I believe so. I even have an "IOL ID Card", stating the following:
    Alcon AcrySof IQ IOL
    UV with blue light filter
    Model: SN60WF
    Power: 20.0 D
    Length : 13.0mm
    Optic: 6.0mm

    Mabe somebody advise me on the quality of what I got...

    The surgery went apparently well, but I can't testify since I was
    fully sedated and practically wasn't there when the procedure was
    done. It was like a general anasthesia, except that it was much
    shorter. When I woke up I had a mild pain and was given Tylenol 3.
    The itching that followed, however, was unbearable!

    Today I had a followup, at which the shield and the bandage were
    removed, together with the nightmarrish itch. However, I still have a
    mild deep pain, which the doc said would go away within a few days.
    As to my vision, well... it's "so-so" -- somewhat better than before,
    but still not very good. The doc said it'd take a couple of weeks to
    settle, at which time I will get a new Rx for new glasses. He did a
    quick refraction to see the correctable potential, which was 20/80 but
    without correcting the astigmatism -- much better than my 20/400 pre-
    surgery with glasses. The prediction is that eventually I will have
    corrected vision of 20/50 or even 20/40, with 20/20 in the other

    People have told me that a cat surgery is a piece of cake compared to
    what I have been through. Well, I am still waiting for the
    cake... :) My next followup is next Tuesday.
    Ms.Brainy, Jun 27, 2007
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  2. Ms.Brainy

    Neil Brooks Guest

    It sounds like a darned good lens. Take a look at:

    Sorry about the itching. Can they give you anything (Benadryl OTC) if
    it hasn't stopped?

    Did you/didn't you go with the topical anesthesia PLUS the sedative??
    I'm grateful that they're aiming as high as they are, though I know
    20/20 would be much, much better. I hope the lens settles well,
    orients itself comfortably to its new home, and gives you crisp clear

    Although, technically, you're now "on the threshold of myopia."

    Have you read about "plus lens therapy?"
    Devil's food okay?

    Good luck on Tuesday :)
    Neil Brooks, Jun 27, 2007
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  3. Ms.Brainy

    Jane Guest

    Well, Ms. Brainy, congratulations on having it all behind you. It
    sounds like everything went well. I have the same model IOL as you do
    in both eyes. (I opted for a clear lens exchange in my non-
    vitrecomized eye, since I saw it as a chance to rid myself of high

    I think you will be pleased with your AcrySof IQ. It's Alcon's
    aspheric IOL, the type of lens that Dr. Stacy recommended to you on
    this forum. (Aspheric IOLs are reputed to improve night vision,
    although its questionable to what extent.) In any case, I've never
    had a problem with glare, halos or the other visual aberrations that
    post-cataract patients sometimes experience. My vision in the clear
    exchange lens eye is every bit as good as it was with my natural lens
    (corrected with glasses or contact.) I really don't understand why so
    many people suggest that you should delay cataract surgery until it's
    really needed so that the drawbacks of having IOLs are easier
    tolerate. (What drawbacks?)

    That said, I do have one complaint about the AcrySof IQ. In some
    lighting situations, the lenses seem to create an amber glow in my
    pupils. It's sort of similar to the glow in the eyes of the aliens in
    "Village of the Damned." On the other hand, with the current media
    emphasis on having a "youthful glow," maybe this effect is actually an

    My surgical experience was a lot easier than yours. I opted to skip
    the sedation and had topical anesthesia only. I didn't have any pain
    and I didn't need a bandage or patch. Did you have topical
    Jane, Jun 28, 2007
  4. Ms.Brainy

    Churie. Guest

    This poster will be useful I presume.

    Cataract is an opacity in the lens of the eye.In a camera, an object
    is focussed onto the film by a lens. Similarly, an object seen by the
    eye is focussed onto the retina by the it's lens. When the lens of our
    eye gets opaque, it is called CATARACT. The normal lens allows light
    to reach the retina. When it becomes opaque and does not allow light
    to reach the retina, we are unable to see clearly.

    To understand cataract better, imagine photographing through a camera
    with grease smeared onto it's lens. In such a case, the image formed
    is very hazy and blurred. Similar to grease smearing onto the lens of
    a camera, if the lens of the eye gets opaque, the image formed on the
    retina will be blurred and one will not see clearly.


    The history of cataract dates back to 3000 years. The earliest
    cataract operation was performed by the famous surgeon of ancient
    India, SUSRUTA, a disciple of Danavantri. Even in that ancient era,
    Susruta described Cataract as an opacity of the lens. He had given an
    admirable account of the technique of its treatment by couching which
    he successfully practiced. In this operation he displaced the opaque
    cataractous lens away from the centre of the eye to another part of
    the eye. Today modern medical advances have made cataract surgery one
    of the most successful forms of surgery. New surgical techniques and
    Intraocular lenses can restore excellent vision in 97% of all cases.
    In the 1960's Dr.Charles Kelman from USA started a technique called
    Phacoemulsification in which cataracts were removed through a 3 mm
    incision, compared to a 12 mm incision in which the whole cataract was
    removed in toto. Then in 1998, Dr.Amar Agarwal from India started a
    technique called PHAKONIT in which cataracts were removed through a
    1.0 mm opening. In the year 2001 a special lens was made which went
    through this small opening of 1 to 1.5 mm. This was called the
    Rollable Intraocular lens.

    The causes of the formation of cataract are not fully known. It is
    basically an aging phenomenon. Just as our hair gets grey, so also
    does the lens of our eye get opaque. Next to old age come other
    factors like deficiency of food like proteins and vitamins, some toxic
    drugs, general diseases like diabetes, infections and injuries.
    Sometimes German measles in pregnant mothers causes cataract in the


    1]Take good and nourishing diet rich in proteins and vitamins. Food
    such as liver, eggs, milk products, carrots, cabbages and yeast are

    2]Protect your eyes from excessive exposure to sunrays, X-rays,
    intense heat and injuries.

    3]Diseases such as Diabetes and syphillis should be treated early
    and effectively.


    SURGERY. The important question is when should one get operated for
    cataract. This depends on the occupation of the patient. If the
    patient is a pilot, he should be operated earlier for slight
    deterioration of vision will affect his work, whereas if the patient
    is a housewife, she can delay surgery for some time. When a person has
    a cataract and the decision is made to operate, then the diseased lens
    is removed and replaced by an artificial lens.


    Once the cataract [diseased lens] is removed, there is no focussing
    ability of the eye as there is no lens in the eye. So one has to use
    an artificial lens to get the object focussed onto the retina. This
    can be either in the form of a spectacle, contact lens or an
    Intraocular lens.
    1]Spectacles can be used but these are very heavy and not comfortable.
    Further, if one removes these glasses the person is blind. Other
    disadvantages of these glasses is that everything is magnified and the
    side view is very poor.

    2]The second alternative is to use a Contact lens. This is an
    artificial lens placed on the eye. The disadvantage as with spectacles
    is that if we remove it the person is blind as there is no focussing
    ability. Another problem with contact lenses is that they have to be
    put on in the morning and removed at night which is difficult for an
    old person.
    3]So, the best method is to give the patient an INTRAOCULAR LENS. This
    is an artificial lens that is placed in the eye at the time of
    surgery. It will remain in place till the end of life. By this all the
    problems of spectacles or contact lenses is removed. This lens does
    not irritate the eye.

    The manual or the old technique for cataract removal use a 12 mm
    incision (cut) to remove the cataract. One technique called the
    INTRACAPSULAR CATARACT EXTRACTION has an incision of 12 mm. In this
    the entire cataract is removed with the capsule of the lens. The
    disadvantage of this technique is that the artificial lens called the
    Intraocular lens (IOL) is placed in the capsular bag with the capsule
    of the lens acting as a support for the lens. As the capsule is not
    present the IOL cannot be placed in the capsular bag position.

    Another manual technique is called the EXTRACAPSULAR CATARACT
    EXTRACTION TECHNIQUE. In this the incision is about 10 mm. In this the
    cataract is removed but the capsule of the lens is left behind. The
    advantage of this technique is that the artificial lens called the
    Intraocular lens (IOL) is placed in the capsular bag with the capsule
    of the lens acting as a support for the lens.

    The disadvantage of this technique is that the incision is quite large
    of about 10 mm which creates scarring in the eye. This means half the
    eye is cut open and then an IOL is inserted inside the eye. The IOL is
    about 6 mm and so easily goes inside the eye. Sutures are then placed
    and the patient admitted. The patient takes rest for 45 days and after
    that suitable glasses are prescribed. The patient is given spectacles
    for fine tuning after 45 days.


    Dr.Charles Kelman from USA started a technique called
    phacoemulsification in the 60's to remove cataract through a 3 mm
    opening. Since then various new modalities have developed which have
    made this technique more refined. The machine for removing the
    cataracts is called a Phacoemulsifier machine which cuts the cataract
    into small pieces and removes them by aspiration.

    Normally, the lenses used are rigid and cannot be folded. The problem
    by this is that one has to make a large cut or incision in the eye to
    implant these lenses. Today, the latest development in Intraocular
    lenses is the FOLDABLE intraocular lens. These are special lenses
    which can be folded. Once they are folded they are placed in a special
    cartridge and then the cartridge is place in a special injector. The
    injector is passed into the eye and the lens also gradually passed
    into the eye. The lens unfolds in the eye. These lenses can be passed
    into the eye through a very small cut. Thus this foldable Intraocular
    lens helps make the incision very small.

    PHAKONIT (Cataract surgery through a sub 1 mm incision)

    One of the biggest breakthroughs in cataract removal has come from
    India by a technique called PHAKONIT. In this the incision is brought
    down from a 3 mm incision to a 1 mm incision.

    The first step is to make the incision. Then the instruments for
    Phakonit are passed into the eye and the cataract cut into small
    pieces by Phakonit and finally the whole cataract removed.
    The problem with this technique was to find an IOL which would pass
    through such a small incision. Then on October 2nd 2001 the first case
    of a Phakonit Rollable IOL was done.

    The lens used was a special lens from USA. This was the first Rollable
    IOL which was implanted after a Phakonit procedure and was a rolled

    The advantage of this lens is that it is a very thin lens and when
    placed in water becomes pliable and can then be rolled and inserted
    into the eye. Inside the eye the lens opens gradually. The patient can
    come to the hospital and go home immediately. The advantages are that
    the 1 mm barrier is broken and the incision now has become so small.

    (Cataract Removed Through A 0.7 Mm Needle)
    On May 21st 2005, a new technique "MICRO PHAKONIT" has been introduced
    by Dr.Agarwal's Eye Hospital, Chennai whereby cataracts were removed
    with a specially designed needle of 0.7 mm. The surgery was carried
    out by Dr.Amar Agarwal, Director of Dr.Agarwal's eye hospital,
    Chennai, India. The instruments were designed by him and manufactured
    in the United States of America.

    Image will come

    As the incision now becomes smaller than the original phakonit
    technique started in 1998, the technique has been termed Micro-
    Phakonit. This technique is absolutely painless and the patient does
    not require any injection at all. Since the incision is below 1 mm the
    patient has no injection, no stitches and no pad. The patient walks
    inside the hospital and goes back immediately.


    Today, we are able to operate patients with cataract and remove their
    diseased lenses and replace it with an artificial lens called an
    Intraocular lens as an out-patient procedure. The patients are not at
    all admitted in the hospital. The patient comes in the morning for
    surgery and after the operation can go home. The patients can go back
    to their work within a couple of days as the healing is very quick
    because of the ultrasmall incision.

    With the advancement of cataract surgery and modern skills, the
    success of cataract surgery is between 97-99%. Complications like
    infection and haemorrhage can occur but are very rare. One should
    remember that if the retina or nerve of the eye are damaged then even
    after a good cataract operation the person will not see.

    Putting large lenses in large incisions is bucking the tide of
    history. Small incisions offer the best chance for most-rapid, stable
    visual rehabilitation of the cataract patient at the least cost,
    including time of impaired vision following surgery, the need for
    follow up care, the attendance of relatives to take care of them to
    the doctor and the like.


    The advantages of performing Phakonit cataract surgery due to the very
    small size of the cut made in the eye is that -

    1.The patients are not admitted in the hospital

    2.The patients come for the surgery and go back immediately after a
    few hours in the hospital

    3.There are no stitches used

    4.The patient gets back to his or her normal routine the next day and
    can go to office, have a head bath or do the normal housework like
    cooking etc.

    Take care and stay in touch.
    Churie., Jun 28, 2007
  5. Ms.Brainy

    p.clarkii Guest

    nice summary. i don't know much about the "MICRO PHAKONIT"
    procedure. sounds like i will be hearing more about it. thanks for
    adding something positive to this NG.
    p.clarkii, Jun 28, 2007
  6. Ms.Brainy

    Ms.Brainy Guest

    I was sedated and know nothing... but the doc told me that I actually
    talked to him during the procedure. Could it be? I don't recall a
    thing! What did I say? What secrets did I reveal? Did the real
    nasty me come out and now the truth can no longer be hidden? All he
    said was that I had been cooperative and didn't move... I probably
    will never know.
    I believe the itching was caused by the adhesive tape with which the
    bandage and the shield are glued to the face. I took Benadryl on my
    own (after obtaining permission), but it didn't help much. Anyway,
    the itch completely disappeared with the removal of the bandage.
    Yes, a couple of drops into the eye, no needles! The incision was
    2.8mm, with no stitches -- all according to the "wish list" that I had
    handed to him at my first visit.

    I still have some corneal swelling that is healing well, and my vision
    IS improving. I can see now with the operated eye the individual
    leaves on the trees outside, and this is exciting! I can't read
    normal print [no accommocation :-( ], but I could see the time (in red
    light) on my alarm clock. Until now all lights were the glaring 4th
    of July fireworks for me, but now I will have only one 4th next
    Yeah, where is Otis when I need him???
    I am of the chocolate persuation.
    Ms.Brainy, Jun 29, 2007
  7. Ms.Brainy

    Ms.Brainy Guest

    I am very grateful for all the good advice I got on s.m.v. from
    William and others, including you, Jane.
    First, there are risks involved, and it's a matter of weighing the
    risks against the potential gains. For that reason I have decided not
    to touch my good eye. Then you lose accommodation, and it's certainly
    a loss. In addition, some people (like me) would do anything to avoid
    surgery, as the thought of it is sufficient to send chills through my
    spine. WE, the chicken crowd, will go to surgery only when it;s
    absolutely necessary. It may be hard for you to understand, but this
    is the way we are...
    You are very brave, Jane, and I wish I could be like you... but I am
    Ms.Brainy, Jun 29, 2007
  8. Ms.Brainy

    Ms.Brainy Guest

    Another note: Finally I too have some floaters, though very few and
    only occassionally. I believe they have been there all along but due
    to my poor vision I couldn't even see them...
    Ms.Brainy, Jun 29, 2007
  9. Ms.Brainy

    Jane Guest

    I'm not brave, just curious. I had read so much about cataract
    surgery that I didn't want to miss anything by being sedated. But I
    was very anxious about doing a clear lens exchange on my "good" eye.
    (My situation was different than yours, Ms. Brainy, and I can
    appreciate your reluctance to risk a second surgery.) I wasn't
    worried about loss of accomodation, since I already needed a +2.00 ADD
    for reading. My concerns related to what my quality of vision would be
    with an implant. I was happy to discover that my AcrySof IQ seems to
    be every bit as good as my natural lens.
    Jane, Jun 30, 2007
  10. Ms.Brainy

    Dan Abel Guest

    I believe that there are medical terms to describe nothing, local and
    knocked out. Did they give you enough "stuff" so that you were relaxed
    during the surgery? My last surgery (retinal detachment repair and
    vitrectomy, two hours), went fine, even though I was awake. My previous
    eye surgery (cataract, a few minutes) was miserable. The doctor didn't
    believe in heavy whatever it's called, so I was a nervous wreck.
    Dan Abel, Jun 30, 2007
  11. Ms.Brainy

    Jane Guest

    I only had the topical anesthetic eye drops, which was fine for my
    first cat surgery because everything went well. Unfortunately, during
    the surgery on my second eye, the IOL got twisted and became stuck in
    the insertion device. While the surgeon struggled to free it, I
    struggled to lie still and not have a panic attack. The AcrySof IQ
    lens had been special ordered for me, and I was terrified that it
    would rip, and they would have to insert some other (leftover) lens
    that was available in my power (14 D). The surgeon ultimately did
    free the lens without ripping it, although I needed a stitch. When I
    saw him the next day, it was apparent that he had had no idea how
    anxious I had become on the operating table.

    Dan, I was also awake during my vitrectomy (my choice), although they
    used propofol IV to administer the retrobulbar block (local
    anesthesia). The propofol left me in a state of elation, which lasted
    for most of the vitrectomy, and the retrobulbar block eliminated all
    sensation in my eye (although I could see--and was able to watch the
    surgery). By contrast, the topical drops for cataract surgery
    eliminated pain but I could still feel pressure. And without the
    residual high from the propofol, the cataract surgery was much less

    I'm really curious whether others can sense a difference in their
    vision with an implant vs. their natural lens (without
    Jane, Jun 30, 2007
  12. Ms.Brainy

    Jane Guest

    I had floaters after cataract surgery and YAG laser. They disappeared
    permanently after a week or two.
    Jane, Jul 1, 2007
  13. Ms.Brainy

    Dave Bell Guest

    Yes, all my retinal surgeries (starting with a buckle, followed by 5
    vitrectomies, PVR "peels", and silicone injections & changes, were under
    conscious sedation. It's pretty interesting to watch the surgery from
    the "inside", and be able to chat with the surgeons. During the latest,
    I mentioned I was beginning to feel some discomfort as he worked, so
    they added more block; up until then, I had always been "tuned out" on
    Fentanyl for that, and I could only imagine what it would feel like! Not
    nearly as bad as the in-office gas injection I underwent...

    Dave Bell, Jul 3, 2007
  14. Ms.Brainy

    Jane Guest

    My retinal surgeon made a big effort to convince me that refusing
    sedation would be a major mistake. He even claimed that it would be
    "the worst day of my life." But I had read that outside the US
    sedation was not used routinely for vitrectomies, and I really wanted
    to experience the operating room atmosphere. The residual high from
    the propofol (and the fact that the local anesthesia never reached my
    optic nerve so I could watch the surgery being performed) made for a
    thrilling experience. I had no problem lying perfectly still and
    watching the show. In retrospect, I suspect that my retinal surgeon
    was just more comfortable operating on a sedated patient. I really
    appreciate his flexibility in letting me skip the IV Versed/
    Jane, Jul 5, 2007
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