Eye Care Blog

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The Operation

The first step in the operation itself is the securing of the eyelids. This is usually done with a small spring speculum, which gently holds the lids open without in any way pressing on the eye.

The removal of the cataract can be achieved in a number of ways, the aim being to clear all the opacity from the pupil of the eye. Basically, there are two methods either of which may be used: (1) the intracapsular, whereby the whole lens is removed; or (2) the extracapsular, whereby the lens capsule is opened and the contents extracted, leaving the capsular bag attached to the zonular fibres.

The particular type of operation is determined by a number of factors, among which are the age of the patient, whether or not an intraocular implant is to be done, and the preferences of the surgeon.

Most surgeons now use a microscope during the operation. This ensures much greater accuracy when placing the stitches and is essential when implanting intraocular plastic lenses. The powerful light within the microscope should not trouble the patient being operated on under local anaesthetic because the injections he has been given will have so deadened his vision that the light will seem dim.

When the cataract has been removed, by whatever method, the wound is closed by a number of very fine sutures (stitches) and the eye protected by a pad. The sutures are so fine that they cause no irritation to the eye and do not have to be removed at a later date as is often the case with sutures used to close skin wounds.

The whole operation, from the first incision to the final stitch, takes about 1 hour. Cataract extraction is not a painful procedure, although when the anaesthetic (either local or general) has worn off a mild discomfort may be felt (the stitches sometimes irritate a little).

Some years ago both eyes were covered and the patient kept quite still for days with the head steadied with a sandbag on either side; only a very light diet was allowed. Today, with the excellent suture material available and with advanced techniques, such restraints are not necessary, and a certain amount of movement is both permitted and encouraged. Most surgeons allow their patients to be up and about the day following the operation; some, indeed, allow them up on the day of the operation, particularly if it has been performed under a local anaesthetic.

In countless films and plays operating theatres are portrayed as alarming places fraught with tension and drama. In fact, this is by no means the case. Unlike a lot of general surgeons, most eye surgeons operate sitting down; there is consequently far less movement in eye theatres than in general theatres. Moreover, many surgeons like to have some background music playing during surgery, as this encourages a relaxed atmosphere which is essential for good results.

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