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Cataract Topics


 

Steps in Cataract Surgery

  • Introduction
  • 1 Anesthetic
  • 2 Side Port
  • 3 Incision
  • 4 Capsulorhexis
  • 5 Phaco
  • 6 I/A
  • 7 Insert IOL
  • 8 Rinse

MarinEyes Cataract Specialists

John C Shin Christian K Kim John R Campbell
John C Shin,     MD Christian K Kim, MD John R Campbell, MD

Phacoemulsification

Micro Incision Cataract Surgery

Once your vision with corrective glasses or contact lenses is no longer adequate for you to comfortably, safely do your normal activities, it is time to consider cataract surgery. The only effective treatment for cataract is cataract surgery. This is a common procedure. At Marin Ophthalmic Surgery Center, we do over 700 cataract surgeries a year. The surgery involves a relaxing sedative and "topical" anesthetic for complete comfort. Under microscopic control, the surgeon removes the cloudy lens and replaces it with a new, clear artificial lens.

Click the tabs above to see the steps in surgery from left to right, starting with "Anesthetic."

The surgery itself generally takes less than 15 minutes in most cases. The patient goes home about 2 hours after arrival at Marin Ophthalmic Surgery Center. The vision may be blurry for the first few days, but is nearly always much better by 2 weeks postop. Typical post-operative care includes eye drops for 6 weeks after, and 2-3 post-operative follow-up appointments. Occasionally the post-operative care involves higher levels of medication and visits, but most people who will need glasses are ready for new glasses about 2 weeks post surgery. Many of our patients are having multifocal lens implants such as the ReStor and enjoying reduced dependency on glasses. Check the links at the upper left of the page for more detailed information. Drs. John R. Campbell, John C. Shin and Christian K. Kim use the most current proven methods in their cataract surgery. The doctors provide pre-operative consultations, second opinions and post-operative care.

 

 

Topical Anesthetic:

Anesthetic gel is instilled in the eye pre-operatively. On arrival in the operating room, a pleasant and very effective relaxing sedative is given intra-veinously. Most patients doze through their surgery. Just prior to surgery, additional drops of anesthetic are applied. Additional anesthetic rinse may be given at the time of the initial incision, assuring patient comfort. The surgery is so delicate that local anesthetic injection is rarely used. Because of the type of anesthetic and the insicions we use, at MarinEyes we generally have patients CONTINUE their blood thinners (Coumadin, warfarin, aspirin, Plavix) before and immediately after their cataract surgery.

topical anesthetic for cataract surgery

 

 

Side Port Incision:

A minute, painless initial "side port" incision is made. Thick, transparent fluid (viscoelastic) is injected to hold open the space between the cataract and the delicate underside of the clear cornea in front of it. Anesthetic rinse is also applied at this time, rendering the eye profoundly numb.

side port incision

 

 

 

Cataract Incision: Microincision

An extremely thin diamond scalpel makes a 2.85mm incision for the cataract removal. There is no sensation at this time. This incision is located at the edge of the cornea, away from blood vessels. Because of this, and because of the type of anesthetic we use, we generally have our patients continue using their blood thinners (Coumadin, warfarin, aspirin, Plavix) before, and immediately after surgery.

microincision

 

 

Capsulorrhexis:

Carefully a circular opening is torn in the fragile clear sac that holds the cataractous lens.

capsulorrhexis

 

 

Phacoemulsification:

Ultrasound softens the harder portion of the cataract so that is can be suctioned from the eye.

phacoemulsification

 

 

Irrigation / Aspiration:

The last remaining soft cataract material (cortex) is vacuumed out of the eye, leaving behind the clear, empty lens capsule.

irrigation and aspiration

 

 

Insert IOL:

The flexible lens implant has been rolled up for insertion by the assistant, and is now injected through a soft tube into the vacant lens capsule.

The aspheric, multifocal and Toric lens implants are all placed by this method. The Toric requires as well an exacting marking and final positioning process to correctly orient the astigmatism correction to the patient's preoperative measurements.

unfolding IOLiol insertion

 

 

Final Rinse:

The thick viscoelastic fluid previously instilled in the eye is removed, and any remaining microscopic cataract fragments are rinsed out as well. The small incision is generally self-sealing, and we use sutures infrequently.

Often, when the patient is told that the surgery is finished, he (or she) is quite surprised: "It's over? I didn't even realize you started!"

rinseIOL unfolded