Cataract surgery and Cataract surgery (Extraction of the cloudy human lens) and clear lense extraction to treat ametropia.

The natural lens inside the human eye is located behind the iris & the pupil. It is supported by multiple suspensory ligaments. The lens consists of crystalline, a special kind of protein. This protein is clear at the early age of life, but metabolic processes change it over time and lead to opacification. The lens is surrounded by a capsule, which gives it the typical form. The lens does not consist of any blood vessels nore nerve fibers, which means that the lens is naturally transparent.

The lens is free of blood vessels or nerve fibers. This is essential to its transparency and inherent in nature.

What is the human lens responsible for?

The lens is responsible for the process of focusing and refraction. On this occasion it has the capacity to change its form for better focusing at near distances (like the lens of a camera).

This ability is called accommodation. By aging, the hardening of the crystalline lens increases, so the result is a decrease in accommodation power, which is called presbyopia.

What is cataract?

Cataract is the opacification of the natural human lens. Additionally, this opacification will lead to a thickening of the lens and therefore the anterior chamber of the eye will be reduced.

How will your eye doctor diagnose a cataract?

Your eye doctor can check the lens during a regular/ routine appointment by using a special microscope (slit lamp). Usually the pupil will be dilated for this examination, so the whole structure of the lens can be evaluated. Giving the patient a postoperative prognosis of his visual ability, some further examinations are necessary before undergoing surgery. Additionally, we will explain to you all different intraocular lenses.

Example of a clouded lens

How does the patient notice a cataract?

Less light will pass the lens, caused by opacification of the proteins in the lens. The more light is blocked, the less light is getting through to the retina, which results in insufficient projection of an image. Patients will become easily dazzled by bright lights, colors seem faded, poor night vision, cloudy or blurry vision, double vision, etc.

The progression of cataract is in every patient individually. The first opacification starts very slightly at the age of 30 and progresses very slowly. Cataract is seen in very few exceptional cases in younger ages and newborns (juvenile cataract). In such cases, the cataract surgery should be performed earlier.

Some forms of cataract result in progressive myopia. The patient observes a better reading in near distance without glasses. This situation is only for a short period of time and results in very poor vision.

Visual impairment in cataracts

The cataract is always individual in its expression and its progression. It starts at the age of about 30 years and progresses very slowly. In exceptional cases, the cataract can lead to a strong haze even at a young age, so that the lens must be removed early (juvenile cataract).

Some forms of lens opacification manifest in an increasing myopia. Most patients notice that your glasses are no longer fit or you can read better without glasses. However, this effect only lasts for a short time and leads to a completely bad view.

different stages of cataract
When does surgery have to be done?

Decades ago, the star operation was very cautious and did not operate until the star was „mature“. Today, the cataract is considered moderate. Decisive here is always the impairment of the patient, as well as the anatomical conditions of the eye. Therefore, the operation time is set individually for each patient.

Are there alternative therapies for cataract surgery?

The only effective cataract treatment is cataract surgery, which removes the clouded lens and replaces it with an artificial lens. There is no other / alternative therapy, such as medication. Delaying the operation for too long carries a number of risks, including complications and even the loss of the eye.

Do I still need glasses after the operation?

The lens power of the artificial lens, which is used during the operation, is calculated individually for you, comparable to the determination of the strength of the glasses by the optician. In this case, pre-existing defective vision can be compensated. With artificial lenses it is also possible to correct myopia or hyperopia. Even a correction of the astigmatism is possible today without any problems.

A monofocal standard lens, however, can not provide a close-up, as the natural eye lens can. Therefore, many patients continue to need reading glasses after cataract surgery.

If a good near vision is to be achieved without glasses, then you need a multifocal lens. This can also reflect the intermediate area, for example the computer workstation, sharply.

Before the operation, the patient and the ophthalmologist must therefore decide in which area (distance, near and / or intermediate area) he wants to see as clearly as possible without glasses.

Important: These considerations are always about the distances in which you would like to see well without glasses. With a correspondingly lightweight additional glasses you can of course always see in all distances sharp, insofar as the eye / brain brings the health requirements!

An explanation about the possible lenses, as well as the discussion of any additional costs, takes over the ophthalmologist in the OP preliminary investigation.

The exact achievement of the planned refractive power can be accurately measured and estimated today, but not guaranteed. Here, anatomical conditions play a role as well as physical forces that can not be measured to the last detail before surgery.

There is no guarantee of freedom from glasses, but today we are able to achieve the best possible result through the best possible technology and operational experience.

How does the preparation for cataract surgery work?

As part of the preparation, the eyes are measured to calculate the thickness of the artificial lens to be used later. Here, the length, width and thickness of the eye and the natural lens are included. In addition, the astigmatism is measured.

Equally important is the exclusion of other eye diseases before surgery to achieve the best possible visual outcome during surgery. The cataract operation is a physically barely invasive procedure usually performed in local anesthesia. Here, the patient can decide whether he wants a short sleep phase or only wants to be operated on by a local anesthetic.

What happens before the start of operations?

On the day of surgery, each patient receives surgical clothing, which must be covered. Undressing is not necessary. After a short preparation by means of pressure measurement and visual performance control, the anesthesia is initiated. The preparation takes only a few minutes.

How is the cataract surgery going?

The operation is performed under a special surgical microscope from Zeiss. While the patient sleeps under anesthesia, the eye to be operated on is stopped by means of a fine clip. The patient does not feel this. First, a minimally invasive cut of 2 to 2.5 mm is made on the eye. Now, the wafer-thin envelope that surrounds the lens, called a lens capsule, is opened to liquefy and remove the tarnished lens material.

Depicting cataract surgery

Here, work is done with minimal ultrasonic vibrations for material liquefaction. In the course of this material is sucked off. This process is called phacoemulsification. The empty lens case (capsular bag) remains, into which the new artificial lens is inserted. The procedure is the same for each cataract operation, also independent of the later implanted lens.

Can complications occur?

Cataract surgery is the most widely used surgical methodology worldwide. The reason for this is that every person gets the cataract and must be operated on in the course of life. It is a minimally invasive procedure, which also involves minimal complication risks.

However, there is always a residual risk of complications in every surgical procedure. Luckily, there are only a few possibilities to be mentioned: Eye pressure fluctuations can occur, which can usually be treated with eye drops or tablets. Likewise, the cornea may cloud through a type of swelling, so that the vision becomes clear after some time. This too can be treated with eye drops. In rare cases, the capsule suspension device (zonular fibers) is so loose that the capsular bag can not be obtained and must be removed.

Likewise, the capsular bag may tear during the operation. In these cases, an experienced surgeon will be able to perform surgery by dislocating the lens within the eye. Some eyes respond to a cataract surgery with a swelling of the retina center, which can be treated with medication again. In the end, in rare cases a detachment of the retina can be triggered, which is then reassembled surgically. All this, however, occurs with a probability of less than 2%.

What happens after the operation?

It is important that you wear the bandage on the day of the operation and the first night, so you can not accidentally rub on the eye or get dirt in the eye. The day after the operation, the bandage is removed and the eye examined by the ophthalmologist. After the bandage is removed, vision is often not clear. This is due to the fact that the pupil is still dilated by drugs after the surgery and therefore lack of depth of field prevails. Seeing noticeably builds up in the first 2-3 days after the operation.

Eye drops: It is important that you regularly drip the prescribed eye drops and also follow the instructions of the doctor. Which eye drops are taken as long decides also the ophthalmologist according to the respective findings. As a rule, eye drops are instilled 6-8 weeks after surgery and can then be discontinued.

As a rule, three follow-up examinations are performed per eye during the first 2-3 weeks after surgery. During this time, the eye should not be influenced from the outside by pressure or excessive wiping. The actual healing process happens automatically. Driving is usually not possible in the first days after the operation, but can be resumed promptly after consultation with the doctor (usually from 5 days after surgery).

Basically, today after cataract surgery any operation is immediately possible again. The only exception is swimming, deep diving or a visit to the sauna or fitness studio. Likewise, flying is prohibited. Here there is a risk of pressure increase, which should be avoided. This is also possible again one week after the surgery.

It is normal for the first few days after surgery to have a slight foreign body sensation. Likewise, any visual fluctuations during this time are completely normal. Glasses, if necessary at all, can be made 6-8 weeks after surgery. Here, the ophthalmologist tells you the right time.

Behavior in case of emergency

Please do not hesitate to contact us directly as your ophthalmologist in case of an emergency. Sudden onset of vision loss after surgery is just as much a part of it as reddened or painful eyes.

The number for emergencies can be found in the surgical documentation.

The posterior (capsular contracture):

The secondary cataract refers to a phenomenon that occurs some time after the cataract removal. It manifests itself by a poorer visual performance and a feeling of permanent blurred vision.

The after-star arises because the posterior aspect of the lens capsule becomes clouded during cataract surgery. This can not be completely influenced by the surgeon. To varying degrees, a posterior after cataract surgery is always and every patient. It can be removed with a laser. This procedure is not painful and is carried out in practice on an apparatus similar to the examination microscope. Then you can enjoy unrestricted vision with the new lens again.

How many times a year after the operation do you have to check?

Follow-up examinations after surgery are usually performed annually. Exceptions to this are patients who have more extensive illnesses or abnormalities that were not affected by the cataract surgery, such as glaucoma or various forms of macular degeneration.

Miss Dr. Paulig during cataract surgery