Microincision Sutureless Cataract Eye Surgery – Modern Microsurgery to Restore and Enhance Vision
Sight is our most precious sense enabling us to enjoy the beauty of the world in which we live. Blindness has been recognized as an important public health problem in India, a country that is now home to a billion inhabitants. A nationwide survey, undertaken in 1999-2001, revealed the prevalence of blindness to be 8.5%. Over 60% of blindness has been attributed to cataract alone.
For centuries, developing cataract doomed a person to blindness. Today modern microsurgical techniques utilizing state-of-the-art equipment, lenses and surgical material, allow people to enjoy good, clear vision after their cataracts have been removed. We at Shroff Eye Centre believe that giving up favorite activities and suffering through years of poor vision due to cataract is no longer an inevitable part of the ageing process. Our centre and its team of Eye specialist and cataract surgeons are dedicated to provide the best possible care to patients for IOL Surgery, Cataract Surgery, and Phaco Surgery.
learn about cataract and its treatment

How the eye works    

Before understanding cataract, it is important to know how a normal eye works. The eye is like a camera. The lens in a camera allows light to pass through and focuses that light on the film at the back of the camera for a clear picture.

The eye works in a similar way. The lens of the eye is normally clear and allows light to pass through. The light is focused on a thin film-like retina, which is situated at the back part of the eye. This is how we see.

What is a cataract?    

It is a cloudiness of the normally clear lens in the eye. It prevents the lens from focusing light onto the retina and hence causes unclear vision. As the cataract advances, this cloudiness of vision increases over a period of time until the vision is completely impaired.

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Why does a cataract develop?    

Cataract development is part of the normal ageing process. Almost all people above the age of 60 years have cataract of a variable degree, although it can occur at an earlier age also. In some people cataract development is aggravated by an eye injury, presence of diabetes, use of medications or other eye diseases. Rarely cataract may be present in the newborn as a developmental defect.

What are the symptoms of a developing cataract?    

Because cataracts form in different ways, the symptoms of cataracts are variable. Most people notice that their vision gradually deteriorates – objects may begin to look yellow, hazy, blurred or distorted. Some people report double vision, or polyopia (objects appearing multiple). Many people also find that they need more light to see clearly, or that they experience glare or haloes from lights at night. A common problem encountered is increasing nearsightedness. In advanced cases, the cataract may be visible as a whitish-looking pupil.

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Can cataract be prevented or treated with medication?    

Cataracts that occur due to the ageing process cannot be prevented as the ageing process itself cannot be prevented. Using the eyes for reading and similar activities has nothing to do with cataract formation. Avoiding the use of eyes will not prevent cataract.

Till date as per all authentic medical research no medication exists to prevent or cure a cataract. The only known treatment for cataract is surgery.

When can one undergo Cataract Surgery?    

Cataract surgery can be performed as soon as the patient feels handicapped in performing routine activities at work and leisure. It is not advisable to wait for the cataract to mature as unnecessary delay can make surgery difficult and prone to complications. Modern cataract surgery can be performed successfully in any season including summers and the rainy season.

What does cataract surgery entail?    

Modern cataract surgery is one of the safest and most successful forms of surgery. It requires a very short hospital stay and is generally performed under local or topical anesthesia. The patient is awake during surgery but does not feel any discomfort or pain. Patients are ambulatory immediately after surgery and are discharged on the same day. Cataract surgery at Shroff Eye Centre is performed with sophisticated operating microscopes, such as the Lumera 700 from Carl Zeiss. A micro incision of 1.8 to 2.5 mm is first made in the eyeball (Step 1). A smooth round opening is then made in the front part of the lens capsule, which is a thin membrane enclosing the entire lens (Step 2). All cloudy lens material within the lens capsule is then removed through the same incision by the procedure of phacoemulsification using a thin titanium probe that emits high-speed ultrasound waves, vibrating at 40,000 times per second. This breaks the cataract into tiny pieces, which are then suctioned out of the eye through the same probe (Step 3). In the final step, a Foldable Intraocular Lens (IOL) is introduced through the small incision, and placed within the capsule of the lens where it unfolds and stays in place securely (Step 4).

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Micro incisions such as those used in phacoemulsification seal themselves immediately after surgery and heal very quickly and allow one to return to normal work and activities within a few days. This is currently the most effective method for removing cataracts.

Great strides have been made in phacoemulsification technology. All top-of-of-the-line phacoemulsification machines currently available have the capability to deliver “Cold Phaco” which has the advantage of significantly reducing the ultrasonic energy to break up the cataract resulting in safer surgery and less damage to the eye, resulting in crystal clear corneas after surgery and faster visual recovery even in hard cataracts. These include “Torsional Phaco” (OZil IP Technology) available in the latest state-of-the-art Infiniti Vision System from Alcon, The WhiteStar Signature with Ellips FX “Transversal Phaco” and Fusion Fluidics from AMO, and The Stellaris Vision Enhancement System from Bausch & Lomb, which are all available at Shroff Eye Centre for the benefit of cataract patients.

One of the most recent developments in this field has been the introduction of the Centurion Vision System from Alcon.  This revolutionary technology works on the principle of “Active FluidicsTM” technology which detects and instantaneously responds to changes in intraocular pressure (eye pressure) during surgery. This system provides unparalled safety by creating a stable environment with a consistent eye pressure throughout cataract surgery.

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Can all patients having a cataract undergo Phaco surgery?    

Your eye surgeon will be the best judge to decide whether you can undergo microincision phaco-surgery. Each patient undergoing cataract surgery at our centre is examined in detail to assess the endothelial count of the cornea using the automated Specular Microscope. This facility at Shroff Eye Centre is one of the very few available in the Capital. Based on findings of the endothelial count by specular microscopy it may be necessary to alter certain medication used at the time of surgery. If the endothelial cell count is low we are using BSS Plus and Viscoat, which are imported medicines, to minimize loss of the already depleted endothelial cell counts during surgery. 

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What are the various types of Intraocular Lenses (IOLs) which can be implanted in the eye?    

1) Monofocal IOLs – These lenses provide good distance vision and most patients are not dependent on their distance glasses for daily activities. However, patients implanted with monofocal IOLs typically require reading glasses after cataract surgery.

In the recent years, monofocal lenses have been designed with aspheric surfaces. These state-of-the-art FDA approved aspheric or aberration-free IOLs greatly improve image quality by enhancing contrast, eliminating glare and haloes, and improving night vision.

2) Toric IOLs – These special lenses correct high cylindrical powers reducing the patient’s dependence on distance glasses.

3) Multifocal IOLs and Accommodative IOLs – These lenses are designed to provide good unaided distance and near vision with less dependence on glasses.

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How is the IOL power calculated prior to cataract surgery?    

IOL power calculations at Shroff Eye Centre are done by trained personnel and every endeavor is made so as to get very minimal post-operative power in the distance glasses. This is done using immersion ultrasound biometry for measuring the eye accurately before the operation.  A new device called the IOLMaster is available at the centre which is capable of extremely accurate measurement of the eye and calculation of the IOL power.

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What is the life of an Intraocular Lens?    

Once the IOL is implanted in the eye, it remains in place for the remainder of one’s lifetime.

Are there any problems with an Intraocular Lens?    

Fortunately, the technological advances in IOL manufacture and surgery have made it quite safe. Complications are rare and similar ones can occur with conventional surgery without an IOL implantation. All patients irrespective of other general illnesses like diabetes, hypertension etc. can have IOL surgery. If there is any reason why you should not have an IOL your ophthalmologist will explain.

Can Cataract be treated with Lasers? What is femtosecond bladeless cataract surgery?    

Until a few years ago cataract could not be removed with lasers. Surgery done by phacoemulsification was commonly termed “Laser Surgery” by lay people.  Now, some of the steps of cataract surgery can be performed by Femtosecond Laser which has significantly improved the precision of some of the most critical steps that were traditionally performed manually. The femtosecond laser is a special laser which allows the surgeon to create high precision incisions. The femtosecond laser technology has already been in use in the recent years for creating precise flaps in bladeless LASIK with more predictable outcomes and increased safety.

More recently, the femtosecond laser is being utilized to assist or replace several aspects of the manual cataract surgery. These include the creation of the surgical incisions in the cornea, circular opening on the lens surface (capsulotomy), and breaking up (fragmentation) of the lens. The femtosecond laser can also be used to make incisions in the peripheral cornea to aid the correction of pre-existing astigmatism (cylindrical power).

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How is femtosecond bladeless cataract surgery different from conventional phacoemulsification surgery?    

In conventional phacoemulsification surgery, the surgeon makes the corneal incisions with a metallic blade, and manually creates an opening in the front of the lens capsule to gain access to the cataract, and then divides the cataract with a hand held ultrasonic probe.

In bladeless cataract surgery, the Femtosecond laser is used for these three critical steps of cataract surgery, i.e. to make the incisions, the opening in the lens capsule, and to divide the lens into fragments. Thereafter, the lens fragments are removed by the surgeon using the ultrasonic probe.

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In both traditional cataract surgery and bladeless laser cataract surgery, microsurgical instruments are used in the operating room to remove the cloudy lens from the eye. The back membrane of the lens (called the posterior capsule) is left in place. An intraocular lens is placed inside the eye to replace the natural lens that was removed.

What are the advantages of femtosecond laser assisted cataract surgery?    

As the entire laser process is carried out under computer-guided OCT imaging, there is greater control and reliability of the incisions with regard to size, shape and location. It also allows perfectly-shaped, perfectly-sized and precisely centered capsule opening to be made into the cataract lens which does not depend upon the surgeon’s skill or experience. This enables accurate positioning and insertion of the artificial lens implant which optimises the visual outcome. This is of utmost importance in premium intraocular lenses such as aspheric design IOLs, Toric IOLs, Multifocal IOLs and Accommodative IOLs where the slightest error can compromise the quality of vision. Moreover, as the laser divides the lens into small fragments, the amount of ultrasound energy used to remove the cataract is greatly reduced, which in turn helps in early visual recovery.

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What is a “Cataract Refractive Suite” and what additional benefits does it offer over only femtosecond laser assisted cataract surgery?    

It is a platform where multiple innovations and advanced technologies come together to provide unparalleled precision and safety to further improve the outcomes of cataract surgery. It consists of the following components: 1) the VERIONTM Image Guided System, 2) the LenSx® Femtosecond Laser System, 3) the LuxORTM LX3 operating microscope and, 4) the Centurion® Vision System for phacoemulsification.

The VERIONTM Image Guided System captures a high resolution image of the patient’s eye which is transferred to the operating microscope. This image is superimposed on the surgeons view. It thereby provides automated incision positioning, guidance for making the opening in the lens capsule, as well as centration and alignment guidance for multifocal and toric IOLs.

The LenSx® Femtosecond Laser System performs the laser assisted steps of cataract surgery and includes corneal incision(s), lens capsule opening (capsulotomy), and lens fragmentation as previously described. The precision and accuracy of these steps of cataract surgery has now been further improved upon by the VERION Image Guided System. The image of the patient’s eye captured by the VERION can be directly fed into the LenSx Femtosecond laser to bring about a significant level of precision, accuracy and predictability to bladeless laser assisted cataract surgery.

The LuxORTM LX3 operating microscope is a top-of-the-line surgical microscope with superior illumination and depth of focus. It allows the surgeon to safely and efficiently perform all steps of cataract surgery with great ease and comfort. It allows the patients eye image as captured by the VERION to be superimposed in the surgeons view, thereby guiding incision creation, capsulotomy and precise alignment of Toric IOLs and perfect centration of Multifocal IOLs.

The Centurion® Vision System for phacoemulsification is a state-of-the-art machine for performing microincision cataract surgery. It has a unique mechanism called “Active FluidicsTM” technology which detects and instantaneously responds to changes in intraocular pressure (eye pressure) during surgery. This system provides unparalled safety by creating a stable environment with a consistent eye pressure throughout cataract surgery.

Combining all these technologies provides multiple benefits to the patient. It translates to safer and more precise surgery, early visual recovery and less chances of dependence on glasses.

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Is clear vision guaranteed after surgery?    

No surgeon in the world can perform a surgery with guaranteed results. However, almost all the patients regain good vision following cataract surgery. In certain cases, eye disease or problems in the cornea, retina or optic nerve may limit the potential for clear vision even when the cataract surgery itself has been successful. However, it might not be possible to evaluate the condition of the retina, optic nerve, in advanced cataracts.

 

What are the possible complications that can occur with Cataract & IOL surgery?    

Modern microsurgical techniques for cataract removal are highly successful procedures. The few complications that exist are becoming even more remote, with newer developments in surgical techniques and anesthesia.

Some minor complications that can occur include a slight drooping of the eyelid, swelling around the eye, corneal haze, reflections or slight distortion from the lens implant, which are usually temporary. The chances for serious complications are negligible. Possible serious complications include infection, severe inflammation, and hemorrhage.

In a majority of cases these complications can be treated successfully or may resolve on their own with a good final restoration of vision. The above list is however not exhaustive.

What is Posterior Capsular Opacification (PCO) or “After Cataract”?    

However, in a certain number of patients undergoing cataract surgery, the back part of the lens capsule may thicken over a period of time causing blurred vision. This is known as Posterior Capsular Opacification (PCO), secondary cataract or “After Cataract”. This is not a complication. The condition is treated with a “YAG Laser Capsulotomy” with full restoration of vision

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Benefits of cataract surgery:    

There are numerous benefits of cataract surgery, many of which cannot be measured statistically. These include: –

  • Improved colour vision – colours are brighter and more vivid
  • Greater clarity of vision – vision is crisper and sharper
  • Improved quality of life – studies have repeatedly shown that people enjoy an improved quality of life after successful cataract surgery. Many people can resume driving, reading, writing,   watching television, sewing, household work and using a computer immediately after.

 

Even when retinal diseases or other problems prevent a total restoration of vision, the remaining vision is usually improved by cataract surgery.