What happens during cataract surgery?
What is happening usually during the procedure?
Cataract surgery is usually done in the day care unit at the London Clinic, opposite Clinica London. It is an outpatient procedure, meaning that you go into the hospital for only an hour or so and are sitting in a comfortable reclining chair while you wait to go into the operating theatre. You then lie down in the operating theatre, have a local anaesthetic, have the surgery and then go back to your comfortable reclining chair with the eye pad on. Shortly after that go home and usually you come back to see the nurse at Clinica London the day after, who will take off the pad and look at your eye to make sure everything has gone well. Well, that is a very potted description of what will happen during your cataract surgery, I want to tell you a little bit more about what is involved when you go to the theatre.
The surgery is done most commonly under local anaesthetic, and this can be just topical local anaesthetic or a combination of local eye drops and an injection around the eye. This completely numbs the eye so although you awake and you can hear your surgeon talking (you are not allowed to speak during the surgery as that moves the head and could be highly dangerous). You lie on a comfortable couch with a bright light. If you require an injection of local anaesthetic, that is done by the anaesthetist and if you need sedation because you are a little anxious that can also be done intravenously by the anaesthetist.
Many patients have cataract surgery without an anaesthetist present with just the consultant ophthalmologist putting in the eye drops and doing the injection. Under the care of Miss Laura Crawley and Mr Jaheed Khan, your surgery will be carried out at the London Clinic usually in the MITU day case surgery unit.
What are the cataract surgery steps?
At the beginning of surgery, your ophthalmic surgeon will clean the skin around the eye and place a plastic cover on the eyelid so that partially covers your face and if your surgery is under local anaesthetic you have some oxygen to breathe and space around your mouth to feel comfortable and non-claustrophobic. The ophthalmic surgeon will then gently open the eyelids with an eyelid clip to stop you from blinking during the surgery. The other eye will blink as normal. The clip does not hurt at all.
The ophthalmic surgeon uses an illuminated operating microscope positioned above your eye from which they are looking directly down at the cataract. Therefore you will not be able to see any instruments coming towards your eye as your vision will be temporarily blurred by the bright light and the local anaesthetic and your other eye is covered by the frosted drape. You will have to lie relatively still for about 20 minutes or so which is the duration of the surgery.
During the surgery, the small incisions are made ranging from 1.5 mm to 2.7 mm in diameter, and the delicate cataract instruments are placed within the eye. A small phaco probe is required after the capsulotomy to aspirate the cataract. After that, the folded intraocular lens is placed within the posterior capsule where it bounces out to its flattened position. At the end of surgery, injections are given against inflammation and infection, and an eye shield or pad is placed. You will be given instructions to either come back to Clinica London the day after to see the surgeon and/or nurse for your first postoperative visit after which you start eye drops. You will also be given instructions on what to do after surgery, what to avoid and what are the risks during surgery, immediately after and longer term after cataract surgery.