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Cataract Surgery

DISCLAIMER! The information on this website is general information for someone who may need cataract surgery. Please discuss with your surgical provider your concerns and questions about the procedure. Your personal health information may differ from the information presented here.

Cataracts occur when the lens part of your eye become progressively more cloudy. This is due to the build up and formation of plaques that prevent light from normally passing through the lens. When vision becomes too difficult, the lens can be removed and replace with an artificial lens. This is known as a cataract surgery. Many different kinds of artificial lenses exist that can replace the old one, some of them able to fix the astigmatism of the eye that glasses would normally account for. In addition, cataract surgery can be performed at the same time as other surgeries such as corneal transplants. Below is information regarding only the cataract procedure.

Before Surgery:

Do not eat or drink anything for at least 8 hours prior to the time of your surgery.  You may take any medication pills that you need to take with a TINY sip of water.

Please use whatever medical eye drops (ie. for glaucoma) that you would normally use for the operative eye on the same day as surgery.

The Operation:

Because cataract surgery can usually be accomplished in only 5 to 10 minutes, the surgery is performed under topical, anesthesia unless you have a strong personal preference for General anesthesia (General anesthesia is when you are asleep during the surgery.). With topical anesthesia, we place strong anesthetic drops on your eye so that there is no pain with the surgery. You are awake, but we can also have the anesthesiologist give you some medicine in your vein to make you fell less anxious. Topical drop anesthesia has nearly no risk and is even safer than going to the dentist.  The surgical procedure will take about 10 to 15 minutes to perform from start to finish. I generally talk to you during the surgery to let you know each stage of this short procedure and how you are doing.  Before you know it, the surgery is over:

Immediately after the surgery, your vision will be dark until your eye recovers from staring into the bright ‘light of the microscope. We do not patch the eye, but simply place a shield over it to protect the eye and remind you not to rub it  Within about 30 minutes after the surgery, you will. notice that your vision is improved and you can see through the holes of the shield.  You will be kept another hour after surgery in the Ambulatory Procedure Center prior to discharge. Surgery is usually done as an outpatient procedure at the hospital and you ate sent home with the shield on your eye that same afternoon. You should have minimal discomfort after surgery, and standard over-the-counter pain medications can be taken if necessary.  You may also be given other pill medications to take for the eye if indicated; Keep the eye shielded until your doctor sees you the next day. Just pull the shield down to put in the eye drops, starting· immediately after surgery until you go to bed that night.

Immediate Post-Op:

Instructions: we request that you try to stay relatively inactive for the first 24 hours. You are quite free to stand up and walk around for going to the bathroom or to sit up for eating meals as much as necessary in that ‘first 24 hours after surgery and it is not a danger to your eye to do so. However, do try to rest, whenever possible, in bed or a chair or on the couch, just kind of relaxing until I see you the next day. You are permitted to bend over and tie your shoes, but generally limit your activities immediately after surgery. The morning after your surgery, you can get up, take the shield off, and you can even take a shower, wash your hair, etc. Just try not to put too much pressure on the eye.                         –

Post-Op Visits Schedule:

You will return to see your doctor the next day. The shield will be removed and your eye will be examined. You will be placed on antibiotic and steroid drops to prevent infection and to help with healing. This first visit will only take about 15 minutes and is primarily done to check the pressure and to be sure that the eye has done well after the trauma of surgery. If all looks good the first day after surgery, we generally don’t need to see you again until 2 to 4 weeks later, and it is at that time that your eye has stabilized enough to get your glasses for reading or distance or whatever. Most patients can see in the distance well enough in those first few weeks after cataract surgery that just plain old over-the-counter reading glasses work reasonably well. If the other eye also has unacceptable vision due to cataracts, then your second eye surgery can usually be done within a few weeks of the first surgery.

Medication Dosage and Schedule:

(Note: you can use your various drops at the same time, just separate them from each other by about 5 minutes, so they don’t wash each other out.)

Vigamox:

Begin using this drop every TWO HOURS immediately after surgery until you go to bed that night. Sleep through the night and then the dosage is FOUR times a day (breakfast, lunch, dinner and bedtime) from the day after surgery until it runs out, usually (or as directed by your physician) within about 2 weeks after surgery.

This drop (Vigamox) is an antibiotic and keeps your eye from getting infected.

Prednisolone Acetate 1 %:

(a milky white drop) – SHAKE WELL BEFORE USING Begin using this drop FOUR times a day (breakfast, lunch, dinner, bedtime) from immediately after surgery until it runs out, usually about 4 weeks.

This drop (Prednisolone acetate 1 %) is what keeps the inflammation down after surgery, so it is important that you DO NOT stop taking this medication unless advised by your corneal doctor.

Nevanac:

Begin using this drop THREE TIMES a day (Breakfast, Lunch, and Dinner) starting immediately after surgery until it runs out,(Or as directed by your physician) usually after about 4 weeks.

This drop is a non-steroidal anti-inflammatory (like ‘Advil’ for the eye) and can not only reduce discomfort but also reduce inflammation of the retina that can rarely occur after routine cataract surgery.

Artificial Tears:

Use these drops if your eye feels dry or uncomfortable. They are only lubricants (do not have medicine) and do not have to be used unless desired.

Please use any other eye medications that you were using prior to your surgery.  Use them on the day of surgery and start them again the morning after surgery when the patch is removed.

Activities:

Immediately after surgery, we like you to be resting as much as possible for the first 24 hours (see comments previous page). You can bend over to tie your shoes, but try to avoid any real exercise in the first 24 hours.

The day after surgery, the shield is removed and does not need to be used again in most cases. No protection is needed during the day, but if you normally wear glasses for the other eye, go ahead and wear them.

Normal activities are permitted even the first post-op day after you see Dr. Terry and he takes the shield off.  You can shower, wash your hair and do normal activities like shopping etc. However, you are at risk for infection for the first two weeks after surgery, so do not do activities like gardening, cleaning out stalls or attics etc.  Just use common sense and it will be fine.

Finally, avoid activities that may lead to taking a direct hit to the eye (eg. playing with small children, wrestling with animals, etc!).

No sports activities of any kind for one week after surgery. No swimming under water for three weeks, but doing water exercises (head always out of water) is fine after one week. Absolutely avoid any sports where you might get hit in the eye (tennis, racketball, etc.) for at least 3 weeks, and if you must play, ALWAYS wear protective eyewear.  I do!!

Vision Expectations:

Almost immediately after surgery, most people notice that the vision is better, with brighter lights, colors, and pretty good vision through the central pinholes of the eye shield.

When the patient wakes up the next morning, that is when the vision really starts to become apparent. However, some patients will have some corneal swelling after cataract surgery or other minor problem, and so their vision may take 2 or 3 days to settle in. The vision is pretty much stabilized at about 2 to 3 weeks after surgery when glasses for reading or other activitie are usually prescribed.

Infection after  Cataract Surgery:

Infections are EXTREMELY rare after cataract surgery, with some estimates at about 1 case in 2 to 3 thousand. Nonetheless, that is the one risk we all worry about.  That is why we put you on antibiotics after surgery and why we want you to know how to tell if the eye might be infected.

How do I know if I am having a serious infection after cataract surgery?

I often ask my patients if they know what “RSVP” means … and they all tell me that it basically means “Call me back” … Well for an eye that just had surgery, RSVP means:

R: the Redness is increasing

S: the Sensitivity to light is increasing

V: the Vision is decreasing

P: the Pain is increasing (not just ‘scratchy’,  but real serious pain)

There is generally nothing  ‘subtle’   about these symptoms if they are due to infection.

If you have these symptoms occurring with the surgery eye, then it may be a sign of infection, and if so, you need to “RSVP” your doctor (me) and let me take a look at the eye.  Infection is most common in the first week after cataract surgery.  Never hesitate to at least call us if you have any concerns about RSVP.