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Cataract Surgery in India

About Cataract Surgery ?

Cataract surgery is the removal of the natural lens of the eye (also called "crystalline lens") that has developed an opacification, which is referred to as a cataract. Metabolic changes of the crystalline lens fibers over time lead to the development of the cataract and loss of transparency, causing impairment or loss of vision.

Many patients' first symptoms are strong glare from lights and small light sources at night, along with reduced acuity at low light levels. During cataract surgery, a patient's cloudy natural cataract lens is removed and replaced with a synthetic lens to restore the lens's transparency.

Types of Cataract Surgery

Two main types of surgical procedures are in common use throughout the world. The first procedure is phacoemulsification (phaco) and the second involves two different types of extracapsular cataract extraction (ECCE). In most surgeries an intraocular lens is inserted. Foldable lenses are generally used for the 2-3mm phaco incision, while non-foldable lenses are placed through the larger extracapsular incision. The small incision size used in phacoemulsification (2-3mm) often allows "sutureless" incision closure. ECCE utilises a larger incision (10-12mm) and therefore usually requires stitching, and this in part led to the modification of ECCE known as manual small incision cataract surgery (MSICS).

Types of surgery

Phacoemulsification (Phaco) is the most common technique used by developed countries. It involves the use of a machine with an ultrasonic handpiece equipped with a titanium or steel tip. The tip vibrates at ultrasonic frequency (40,000 Hz) and the lens material is emulsified. A second fine instrument (sometimes called a "cracker" or "chopper") may be used from a side port to facilitate cracking or chopping of the nucleus into smaller pieces.

"In rare cases, infections have caused blindness among some of the patients in mass free eye camps in India."
Cataract Surgery

Preoperative evaluation
  • The degree of reduction of vision due, at least in large part, to the cataract should be evaluated. While the existence of other sight-threatening diseases, such as age-related macular degeneration or glaucoma, does not preclude cataract surgery, less improvement may be expected in their presence.
  • The eyes should have a normal pressure, or any pre-existing glaucoma should be adequately controlled on medications. In cases of uncontrolled glaucoma, a combined cataract-glaucoma procedure (Phaco-trabeculectomy) can be planned and performed.
  • The pupil should be adequately dilated using eyedrops; if pharmacologic pupil dilation is inadequate, procedures for mechanical pupillary dilatation may be needed during the surgery.
  • The patients with retinal detachment may be scheduled for a combined vitreo-retinal procedure, along with PC-IOL implantation.
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