MANSAROVAR EYE HOSPITAL, LUCKNOW, INDIA.
Phones: 91-522-224292/228655/201717
Fax: 91-522-239259
E-Mail: 




CATARACT  AND  INTRA-OCULAR   LENS  IMPLANTATION 
  
 WHAT IS A CATARACT ?                                                                     

	The construction of our eye is very similar to that of a 
camera. Both have the same components inside them. Just like 
the camera our eye contains a 'LENS' whose function is to focus 
the rays of light entering the eye so that we may be able to see 
clearly. When this lens of our eye which normally is totally 
transparent,  becomes cloudy and loses its transparency, a 
'CATARACT' is said to have formed. 

WHAT ARE THE SYMPTOMS ?

	When the lens instead of focusing the light starts 
obstructing it then the main effect will naturally be the 
BLURRING OF VISION and this is the main symptom of 
cataract. The vision becomes progressively blurred 
as the cataract matures and a stage comes when the 
patient cannot see anything except light. The other symptoms 
of cataract are excessive feeling of GLARE , DOUBLE-VISION, 
DIFFICULTY IN READING  in normal room lights and the blunting 
of color perception.  There is never any pain, irritation, headache 
or redness.

WHY DOES CATARACT FORM ?

	The development of cataract is a part of the normal 
human aging process and can be compared to the graying of 
hair with age. As we grow older the lens of our eye gradually 
becomes less transparent and even totally opaque leading to 
complete loss of vision in the affected eye. By the age of 60 
years a majority of the population has some degree of cataract. 
The development of cataract is a very slow process and takes 
anything from a few months to a few years.It may even stop 
progressing after a certain stage, but these changes cannot 
be predicted.
	Cataract can also form due to injury, due to metabolic 
diseases like diabetes, due to the prolonged use of drugs 
called steroids and some local eye diseases like iritis. 
Cataract can rarely even be congenital i.e. present since birth !	

CAN WE PREVENT CATARACT ?

	Much research has been going on in this area, 
but till date no medicine is available that can be used to 
prevent cataract from developing. Many expensive medicines 
are available in the market claiming to have an effect on the 
development and progress of cataract but none of them has 
been scientifically proven to have any effect whatsoever on 
cataract. Although we cannot prevent or halt the growth of cataract
 we can still see better inspite of cataract if we go to a qualified 
person and get glasses tested. Glasses help to focus the rays 
of light entering the eye and to some effect can temporarily 
neutralize the effect of cataract. These glasses may need 
frequent re-testing as the cataract progresses, but they 
are helpful till the cataract matures sufficiently for operation.

WHEN SHOULD OPERATION BE DONE ?

	 Except for a few rare situations, cataract is not an 
emergency and enough time is available to the patient to plan 
his operation. The choice of when to get operated is the 
patient's depending on his visual disability and need.
	 IT IS NO LONGER NECESSARY, AS IN THE PAST, 
FOR THE CATARACT TO BE FULLY MATURE  OR 'RIPE' 
BEFORE IT IS OPERATED. Modern surgical techniques 
have revolutionized the operation of cataract and made it 
extremely safe. It is now possible to perform the operation 
at any stage of the cataract with equally good results. In fact 
allowing the cataract to become fully mature is now not preferred 
as it can lead to more complications during surgery than an 
immature cataract.
	Taking these considerations into account it is 
recommended that surgery be performed as soon as the 
clouded lens begins to interfere significantly with the person's 
comfort and normal daily activities.



WHICH IS THE BEST SEASON FOR OPERATION ?

	All seasons are ideal for cataract surgery. There is 
a big  misconception among the people in India that cataract 
operation should only be done in the winter months. The results 
of surgery are equally good all through the year. Therefore 
while deciding about operation no thought should be given 
to the season.

WHAT CAN BE EXPECTED FROM CATARACT SURGERY ?

	The results of modern cataract microsurgery 
techniques are extremely good and in a vast majority of 
cases normal eye-sight is restored completely. The 
complication rates are negligible and post-operative discomfort 
is minimal.. It is due to these reasons that we can confidently 
advise patients to undergo early surgery and regain good vision.  
	In case the patient is suffering from some other  
eye disease like glaucoma, diabetic retinopathy or other retinal 
diseases all of which cause a reduction in vision then after 
cataract surgery only that part of the vision will be regained 
that had been lost due to the cataract.    The vision that has 
been lost due to the other eye disease that was concurrently 
present will not recover after cataract operation. Inspite of this 
it may be wise to undergo cataract surgery because after 
the removal of cataract it may be possible to treat the other 
conditions better than would be possible in the presence of 
cataract.

WHAT ARE THE MODERN SURGICAL TECHNIQUES ?

	In the modern method operation is done using an 
operating microscope  by which the structures of the eye are 
magnified 10 times . This allows the surgeon to operate very 
precisely causing least amount of trauma to the delicate tissues 
of the eye. This in turn leads to less pain and discomfort 
post-operatively and faster recovery.
EXTRA-CAPSULAR CATARACT EXTRACTION (ECCE)  is the most 
common method in use today. The surgeon makes a 10 to 12 mm 
long incision in front of the eye and removes the front part of the 
lens 'capsule' and the whole 'nucleus'. The back part of the 
capsule which is a thin transparent membrane is left behind . 
The wound is closed using 7 to 10 very fine stitches that don't 
need to be removed later. The very latest technique which gives
the best results is called 'PHACO-EMULSIFICATION' and is 
available only at a few highly advanced centers in the country 
including this hospital.

INTRA-OCULAR LENS IMPLANTATION :

	An intra-ocular lens (IOL)  is an artificial lens made of 
special non-reactive plastic that is placed inside the eye  during 
the ECCE or  phako-emulsification  cataract operation. Intra-ocular 
lens implantation is now a standard procedure and millions of 
lenses have been implanted world-wide in the last 20 years. 
In the west more than 99% cataract patients get an IOL implanted 
in their eyes. An IOL offers significant advantages to the patient. 
In the modern method the IOL is inserted in the 'posterior chamber' 
of the eye i.e. it is placed at the very spot in the eye from where the 
cataractous lens of the patient is removed. This is vastly superior 
to the old technique of putting the lens in the 'anterior chamber' as 
is still being practiced by some. The anterior chamber lenses do 
not do well in the long-term and the patient can completely lose his 
sight after a few years.
	 After a simple cataract operation in which the cloudy 
lens has been removed, the patient's eye does not have any lens 
in it so his vision after the operation remains very blurred as the rays 
of light are not being focused at-all. The obstruction which was 
present in the form of cataract has been removed , but no alternative 
has been provided in order to focus the rays of light. He is able 
to see only after he has been prescribed his 'cataract glasses' 
6-8 weeks after the operation.These cataract glasses are very 
thick due to their high plus power and the patient takes 
5-6 months to get adjusted to them. Moreover he becomes 
totally dependent on his glasses because his vision without 
them is so poor that he cannot walk even a few steps and he 
cannot recognize people even at very close distances. 
Reading or doing any fine work without these thick glasses is 
absolutely out of the question. Even newspaper headlines 
cannot be seen clearly.



ADVANTAGES OF IOL :

	1. Between 60 - 80 % of the person's normal eyesight is 
                          restored even without glasses. He can easily read headlines                                   without glasses. All routine house-hold works can be done                                          without glasses.
	2. Only low power glasses needed for reading and precise vision.
	3. Difficulty in judging distances ( false orientation ) that occurs after                           conventional operation due to thick glasses does not occur.
	4. A wide field of vision is maintained after IOL implantation,
	5. Patient can use both, the operated eye and the un-operated
                         eye together without any double  vision as occurs after                                                conventional operation : 'binocular vision' is maintained.
	6. The IOL cannot get displaced by rubbing or washing the eye.
                         It lasts for the patient's life-time. It never needs replacement. It                          cannot break inside the eye no matter what the patient does.
	
WHAT IS PHAKO-EMULSIFICATION AND STITCH-LESS CATARACT SURGERY :

	This is science's latest gift to humanity by which cataract 
surgery has become even safer and the post-operative recovery 
even faster. In this technique the cataract is removed from the eye 
through a much smaller incision by first dissolving it inside the eye. 
This is made possible with the use of a very sophisticated 
computer-controlled  machine that produces very high frequency 
sound waves which are used to break-up and dissolve the lens 
in the eye. This dissolved lens is then sucked out through a 
3.5 mm long incision.  A limitation of this procedure is that it cannot 
be done in fully mature, hard cataracts. It is ideal for immature cataracts.
A special  type of IOL is then inserted through this incision. 
Because the incision is so small no stitches are required in 
this method and the patient gets back 70 - 90 % of his vision the 
very next day. Post-operative restrictions and precautions are 
minimal.. This latest technique is available in this hospital .

WHAT IS 'YAG LASER CAPSULOTOMY' ?

	Following the cataract operation ( with or without IOL ) 
the 'posterior capsule' that has been left behind may, after a few 
months or few years, start becoming cloudy. When this happens 
the vision becomes blurred as if the cataract is developing again. 
This condition is called 'after-cataract' and is quite common, 
occurring in 60-70 % patients at some time or the other after 
operation. For useful vision to be restored a small opening has 
to be made in the center of the capsule. This can be done by
two methods : operative method and LASER method.  The laser 
method is superior because it is faster , painless, does not involve 
injections, tablets etc. and you can go home immediately with full sight restored. The laser used is called a YAG laser and the procedure
is called a 'capsulotomy'. This laser is available in this hospital 
to take care of this problem whenever it arises.

PREPARATION FOR SURGERY :

	Once you have made the decision to get operated 
special tests will be done to determine the exact power of the 
IOL to be implanted. You will be prescribed eye drops to be put 
in the eye for e few days before the operation so that the eye 
becomes free of all infections. You will have to deposit some 
advance for the operation and a confirmed date will then be given 
to you along with a list of pre-operative instructions. You will have 
to report to the hospital at the time given to you and a room will be 
provided to you when you come. Only two relatives will be allowed 
to be with you. No children will be allowed.




HOSPITAL STAY :

	No real need of hospitalization is there and the operation 
can be done on OPD basis. Those who have their own conveyance 
and live locally can go home 3 hours after the operation. A room with 
attached bath is provided to all. .You however, have to come back 
the next morning to get the eye examined and to get advice 
regarding the medicines etc. Those who find it inconvenient to 
go and return the next morning are provided a room with attached 
bath for the night stay.

OPERATION :

	The operationis done under local anesthesia only 
andthe patient is fully conscious during the operation. The surgery 
takes approximately one hour. There is no pain during the operation.

POST-OPERATIVE CARE :

	Immediately after the operationthe patient should rest in bed
for a few hours.  Patient can walk to the bathroom if needed.
	A set of post-operative instructions are given at the time of discharge. These are to be followed after reaching  home.
	The patient is called for periodic follow-up and the dates 
are given at the time of discharge.Complete recovery will take 
6-8 weeks for ECCE (with or without IOL ) and 2-3 weeks if for phako-emulsification. At the end of this period  final glasses will be
prescribed .
	It is very usual for the glass power to change 4-6 months
after the operation especially in the ECCE group 
( not so with phako) sothe patient may have to come 
back for re-testing of glasses.

WHAT ABOUT COMPLICATIONS ?

	Regardless of the care, expertise and 
sophisticated instrumentation, there exists the chance 
of complications in any surgical procedure.Luckily complications 
are rare and when they do occur they can usually be tackled 
in such a way as to not affect the final result. However, 
unexpected and serious complications like infection, 
hemorrhage and retinal-detachment can occur and cause 
permanent decrease in vision. It is necessary that you have 
knowledge of these possibilities. 

CONSENT FOR SURGERY :

	On the day of admission you will be asked to sign a 
consent form indicating that you understand your diagnosis, the 
surgery that you are about to undergo and the possibility of 
complications.If you do not understand please ask the doctor to 
clear your doubts.

This information brochure is part of informed consent for 
cataract operation ( ECCE or phako-emulsification ) with or
without intra-ocular lens implantation.

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