Cataract surgery is perhaps the most important procedure for preserving vision for a lifetime. Many advances have been made since the early days of surgery under general anesthesia followed by thick glasses. Today there are three surgical techniques in use:
1.Intracapsular cataract extraction. This is the original operation, which is still used in the developing world. The capsule is removed with the lens. In the developed world, it is used only for rare cases such as a partly dislocated lens. Thick, “aphakic” glasses are required because the lens is not replaced.
2.Extracapsular cataract extraction. This is an advance which leaves the lens capsule in place. An artificial lens is inserted to replace the natural lens.
3.Phacoemulsification. This is a less-invasive version of extracapsular extraction, which requires a smaller incision. It is currently the most commonly used cataract procedure in the United States.
Multifocal lens implants are available for patients who would like good vision for both distance and reading without wearing glasses. Three types are approved by the U.S. Food and Drug Adminstration. Some patients get adequate focusing power for all distances from these lenses. However, they may experience contrast sensitivity and see halos around lights. The choice of lens type should be discussed with the surgeon in detail. Patients who are used to external bifocals, trifocals, or progressive lenses may be more interested in multifocal intraocular lenses.
Advances in anesthesia technique have made cataract surgery much easier for both patient and physician. Eye drops provide the primary anesthesia in most cases. Mild sedation can be used for patients who want it. As long as the patient can cooperate with the surgeon, this combination allows for rapid recovery with minimal side effects. Older techniques are still available for special needs. General anesthesia and retrobulbar or peribulbar injections provide stronger anesthesia for patients who are unable to cooperate.
The most common complication is posterior capsular opacification. This can be treated with laser surgery.