 A
few short years ago, the accepted method of cataract surgery was
to make a large incision, open the front portion of the eye and
remove the cataract in one piece. This meant that the cataract
had to "mature" or "ripen" to the point that it was firm, making
it easier for the surgeon to grasp. For a cataract to reach this
stage, vision in the eye usually became dramatically impaired
before surgery was performed.
At first, there
were no suitable materials to use as sutures in the eye, so the
eye had to be bandaged and heal on its own. This meant the
patient was confined to bed with their head sandbagged
to prevent movement that might jeopardize the healing process.
"Cataract" glasses with thick lenses or contact lenses were
required to assume the focusing power of the natural lens, which
was removed during surgery. Memories of this type
of surgery have caused many people to wait needlessly before having
cataract surgery.
"No-Stitch"
Cataract Surgery Uses a Self-Sealing Wound
Although sutures
were a major advance, they have been supplanted in most cases by
the use of a self-sealing incision. The shape of the incision
creates a flap that takes advantage of the natural fluid
pressure inside the eye to seal it shut without the need for
sutures.
The advantages of
"No-Stitch" cataract surgery using a self-sealing wound include
the following:
- Shorter surgery time
- The ability to stop surgery at any point
in the procedure
- Dramatically reduced recovery time
- Less surgically-induced astigmatism
- Less discomfort after surgery
To perform
"no-stitch" cataract surgery, two other advances were necessary:
the development of microsurgical techniques and the creation of
foldable artificial lens implants.
Microsurgical
Techniques
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Using
a
high-powered microscope, the surgeon makes a tiny
incision so that a probe |
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approximately the width of a match stick can be
used to remove the cataract. By use of ultrasound, the probe
dissolves the cataract, allowing it to be gently vacuumed from
the eye. Many people confuse this procedure (called
"phacoemulsification")
with LASER surgery. If
you hear of
a cataract being removed by LASER, you can
be sure the procedure really used was phacoemulsification. |
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enlarge |
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Foldable
Artificial Lens Implants
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Tiny artificial
lenses, called intraocular lenses, that could be
placed inside the eye |
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proved to be a dramatic solution to clear vision
following cataract surgery. By using
a soft
material that can be folded, the artificial lens can be inserted
inside the eye through the same incision used to perform the
phacoemulsification.
The lens is rolled up
into a special insertion device and "injected"
through the tiny 3 mm (1/8 inch) incision. |
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Once unfolded inside the eye, the artificial lens is
held firmly in place in the space |
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previously occupied by the cataract. After a few
weeks, the lens heals
into place and becomes even more stable.
The
micro incisions used to insert foldable lenses
induce much less astigmatism and generally
make the final visual
result far more predictable than was true in the
past. |
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enlarge |
Illustrations
are courtesy of Staar Surgical Co., Monrovia, CA |
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