After The Operation
After the Operation - More
This section provides more information about the care of the eye after a cataract operation and what to expect during the recovery period. It expands on the brief explanation given on the previous page. It includes information about:
During the recovery period the eye should become progressively less red, more comfortable and have improving vision. If the opposite happens, i.e. if the eye becomes more red, more painful or the vision becomes worse then the patient should seek urgent review by their surgical team.
The morning after surgery the lids may be slightly crusted. This is the dried residue from the watering of the previous day and night. This crusting should be wiped away by simple bathing of the eyelids with cotton wool wetted with sterile saline. If the patient is returning to the eye unit on the first post-op day this will be done by nurse there. If not the patient may easily and safely do this for themselves at home. A small dressing pack and instructions may be provided for this purpose. No undue pressure should be put on the eye. Once the lids have been cleaned the post-operative eye drops should be commenced.
One or two drops should be placed just inside the lower lid. It is easier if some one can do this for the patient. The patient should look slightly upwards and the lower lid should be pulled slightly downwards. This will create a gutter between the lower lid and the eye and the drop should be placed here. The eye should then be gently closed and dabbed lightly with a tissue to absorb any excess of drops that spill from the eye. It may be helpful to keep the eye closed gently for a minute or two.
The patient may wash their face, bath and shower and wash their hair as necessary but pressure on the eye must be avoided. It is sensible to try to avoid getting soap or splashes in the eye. It is unlikely to do any harm, as long as the eye is not rubbed, but may cause more irritation than normal in the early days following surgery.
Post - Op Dos and Don'ts
Post Operative Recovery
Following cataract surgery the eye may initially be a little red and light sensitive. This is normal. Sometimes there is a bruise overlying the white of the eye. This is called a subconjunctival haemorrhage. It can make the eye look quite red and alarming but is of no consequence. Like a bruise elsewhere it will clear over a week or two.
The speed of improvement in vision varies from patient to patient. If cataract was the only problem with the eye many patients obtain good vision within a few days. For others the vision may require longer to settle even when the surgery has been entirely straight forward. For most cases of small incision phacoemulsification cataract extraction the eye will be recovered from surgery in about 3 weeks. If a larger incision has been used, requiring stitches, full recovery may take 2 to 3 months.
Even before the eye regains perfect focus patients often report that vision is far brighter and that colours are much more vivid. This is particularly striking when the first cataract is removed in someone with cataract in both eyes.
The operation will usually alter the focus of the eye. This means that the patient's existing spectacles may not provide clear vision after the operation. The patient need not wear their old spectacles, unless they wish to do so for the benefit of the vision in the other eye. If old spectacles are used they may cause the operated eye to be out of focus but for anyone over the age of 7 years this is not harmful. It is not damaging to the eye.
The usual intention is to restore clear and focused distance vision to the eye. If this is achieved the patient may see better after the operation without their old distance spectacles, though new near vision spectacles will be required. The precise requirement for spectacles following cataract surgery will though vary from patient to patient.
Before visiting the optician for new spectacles the eye should have fully healed. This is because the focus of the eye may change a little during the healing process. If new spectacles are purchased too soon after the operation they may need to be changed again within a short period. The surgical team will advise the patient when new spectacles may be obtained. For small incision phacoemulsification cataract surgery this is usually at around 3 to 4 weeks after the operation. For larger incision surgery with stitches it may be 2 to 3 months before the focus of the eye has settled sufficiently for a visit to the optician. If both eyes are to have cataract surgery within a short period the patient may wish to wait until both operations have been done before obtaining new spectacles. If there is a planned large change to the focus of the eyes the patient may have difficulty in working the vision of the two eyes together in the interval between surgery on one eye and the other. In this situation also it may be better to wait until both cataracts have been removed before obtaining new spectacles.
Posterior Capsule Opacity ("after cataract")
With modern cataract surgery the aim is to retain the thin outer membrane of the natural lens of the eye. Eye surgeons call this the "capsular bag". It provides support for the plastic lens implant.
The natural lens of the eye is shaped like a small disc very similar in size to a smartie sweet. The capsular bag is like the outer coloured sugar shell of a smartie. Using this analogy the cataract is the chocolate inside the sugar coating. In order to remove the cataract (the opaque lens) an opening is made in the front part of the capsular bag. This is rather like removing part of one surface of the sugar coating of a smartie in order to get at the chocolate inside. The back layer of the capsular bag remains intact. This layer is called the "posterior capsule". It is extremely thin and delicate. Preserving this layer during the operation keeps the vitreous jelly that fills the main cavity of the eye in place. If the posterior capsule breaks the vitreous may move forwards into the front part of the eye and complicate the surgery. Eye surgeons therefore make every effort not to rupture the posterior capsule.
At the end of the cataract operation the posterior capsule is usually perfectly clear and transparent. In some patients in the months following surgery it may become less clear and hazy. This is called "posterior capsule opacity". This can then reduce vision giving the patient the impression that the cataract is coming back. It has therefore also been called "after cataract". Posterior capsule opacity occurs because some microscopic lens cells are inevitably left in the recesses and lining of the capsular bag at the end of the cataract operation. In the weeks and months after the operation these cells proliferate and migrate across the posterior capsule surface. They may change character and lay down material which is not transparent. The posterior capsule then becomes hazy sometimes resembling thin tissue paper. This progressively obscures vision.
The treatment for posterior capsule opacity is to use a laser to zap a small hole in the centre of the membrane to clear the line of vision. The laser concerned is called a YAG laser and the procedure is known as a YAG laser posterior capsulotomy. It is very simple to perform and is an outpatient procedure. It takes just a few minutes to do and is completely painless. A special contact lens may be placed onto the eye to hone the laser beam. Short acting anaesthetic eye drops are used to numb the surface of the eye so that this contact lens can be tolerated.
There is a small risk, perhaps of the order of 1 percent, that a YAG laser posterior capsulotomy may cause a disturbance to the retina at the back of the eye, e.g. a retinal tear or retinal detachment. Eye drops are sometimes used for a short period after the procedure to prevent a pressure rise and inflammation within the eye.
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