The Operation

What does a cataract operation involve?

A cataract is an opacity or haziness of the natural lens within the eye. A cataract operation involves removing this cloudy natural lens and replacing it with a clear plastic artificial lens. This lens is called the "intra ocular lens implant". These days a cataract operation is usually done under local anaesthetic as a day case. Surgery typically takes about 15 minutes, but may be longer.

Over the years the surgical techniques for removing cataract have evolved and improved. These improvements have brought about more rapid recovery after surgery with good vision achieved sooner. Most cataract operations performed in the UK nowadays use a procedure called "phacoemulsification".

Phacoemulsification

With phacoemulsification the cataract is broken up and disintegrated inside the eye. This means that the incision can be kept small, usually only about 3 mms in length. This is just enough to allow the tip of the phacoemulsification instrument to be inserted into the eye. During phacoemulsification fluid is continuously flushed through the front part of the eye to remove the cataract debris and to keep the eye inflated. Once the cataract has been removed the lens implant is placed into the eye. In order to keep the incision small many surgeons use foldable lens implants. As the name suggests these are made from a pliable plastic and are folded to allow them to pass through the small incision. Once inside the eye they unfold and are manoeuvred into place. Often no sutures are needed.

Figure 1.1 - The phacoemulsification tip used during cataract surgery

The best position for the lens implant is the same location as the natural lens of the eye, i.e. behind the pupil and iris. In order to provide support for the lens implant in this position part of the thin membranous outer shell of the natural lens is preserved. Eye surgeons call this the "capsular bag". When ever possible the lens implant is placed into it.

Sometimes the particular features of a cataract mean that a different surgical approach is needed. For example it may be necessary to use a larger incision to remove the cataract from the eye in one main piece. Sutures will then be required.

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