Reply To: cataract surgery

November 6, 2008 at 2:57 am

Warning, this is a long post.

I just recently finished having cataract surgery. I had one eye done, waited 5 weeks, then had the other one done. The process required several office visits. I had the initial confirmation of the cataracts and a pre-operative visit. This visit had three parts: a discussion of the surgery in detail, a measurement of several parameters of my eyes (to pick the correct replacement lens), and discussion of about anesthesia. I then had the surgery and three post-op visits, at one day, one week, and one month after.

I did each surgery without sedation, just lidocaine applied to the eye. I had very little pain afterwards. They covered my eye with a patch for a day. Once the patch was removed, I took an antibiotic eyedrop and an anti-inflammatory eyedrop 4 times a day for a week, then those same drops twice a day for a week or so. The anti-inflammatory was a steroid, given partly because the cornea does swell as a result of the surgery and partly because the antibiotic is irritating. I slept with a hard plastic patch (think pirates) over the eye for a week, to keep from rubbing it at night.

On the lack of sedation, the [COLOR=black]anesthesiologists [/COLOR]were clearly uncomfortable about it, but they went along with it. I decided to go without sedation because my one experience with it ramped up my CIDP symptoms quite a bit. It could have been coincidence, but as long as I could tolerate the surgery without it, why take the risk. As a tip, if you decide to go down that route, make sure they apply lots of lidocaine. My second surgery did not use as much as the first and it was definitely more uncomfortable. Of course, if you get anxious about surgery or don’t want to remember what happened, then sedation is appropriate.

When I went in for the surgery, I changed into a into a hospital gown (take very little with your and wear clothes that are easy to get out of and that you don’t mind getting rumpled) and laid on a gurney made for this sort of surgery. My eye was dilated and numbed. I had an IV placed, although it turned out I did not need it. Once my eye was dilated and numb (it takes about 1/2 to 3/4 hr), I was wheeled into the operating room.

Once there, my eye was sterilized with betadine. The doctor then applied a dressing over the eye and propped the eye open. He then made a small (3 mm) incision completely through the cornea. He used an ultrasonic probe to break up the lens and then flushed the pieces out with sterile saline. He then inserted the replacement lens. This lens was rolled up into a small cylinder and unrolled in the eye as he removed the insertion tool. He made sure it was properly centered. My eye was then washed and the patch applied. Total time from dressing to patch was under 10 minutes.

I was then wheeled out to recovery. Since I had not been sedated, they promptly removed the IV, took some vital signs, gave me my post-op instructions, and I was on my way. If I had been sedated, I would have laid there for an hour or so, while the anesthesia wore off.

After effects include seeing flares from light sources at oblique angles to your eye (commonly called halos), a general sense of haziness, and the inability to focus. The flares abate with time, but never go away completely. The haziness (technically, spherical aberration) is a consequence of removing the God-given lens and replacing it with one of a different shape. The inability to focus is a consequence of using a lens that does not deform. All of these are largely unavoidable with current technology, although some of the newer lenses can reduce spherical aberration or lack of accommodation. The cost can be pretty high, though. My standard lenses (American Medical Optics AR40e) had no copayment. The accommodating AMO lens would have had a copayment of $2500/eye.

As far as tips go, get very little sleep the night before the surgery. You will then sleep most of the day after the surgery, making the day less boring. Plan on taking the following day off from work, and keep your activities quite light for a day or two after that. Take your eye drops and wear the patch. Do not rub your eye; it will hurt like crazy. Try to get the two surgeries scheduled close together, especially if you are very myopic. The large difference in your vision is very disconcerting.

Godspeed to all who have this surgery.