Phacoemulsification for Cataracts Health Article

Risks

Complications are unlikely, but can occur. Patients may experience spontaneous bleeding from the wound and recurrent inflammation after surgery. Flashing, floaters, and double vision may also occur a few weeks after surgery. The surgeon should be notified immediately of these symptoms. Some can easily be treated, while others such as floaters may be a sign of a retinal detachment.

Retinal detachment is one possible serious complication. The retina can become detached by the surgery if there is any weakness in the retina at the time of surgery. This complication may not occur for weeks or months.

Infections are another potential complication, the most serious being endophthalmitis, which is an infection in the eyeball. This complication, once widely reported, is much more uncommon today because of newer surgery techniques and antibiotics.

Patients may also be concerned that their IOL might become displaced, but newer designs of IOLs also have limited reports of intraocular lens dislocation.

Other possible complications are the onset of glaucoma and, in very rare cases, blindness.

It is possible that a secondary cataract may develop in the remaining back portion of the capsule. This can occur for as long as one to two years after surgery. YAG capsulotomy, using a laser, is most often used for the secondary cataract. This outpatient procedure requires no incision. The laser makes a small opening in the remaining back part of the lens to allow light to penetrate.

Normal results

Most patients have restored visual acuity after surgery, and some will have the best vision of their lives after the insertion of IOLs. Some patients will no longer require the use of eyeglasses or contact lenses after cataract surgery. Patients will also have better color and depth perception and be able to resume normal activities they may have stopped because of impaired vision from the cataract, such as driving, reading, or sports.

Morbidity and mortality rates

Phacoemulsification has taken the previous risks from cataract surgery, making it a much safer procedure. Before phacoemulsification, death after cataract surgery was still rare, but usually stemmed from the possible complications of general anesthesia. Phaco is performed under local anesthesia, limiting the risk of general anesthetic use.

Other serious complications such as blindness also have been reduced with the widespread use of phaco. Better antibiotics have enabled physicians to combat former debilitating infections that previously would have caused blindness.

Alternatives

Some older methods of cataract surgery may have to be used if the cataract is too large to remove with a small incision, including:

• Extracapsular cataract extraction. While phaco is considered a type of extracapsular extraction, the older version of this technique requires a much larger incision and does not use the phaco machine. It is similar in that the lens and the front portion of the capsule are removed and the back part of the capsule remains. The surgeon might consider this technique if the patient has corneal disease or if the pupil becomes too small during the first stages of surgery.
• Intracapsular cataract extraction. This also requires a larger incision than phaco. It differs in that the lens and the entire capsule are removed. While it is the easiest cataract surgery for the surgeon technically, this method carries an increased risk for the patient with increased potential for detachment of the retina and swelling after surgery. Recovery is long and most patients will have to use large "cataract glasses" to see.

See also Extracapsular cataract extraction.

BOOKS

Buettner, Helmut, ed. Mayo Clinic on Vision and Eye Health. Rochester, MN: Mayo Clinic Health Information, 2002.

Cassel, Gary H., Michael D. Billig, and Harry G. Randall. The Eye Book: A Complete Guide to Eye Disorders and Health. Baltimore, MD: Johns Hopkins University Press, 1998.

Jaffe, Norman S., Mark S. Jaffe, and Gary F. Jaffe. Cataract Surgery and Its Complications, 6th Edition. St. Louis: Mosby, 1997.

Massengill, R.K. Supersight: The Lens Implant Miracle. Boston, MA: Health Institute Press, 1987.

Slade, Stephen G., Richard N. Baker, and Dorothy Kay Brockman. The Complete Book of Laser Eye Surgery. Naperville, IL: Sourcebooks, Inc., 2000.

Spaeth, George L., ed. Ophthalmic Surgery Principles and Practice. Philadelphia, PA: W.B. Saunders Company, 1982.

ORGANIZATIONS

American Academy of Ophthalmology. P.O. Box 7424, San Francisco, CA 94120-7424. (415) 561-8500. <http://www.aao.org>.

American Optometric Association. 243 North Lindbergh Blvd., St. Louis, MO 63141. (314) 991-4100. <http://www.aoanet.org>.

American Society of Cataract and Refractive Surgery. 4000 Legato Road, Suite 850, Fairfax, VA 22033-4055. (703) 591-2220. E-mail: <ascrs@ascrs.org>. <http://www.ascrs.org>.

National Eye Institute. 2020 Vision Place Bethesda, MD 20892-3655. (301) 496-5248. <http://www.nei.nih.gov>.

OTHER

"Cataract Surgery." EyeMdLink.com, [cited March 28, 2003]. <http://www.eyemdlink.com/EyeProcedure.asp.EyeProcedureID=19>.

Samalonis, Lisa B. "Cataract Surgery Today." Eye World, February 2002 [cited March 28, 2003] <http://www.eyeworld.org/feb02/0202p34.html>.

Mary Bekker