Cataract surgery treats cataracts, a common eye disease that occurs mainly in older people. During cataract surgery, the surgeon replaces the body's own cloudy eye lens with an artificial lens. Today, cataract surgery is a routine procedure. It can usually be performed on an outpatient basis and complications are extremely rare.
Here you will find further information and selected cataract surgeons.
A cataract, also known as a cataract, is the discoloration of the body's own eye lens. The lens becomes cloudy and those affected have the feeling of seeing through frosted glass.
In cataract surgery today, the cloudy lens is removed and replaced with an artificial lens. This also removes the perceived haze in the field of vision. It is one of the most common surgical procedures.
The term "cataract" comes from the Greek "katarrhaktes" and means "falling down" or "waterfall".
Easily recognizable clouding of the lens in an older man © 2707195204 | AdobeStock
Cataracts were already known in ancient times. Sufferers thought they were looking through a falling waterfall, a cataract, because of the blurred vision. It was believed that a liquid flowed behind the pupil, which then solidified and caused the cataract.
Cataract surgery was already known in Babylonian times. The cloudy lens was simply removed from the eye by means of a "cataract stitch".
Cataract extractions, i.e. the removal of a clouded lens, have been performed since the 18th century .
The physician J.J. Daviel first attempted to remove the cataract from the eye in 1745. The procedure that Daviel introduced promised better surgical results than the then predominant method of cataract surgery. His procedure became established and today's methods of cataract extraction are strongly based on his method.
Cataract surgery is the only way for cataract sufferers to see the world clearly and unobscured again. This involves replacing the body's own cloudy lens with an artificial lens .
There are basically two lens replacement procedures. They differ in whether the lens capsule remains in the eye or is also removed. The lens capsule is the natural holding apparatus for the lens of the eye. One therefore speaks of
The advantage of the lens capsule remaining in the eye is that it can also serve as an anchor for the subsequently inserted artificial lens.
The anatomy of the eye © bilderzwerg | AdobeStock
Without the lens capsule, implantation of the artificial lens is more difficult, but not impossible. The absence of the capsule can also affect the stability of the vitreous body. This increases the risk of retinal detachment by around 6 to 8 percent. Last but not least, a larger incision is required to remove the lens and capsule from the eye. This leads to an increased risk of infection.
Extracapsular cataract extraction is therefore the more advantageous method. It has replaced intracapsular cataract extraction since the 1960s.
In rare cases, intracapsular cataract extraction is still used. In Marphan's syndrome, a connective tissue disorder, the zonular fibers of the suspensory apparatus can become so loose and stretched that the lens slips out of place. In this case, the intracapsular method is used.
In third world countries, it is used as a standard procedure for the treatment of cataracts due to its low cost.
Today, phacoemulsification is the most common procedure in refractive surgery. The surgeon liquefies the lens of the eye using an ultrasound probe and then aspirates it. He then inserts a foldable artificial lens into the body's own lens capsule. This is therefore an extracapsular cataract extraction.
The procedure is associated with low risks. It can usually be performed on an outpatient basis, so that no hospital stay is necessary.
Numerous preliminary examinations are required before the actual cataract operation in order to minimize the risk of complications. These include measuring blood pressure and an ECG.
Blood coagulability is also important. In the days before cataract surgery, you should refrain from taking blood-thinning medication.
Before the cataract operation, the patient undergoes a thorough eye examination. The doctor will take precise measurements to determine the extent to which the clouding of the lens affects visual acuity. He can see how far the cataract has progressed.
The strength and refractive power of the artificial lens is also calculated. Using a slit lamp, the ophthalmologist examines whether and to what extent the cornea or even the retina is damaged. His aim is also to find out whether the clouding of the lens is caused solely by cataracts.
Cataract surgery is a routine procedure that can generally be performed on an outpatient basis. However, the prerequisites for this are that
If the patient suffers from other illnesses, outpatient eye surgery is not advisable.
Post-operative monitoring in hospital is particularly necessary in the case of cardiovascular diseases and diabetes. The inpatient stay will be around two to four days.
The doctor will inform you about possible risks and complications before the cataract operation.
The artificial eye lens is only a few millimeters in size. Ideally, it is anchored in the body's own lens capsule with its two holding arms © Axel Kock | AdobeStock
Cataract surgery is usually performed under local anesthesia. Special eye drops or local injections into the area around the eye are used for this purpose. The anaesthetic eliminates the sensation of pain and the eye's ability to move. For children or particularly anxious adult patients, the operation can also be performed under general anesthesia.
The aim of the procedure is to remove the clouded lens or the damaged parts of the lens and insert an artificial lens.
As a rule, only one eye is operated on initially. If the procedure is successful and free of complications, the second eye is also operated on.
To access the inside of the eye, a small incision of a few millimeters is required in the cornea or sclera.
The insertion of an artificial lens into the body's own lens capsule in the posterior chamber of the eye is standard today. This lens replacement can be carried out using various procedures, including cataract surgery with a femtosecond laser and phacoemulsification.
Cataract surgery with femtosecond laser
This procedure is the most precise and tissue-sparing method for lens replacement. It is only just beginning to establish itself and is currently only offered at a few eye centers.
Here, a computer-controlled femtosecond laser
The incisions are made with the utmost precision. This means that only very small incisions are required, which heal even better afterwards.
The artificial lens can be optimally anchored to the eye capsule through the precisely circular incision.
Phacoemulsification
Phacoemulsification is the most commonly used surgical method today. It replaced manual ECCE (see below) at the end of the 1990s.
An ultrasound probe is inserted into the eye through a 2-3 mm incision in the cornea. This uses ultrasound waves to destroy the lens of the eye, which is then sucked out through the small incision using a suction irrigation device.
A foldable artificial lens is then inserted into the eye through the tiny incision and fixed in the lens capsule. The incision on the cornea closes automatically after the operation.
The exact precision of the computer-controlled laser is lacking in this method compared to surgery using a femtosecond laser. The use of ultrasound waves to shred the lens of the eye can also damage surrounding tissue.
Nevertheless, this procedure is very safe and promising today.
In step 1, the lens is removed. The foldable artificial lens is then inserted (steps 2 and 3) © alexonline | AdobeStock
Manual ECCE
Manual ECCE is performed by the surgeon by hand and without laser or ultrasound assistance. In this way, larger and therefore naturally less precise incisions have to be made. The crystalline lens is removed through the approximately 7 mm long incision without being crushed. However, the lens capsule remains intact and can accommodate an artificial lens.
The surgeon then sutures the long incision. The resulting suture pulls the cornea together and distorts it. Visual performance can therefore not achieve an optimal result until healing is complete.
Compared to phacoemulsification, this type of surgery carries more risks. It can
The procedure is now only used in exceptional cases.
However, it is gentle on the cornea and can therefore be used if it has already been damaged. This is the case with advanced cataracts, for example.
If the lens nucleus is severely hardened and cannot be easily liquefied, it is also removed in one piece.
During intracapsular cataract extraction, the lens is removed together with the lens capsule. This requires a larger incision of around 8-10 mm in length on the cornea/leather membrane.
The surgeon uses a cold pin to freeze the lens and removes it from the eye in one piece together with the lens capsule. As the natural suspension for the lens is now missing, there are the following options for inserting the artificial lens:
The procedure usually only takes a few minutes per eye. The anesthesia lasts for around 10 minutes, but is renewed again and again if necessary.
During anesthesia, the patient must not touch the eye under any circumstances, as the lack of sensation could cause serious injury.
Cataract surgery takes about 15 to 20 minutes per eye. The operated eye is covered with an ointment dressing, which can be removed the following day. Vision improves immediately.
The first few days after the operation require intensive treatment with ointment and eye drops. You should always keep the subsequent appointments for check-ups.
You should be patient until full vision is restored. Even if the cataract operation is successful, you will still need to use a slight visual aid, such as glasses for near and possibly also for distance vision.
Cataract surgery on the eye is a routine procedure in eye surgery today. Around 600,000 cataract operations are performed every year, most of which are completely free of complications.
Nevertheless, complications can occur under certain circumstances. There are the following risks:
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