Cataracts and No Stitch/Small Incisions Surgery - WMBB News 13 - The Panhandle's News Leader

Cataracts and No Stitch/Small Incisions Surgery

Topical Anesthesia, with a Clear Cornea Incision,
No Stitches, No Eye-Patch

A New Technique for Safer and Faster Vision Restoration

Although the formation of a cataract can make activities such as reading and driving difficult, good vision can be safely restored with outpatient cataract surgery. Today, with the development of no stitch/small incision cataract surgery, many patients are experiencing a faster recovery and a quicker return to good vision.

What is a Cataract?

A cataract is the clouding of the lens of the eye. Normally, light passes through the clear lens of the eye and is focused onto the retina. However, as a result of the natural aging process, the lens gradually becomes cloudy. The cataract or cloudy lens blocks the passage of light through the eye and causes distorted or blurred vision.

Restoring Vision

Once a cataract has formed, the most effective way to restore vision is to remove the cloudy cataract and replace it with a plastic lens implant (Intraocular lens or IOL).

With recent advances in cataract surgery equipment and techniques, vision can be restored safer and faster, allowing patients to resume normal activities within hours after surgery (some activities may be limited during healing). Using these state of the art techniques, cataract surgery has a success rate greater than 98%.

Topical or No Needle Anesthesia

Previously, cataract surgery was performed under general anesthesia requiring patients to stay in the hospital. Later advances used a local anesthesia (retrobulbar or peribulbar blocks) where a needle stick is made, penetrating to just behind the eyeball where the anesthetic is injected. Although this procedure allows patients to return home the same day and is safer than using general anesthesia, it is not entirely free of risk.

Today, with recent advances in cataract surgery anesthesia, topical anesthetics are used. A patient may be given a sedative to help them relax and to keep them comfortable during the procedure. Next the eye is anesthetized with eye drops instead of a needle injection.

Advantages of Topical Anesthesia

  • Faster with greater patient comfort.
  • No patient anxiety over receiving a deep injection next to the eyeball.
  • Visual recover begins immediately since the eye muscles aren't paralyzed as with local block anesthesia.
  • Eliminates potential complications such as perforation of the eye, hemorrhage or damage to the optic nerve.
  • Removes the chance for a relatively dangerous anesthesia induced allergic reaction.
  • Eliminates potential for postoperative headaches caused by conventional blocks.
  • Eliminates need for an eye patch.

No Stitch / Small Incison Surgery

No-stitch/small incisions are surgical techniques used to restore vision loss due to cataracts. The cloudy lens is removed and replaced with a plastic lens (IOL) implant. Ultrasound technology (phacoemulsification) is often used to remove the cataract. A special lens can then be implanted through a smaller incision than is required in traditional cataract surgery.

Phacoemulsification (phaco) is a surgical technique which uses ultrasonic technology. In "phaco" or small incision surgery, a small probe is inserted into the capsular membrane which surrounds the cloudy lens. Ultrasound is used to gently break up (or emulsify) the cloudy lens into tiny pieces, which can be removed through the tip of the probe. In comparison, traditional surgery techniques require the lens to be removed in one piece through a relatively large incision.

Traditional cataract surgery requires an incision that spans a third of the circumference of the cornea and needs as many as eight stitches to close. In contrast, the phaco technique allows the cloudy lens to be removed through an incision as small as 1/6 of an inch wide.

In many cases, the incision can be closed with just one stitch. In cases where the surgeon can use a technique that does not require sutures, the natural pressure inside the eye is used to keep the incision closed while the eye heals.

Advantages of No Stitch / Small Incision Surgery

  • Faster recovery of good vision
  • Faster return to normal activities
  • Good vision in a matter of days instead of weeks or even months
  • Return home within hours of the procedure
  • Reduces the chance of surgically induced astigmatism or ruptured sutures

No stitch/small incision surgery not only speeds the healing and recovery process, but also reduces the risk of possible complications. In traditional surgery, tying the sutures too tightly may create astigmatism or a distortion of vision. The patient may experience blurred vision until natural healing corrects the astigmatism or the sutures are removed. However, if tied too loosely, the incision may leak or rupture. A no-stitch/small incision can be closed very securely without causing astigmatism. In addition, there is less chance of leakage and ruptured sutures.

No-stitch/small incision cataract surgery is performed on an outpatient basis. Before the surgery, the patient is given an anesthetic to numb the eye and keep them comfortable during surgery. Most patients return home a few hours after the procedure, with little or no need for pain medication.

Most patients can expect a rapid return to good vision following no-stitch/small incision cataract surgery. In many cases, patients are able to see relatively well the day after surgery without glasses. However, some patients will need to wear glasses for reading and other activities following the procedure. Quickly returning to an active lifestyle is one of the primary benefits of no stitch/small incision cataract surgery. "Secondary" cataracts may develop following cataract surgery. If this occurs, an outpatient laser procedure will quickly restore good vision.

With the no-stitch/small incision techniques, fewer or no stitches are needed than with traditional techniques. However, the size of the incision and the number of stitches used varies from patient to patient. Some patients, because of their eye structure or other health factors, are not good candidates for no-stitch/small incision surgery. In these cases, patients can have traditional surgery and expect to do well.

Although there is no way to prevent the development of cataracts, loss of sight from the disease is largely preventable. With modern technology, cataracts can be removed and good vision restored. Cataract surgery can be performed when a loss of vision begins interfering with daily activities.

If you are experiencing the symptoms of cataracts, or other vision problems, you should obtain a complete eye examination.

After surgery

Many patients are pleased to find that after topical, clear corneal cataract surgery their vision improvement begins almost immediately, and they return home within a few hours after the procedure. Patients may find their vision better than ever; however, some will need to wear glasses for reading and other activities following the procedure. During the initial healing period there may be a few limitations on strenuous activities. However, most people find they are able to return to a normal lifestyle immediately, plus start doing things poor cataract vision had restricted them from doing in the past.

"Secondary" Cataracts

During cataract surgery, a clear capsule is left in place to support the lens implant. In some cases this capsule may turn cloudy months or years after surgery creating a "secondary" cataract. If this occurs an outpatient laser procedure will quickly restore good vision.

Is Topical Anesthesia, No-stitch, No-patch Cataract Surgery for Everyone?

In most cases the topical anesthesia, no-stitch, no-patch techniques are preferred. However, some patients, because of their eye structure, health or other factors, may not be good candidates for the new techniques. In these cases, patients can have traditional surgery and expect to do well. A complete eye examination and consultation with the doctor is necessary to determine each individual's specific needs and potential for improved vision.

Sight Loss Can Be Prevented

Loss of sight from cataracts is usually preventable. With modern technology, cataracts can be removed and good vision restored when a person feels the loss of vision is great enough to interfere with daily activities.

If you are experiencing the symptoms of cataracts or other vision problems, you should obtain a complete eye examination.