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ISO 9001:2008 Certified Hospital For Cataract & Glaucoma 

   

>  CATARACT OPERATION

>  LASIK 

>  GLAUCOMA

>  SQUINT CORRECTION

>  CONTACT LENSES - RIGID & DISPOSABLE

>  SPECTACLES

Yag Laser Capsulotomy

State of the art Operation Theatre with Cold Phaco System

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Phacoemulsification
with Injectable/ foldable Lens

Cataract being emulsified

Introducing Injectable lens through the injector

 

The Injected Lens in place

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The injectable Intraocular lens emerging out of the injector

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  • Out Patient Section:

    WESTEND EYE HOSPITAL
    High Court Junction
    Banerji Road,
    Cochin
    Kerala, India.
     

  • Surgical Wing & OP Section

    WESTEND EYE HOSPITAL
    Near Vimalalayam,
    Chittoor Road
    Cochin, Kerala, India.

    Phones: High Court Jn: (0484) 235 4452
    Kacheripady: (0484) 329 3051
    Mobile : (91) 94467 07272
    e-mail :

Call (0484) 235 4452 or 329 3051 for advance Booking

RECENT TRENDS OF CATARACT TREATMENT

Dr. Davis J. Akkara &
Dr. Ethamma Davis
Westend Eye Hospital.
Cochin 31.


We realize the importance of our eyes only when our vision reduces or when there is an ailment affecting the eye. Most of the times the eyes are taken for granted! The most common cause for reduced vision is cataract.

Cataract is the clouding or pacification of the clear God given lens within the eye. If the lens of a photographic camera becomes dirty or opaque, the pictures taken with it also becomes blurred. Similarly, a person with cataract can not see clearly. The vision will be like seeing through a glass pane with a silk curtain or fog in front of it.

Cataract usually affects people above 50 to 60 years of age. Even new borns and young adults also have cataract though it is not very common. Injury to the eye, radiation, food habits, maternal infections during pregnancy, heredity, etc. are known to cause cataracts. But in majority the cause may not be known. Cataract can be compared to graying of hair in many aspects. It can happen at any age; and the cause is unknown.

The medical science is developing so very rapidly that it is difficult for the common man to get the latest information always. It is important for a person who has cataract to know the latest in cataract treatment. Many people with poor vision suffer unnecessarily and wait for the cataract to mature for the operation. With the present technology cataract need not be mature for its removal. In fact cataract operation is safer when cataract is NOT mature!

Treatment of cataract

Change of the spectacles improves the vision to a certain extent in the early stages of cataract. As the cataract advances, change of glasses does not improve the vision. He can undergo cataract operation at that time.

No eye drops in any system of medicine have scientifically proved its ability to reduce cataract. The claims that the medicines work are with out proper reliable scientific studies. Some doctors do advice medicines for the psychological effect it has and because it does not do any harm. Recently a group of vitamins called anti-oxidants have been reported to slow down progress of cataract. It may be beneficial to take these vitamins to slow down cataract.

Operation is the only accepted method of treatment for cataract. Cataract has a diameter of approximately 10 mm. and so when the cataract is to be removed in one piece the wound also should be of approximately 10 mm. A plastic lens is implanted in the place of cataract (intraocular lens) to regain vision. Commonly done operations are:

1. Cold Phaco with Rollable/ Multifocal IOLs. (High Efficency Low Energy Phaco)

2. Phacoemulsification with Injectable/ Foldable/ Multifocal Lens (Commonly called laser operation)

3. Small Incision Cataract Operation (SICS, key hole surgery with rigid Lens).

4. Conventional Cataract Operation with IOL (Intra Ocular Lens) implantation.

Cold Phaco with Rollable/ Multifocal Lens

It is the latest technique where the cataract is removed with a High Efficiency Low Energy Phaco System which is even less traumatic to the eye than the regular phacoemulsification. Using micropulses the phaco tip is kept constantly cool, further reducing the chances of tissue injury. The wound healing is even faster than phaco and quality of vision is better because of reduced scaring and faster healing.

Phacoemulsification with Injectable/ foldable Lens

It is the technique of cataract operation where the cataract is emulsified (made into fine powder) with the help of a computerised machine using high frequency waves and aspirated (sucked out) through a needle from within the eye. Contrary to the popular belief, no laser is used for this procedure. Femtosecond lasers can now be used to do a part of the surgery in phacoemulsification. The cost of the laser machine defeats the advantages of using it. The Intra Ocular Lens is 'injected' into the eye through a similar needle. The size of the incision varies from 0.9 mm to 5.0mm depending on the type of the lens implanted. The best results are when the wound is 3 mm or smaller. Only the lenses that are injectable or foldable go in through these small puncture wounds. Foldable multifocal IOLs are done only after phacoemulsification. Since the wound is small, there is no need to apply sutures. Phacoemulsification eliminates the need for large wound in cataract operation.

The advantages of phacoemulsification are very apparent. Stable vision is restored in one or two days. Since the wound is only the size of a needle puncture, the healing is a lot faster and the patients can go to work almost the next day. They can have bath also the next day. However as a matter of caution some doctors advice rest for about a week. Because the wound size is small, and because the wound is not "opened" like in conventional surgery, the chances of infection are greatly reduced in phacoemulsification. The scar is also very small and so the anatomy of the eyeball is least distorted. Since there is no suture (stitch) applied, the irritation due to suture does not arise.


The Phacoemulsification has its limitations also. Hyper Mature (Over-ripe) cataracts and certain types of black and hard cataracts are difficult to emulsify. Only a highly skilled surgeon will be able to emulsify even hard cataracts. In fact it is better to operate on a cataract before it is fully mature.

The Phaco machine is very expensive. The semidisposable phaco tips and tubings are also expensive. The new generation injectable lenses also add to the cost of the operation making the operation expensive. However, the advantages of the phaco operation outweigh the disadvantages and so more and more patients opt for phacoemulsification.


Low Cost Phaco/ Manual Phaco/ Key Hole Operation/ SICS.

Small Incision Cataract Surgery(Key Hole surgery, SICS) is a technique where the cataract is squeezed out manually through a small incision. The size of the incision varies from 6.00 mm to 7.5 mm. depending on the size of the cataract. Because the incision size is larger when compared to machine phaco, one or two sutures may be required to avoid astigmatism and to get good vision after operation. The patients will have to take longer rest as larger incision takes longer to heal when compared to machine phaco.

It is not worth implanting an injectable lens through a SICS incision because the injectable lenses are made so that they can be injected through an incision as small as 2.8 mm. The incision for removal cataract in SICS is at least 6.00mm. And so 6 mm rigid lenses which are much cheaper are used in SICS.


The main advantage of SICS is that since no costly machines are used in this operation and only rigid lenses are used for implantation, it is cheaper when compared to computerised machine phaco. The total expense of the surgery comes down with SICS though the period of rest will have to be longer for wound healing.

Though a little more expensive, the best operation available today for cataract is Phacoemulsification with injectable lens. Manual operation is a good operation done at lower cost.

Conventional Cataract Operation with IOL implantation which gave people with cataract vision after cataract operation with out thick cataract spectacles was considered a revolution in 1980 s. This type of surgery needed 8 to 10 mm incision for cataract removal and IOL implantation. Sutures had to be applied and it took longer to heal and hence longer rest. Our life has become so fast that few people opt for conventional surgery because they do not want take long periodsof rest.

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