“You have a cataract. This occurs when lens of the eye (that focuses light onto the back of the eye) becomes cloudy (it is normally clear like glass). Cataracts can cause blurred vision as well as glare.”
Aim: “Remove the cataract and replace it with a clear artificial lens to improve vision”.
NB: Cataract surgery is increasingly being undertaken as a refractive surgical procedure and community expectations of refractive outcomes are high. Expected refractive outcomes form an important part of the consent process for all cataract operations. The consent process is different depending on the patient’s current level of vision and desired refractive outcome. Patients requesting spectacle independence must be assessed fully from a refractive surgery perspective. Candidates must be clear with their patients pre-operatively about the expected refractive outcome and criteria for surgical “success”.
“A cataract operation involves making a small incision in the front of the eye, taking out the lens with an ultrasound probe and inserting an artificial plastic lens that stays in for life. (Use a model or diagram).
“Although cataract surgery has excellent success rates, complications may occur that can leave you with vision worse than you have at present”:
Many patients still require glasses after cataract surgery, particularly for reading. More common after previous refractive surgery. Clearly establish pre-operatively what refractive outcome is desired and guaranteed, and steps that can be undertaken if this is not achieved
e.g. Pseudophakic cystoid macula oedema. May need drops or another procedure
“Membrane growing on the back of the lens”. Treated with laser in clinic
Difficulty Removing Lens
May need another operation
Infection in the Eye
1:1000 risk of endophthalmitis. Permanent loss of vision or eye is rare but possible
Very rare but can result in permanent loss of vision
Especially if young, high myopes
Extremely rare but essential to mention
Stress compliance, close follow-up, need for urgent review if develops a sore red eye or reduced vision.
“Your cornea (the front “window” of the eye) has become cloudy (draw a diagram). A corneal graft is the only way to restore its clarity and improve your sight.”
Aims depending on indication:
“A corneal graft is an operation where the damaged cornea is removed and replaced with a donor cornea. The donor cornea comes from someone who has died and has donated his or her eye (so the timing of the operation may depend on availability).”
e.g. Descemet’s Stripping Endothelial Keratoplasty (DSEK)
Deep Anterior Lamellar Keratoplasty (DALK)
“Although corneal grafts have excellent success rates, complications may occur that can leave you with vision worse than you have at present”:
May need admission, medications, another operation
Astigmatism is common
May need glasses / contact lenses / another operation
Takes time for good vision
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Vitreoretinal Surgery Online
This open-source textbook provides step-by-step instructions for the full spectrum of vitreoretinal surgical procedures. An international collaboration from over 90 authors worldwide, this text is rich in high quality videos and illustrations.