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Cataract Management

I have been diagnosed with cataract. My daughter is getting married next month. Can the surgery wait?

Cataracts usually mature slowly.

The patient, in consultation with his ophthalmologist, should decide when his eye should be operated. 

Unless it is a Hypermature cataract, there is generally no emergency about cataract surgery. If you get the surgery done before the wedding, may be you can admire the newly-wed couple better!

Today, cataract surgery is performed when the cataract is interfering with the subject's daily life and duties - it may be done even when the cataract is immature.

Spectacles - The cataract increases the refractive power of the lens, making the person myopic. This can be corrected wholly or partly with appropriate glasses.


Protection from ultraviolet light (UV B) and strong sunlight, by using Sunglasses.
Balanced Diet and Healthy habits. Role of Antioxidants like Zn, Se,  Lutein, Zeaxanthin, Vit A, B, C, E, Calcium etc is not proven.


Why should I get my cataract removed?

A Cataract can become Hypermature. This means, the material inside the lens becomes liquid, milky white. It starts leaking proteins into the aqueous. This causes inflammation of the eye, pain, severe headache and glaucoma. This requires an Emergency hospital admission and surgery.

Routine Cataract Surgery -

Anaesthesia- Local injection for the eye or topical anaesthesia with drops.


Antibiotic drops prior to surgery may be given.
Dilating drops every 10 min, 2 hours before surgery.
Other medications like those of diabetes, hypertension are to be continued as before.

Procedure -

The patient lies down on the operating table.

  1. The eye to be operated is cleaned with Betadiene or and other antiseptic solution. An eye drape is placed, other eye is covered. 
  2. The surgeon sits at the head-end. He views the eye through the operating microscope. 
  3. The lids are kept open. A small incision is taken in the upper cornea. 
  4. The anterior capsule of the lens is cut open. 
  5. The cataract is extracted either by manually delivering out the nucleus or by cutting the nucleus into very small parts, using Phaco-emulsification. These small bits are then sucked out. 
  6. All the cortical matter is removed. 
  7. An artificial lens is placed over the posterior capsule. 
  8. Sutures may or may not be applied, depending on the size of incision and the surgeon's technique. This type of surgery is called as ECCE, Extracapsular cataract extraction.

In olden days, Intracapsular cataract surgery (ICCE) was done, when the whole lens with the anterior and posterior capsule was removed. In those days, IOL was not used and thick aphakic glasses had to be used postop. These were heavy, cosmetically disfiguring and had a lot of problems, vision was never satisfactory, since everything got highly magnified with them.

Cataract surgery is NEVER done by LASER.


Post-operatives -

The eye is kept closed, with an eye-pad for about 6-8 hours after surgery. Painkillers are given. Other medications for diabetes, hypertension  are to be continued as before.

Dark glasses are worn for 2-3 weeks post surgery. These keep the eye protected from dust or any mechanical injury.

Eyedrops are to be instilled as advised. They consist of 

Steroid eye drops to keep the inflammation under check.
Antibiotic drops to prevent infection
Cycloplegics to relax the eye.

Each ophthalmologist has his own regime, but the general scheme remains the same.


Post Operative Visit Schedule

A Follow-Up on -

    Day 1

    2 nd Week

    3 rd - 4th Week

    6 th Week 

By sixth week, the eye has healed and any corrective glasses, that are required may be given. Glasses for near vision are usually required after cataract surgery, inspite of the IOL. This is because the IOL cannot change its refractive power like the natural lens.

Post-Operative Instructions

The eye needs to be cleaned 3-4 times a day with clean cotton, to remove the discharge. The cotton is boiled in water, cooled and then used, for better sterility. Water for cleaning is better if boiled and cooled.
A head bath is avoided for 3-4 weeks, post-op.
Swimming is avoided for 6 weeks.
Avoid lifting heavy weights 3-4 weeks post-op.
Persons doing table-jobs can return to work in one week.
An eye- shield should be placed on the eye while sleeping, for about 4 weeks.

Any complaints or sudden redness should be treated as emergency and ophthalmologist seen immediately.


Complications -

Every surgery is a risk, but every precaution is taken to avoid the untoward.

Early -

Infection- This can be mild or may be severe. Usually presents as increased redness, pain and watering. Infection involving, the whole eye called endophthalmitis. For this, antibiotics are given, in form of drops, tablets or injections into the eye. It is vision threatening.

Inflammation - Mild inflammation is okay, but it can be severe especially in diabetics, and requires treatment and follow-up. 

Increase in intra-ocular pressure can occur, and is controlled by drops.

Late complications-

Infections are rare.

The posterior capsule gets opacified. Sometimes, few lens fibers remain behind inspite of through cleaning and these can grow and opacify later, thus reducing vision at a later date. These are remedied by cutting the posterior capsule with Laser. Posterior capsule opacification occurs to at least a minute extent in 60% cases.

CME - Cystoid macular edema. This means swelling of the center of the retina at the macula. This is not very common, except in diabetics and uveitis.

IOLs are very commonly in use now and they rarely cause any complications.




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