- Cataracts
Cataract
What is cataracts?
Cataracts is a clouding of the lens that causes it to become opaque and scatter light. Cataracts are still cited as the most common cause of blindness in the world. Cataract surgery with implantation of an artificial intraocular lens is perhaps the most effective surgical method in all of medicine. To date, no conservative way has been discovered to prevent cataract formation and progression in an otherwise healthy eye. Today, there are some known risk factors that can lead to cataract formation - UV-B radiation, smoking, diabetes, alcohol, diarrheal diseases and oxidative disorders. The most common type is called senile or age-related cataract. The causes are multifactorial and have not yet been accurately explained. During aging, the lens enlarges, gains weight and loses elasticity. The proteins in the lens chemically change to a high molecular weight protein, resulting in changes in the refractive properties of the lens and a decrease in its transparency.
How can I tell I have cataracts?
Visual acuity is reduced, but this also depends on the intensity of light, the size of the pupil and the degree of myopia. Another symptom is a reduction in the contrast sensitivity; the eye's ability to discern is reduced. Furthermore, there may be impaired vision in bright light, glare. Another sign is a change in the diopters in glasses. Myopic people experience a worsening of myopia; farsighted patients may no longer need distance glasses. Sometimes monocular diplopia may occur. This is caused by an increase in the number of refractive surfaces in the centre of the lens, which can then produce a double image often associated with 'ghosting' (like a poor quality TV signal).
What tests do I need to undergo before cataract surgery?
Before cataract surgery, it is always important to ask the doctor a few questions about personal history, such as have I ever been treated with eye medications, did I wear glasses as a child, did I squint, did I have any other eye surgeries, if so, how did I heal after surgery, do I have high intraocular pressure, and so on. After a detailed history, the actual eye examination follows, where the position of the eyelids is examined, how the front segment of the eye looks (conjunctiva, cornea, anterior chamber, iris and of course the lens itself). This is followed by an examination of the ocular background, determination of refraction using an autorefractometer and Snellen optotypes, and measuring intraocular pressure. Then it is important to calculate the optical power of the lens, called biometry. The basic parameters that are measured are the axial length of the eye and the optical power of the cornea. The length of the eye can be measured by ultrasound or optically with the IOL Master. At our clinic, patients are booked in for this detailed examination by the referring doctor, who may be a general practitioner, a specialist consultant or the attending ophthalmologist. The examination also includes a detailed introduction to the pre-operative preparation, the internal pre-operative examination, the course of the operation itself and instructions on how the patient should act after the operation.
Is it necessary to take any eye drops before surgery?
During a detailed pre-operative examination, patients are given a prescription for antibiotic drops to be administered three days before surgery and then throughout the healing period after surgery until the attending physician determines that treatment is complete. The drops can be picked up immediately after the examination, and should not be opened until just before application. The drops are dropped 5 times a day 1 drop into the operated eye. One packet of drops lasts for approximately 14 days.
How does it work on the day of surgery, do I have to be hospitalized in the eye department or is it an outpatient procedure?
In 90% of cases, cataract surgery is an outpatient procedure, after which the patient goes home. In case of complicated operations or in case of significant patient dismobility, hospitalization is indicated. At our department there is also a possibility of a paid bed after cataract surgery. This option is particularly suitable for patients who are unable to arrange for a ride home after surgery. In the case of an outpatient procedure, the patient will arrive at our outpatient clinic at 6:30 am on the day of surgery. Here, the patients' dioptres are measured on an autorefractometer and the intraocular pressure is measured. Afterwards, an interview with the doctor is conducted, where there is an opportunity to ask additional questions about the operation, the doctor also checks whether the patient has undergone an internal pre-operative examination. If everything is in order and the patient feels fit for the operation, the patient is further referred to the inpatient part of our department. Here, a pre-operative examination is carried out by the head of the department, a suitable intraocular lens is selected and finally the order of patients for surgery is determined. If the procedure is an inpatient procedure, the patient arrives at the reception the day before.
What is the procedure for cataract surgery?
Cataract surgery is performed under local topical anaesthesia (numbing drops). The patient is awake throughout the operation, cooperation with the surgeon is very important. Afterwards, surgical instruments the size of a pen tip are inserted into the eye through a small incision, which are used to gradually break down the structure of the original cloudy lens. The cloudy lens is then removed using high-frequency ultrasound (phacoemulsification) or micro-pulses of fluid (AquaLase), while the lens is sucked out of the eye. The original lens is then replaced with an artificial intraocular lens. These lenses are made of a flexible material that allows the surgeon to roll it up and insert it into the eye through a very small incision. Once inserted into the eye, the lens unfolds and holds itself in place with its haptics (feet).
How to act after the surgery?
Immediately after the operation, the eye is sealed with a bandage and a firm flap to prevent unwanted bruising during the day and the following night. The eye remains like this until the next day, when the flap is removed and the first postoperative follow-up takes place. At the follow-up, visual acuity is tested using Snellen optotypes and the anterior segment of the eye is examined using a slit lamp. After the check-up, the operated eye is not taped again. After surgery, the patient must continue to receive antibiotic drops 1 drop 5 times a day in the operated eye and attend regular check-ups as instructed by the attending physician. In case of difficulties (impaired vision of the operated eye, pain or redness of the operated eye), a check-up is necessary immediately. After the operation, the patient must not lift heavy objects, exercise or work in a bending position. He can watch TV, go for walks, read and do normal household chores.
How long will it take for the operated eye to heal?
The total recovery time of the operated eye with a good postoperative course is approximately 2-3 months. After this time, a new glasses correction can be prescribed. In the meantime, the diopters may still change
- Eyelid surgery
Blepharoplasty (eyelid surgery):
What is blepharoplasty?
A surgical procedure in which we remove excess skin in the upper or lower eyelid area caused by loosening and aging of the skin. As it is a cosmetic procedure, blepharoplasty is not covered by health insurance (see price list).
How can I make an appointment for this procedure?
Before any blepharoplasty, a consultation and examination by a doctor of our eye department is necessary. This examination can be arranged at any time during the office hours of the general eye clinic.
What is the actual surgery like?
Blepharoplasty is performed under local anaesthesia, the patient is conscious and can communicate with the surgeon throughout the procedure. First, the extent of the skin excess is determined and a drawing is made on the skin. Once the skin excess is removed, the circular eye muscle is divided longitudinally, the connective tissue sheath of the fat pads is broken and the excess fatty tissue is removed. The skin edges are then stitched together and covered with a sterile dressing.
What to do after surgery?
After surgery, cold compresses should be applied to the eyelids to prevent any swelling and bruising. The next day the patient comes to our outpatient clinic for a check-up, when the sterile cover is removed. The stitches are then removed approximately 7 days after surgery.
