CATARACT EXTRACTION DEFINITION Cataract extraction is a short, outpatient procedure.

The procedure can usually be done in less than an hour in the hospital or in an outpatient surgery center. The patient can go home the same day of the surgery. Cataract surgery is a procedure performed to remove a cloudy lens from the eye; usually an intraocular lens is implanted at the same time. INDICATION It is indicated when cloudy vision due to cataracts has progressed to such an extent that it interferes with normal daily activities. It is one of the most commonly performed surgical procedures in the world. Cataract surgery is usually done if you cannot see well enough because of cataracts. Cataracts usually do not harm your eye, so surgery can be done when it is convenient for you. ANATOMY OF AFFECTED PART The crystalline lens is a transparent, biconvex structure in the eye that, along with the cornea, helps to refract light to be focused on the retina. The lens, by changing shape, functions to change the focal distance of the eye so that it can focus on objects at various distances, thus allowing a sharp real image of the object of interest to be formed on the retina. This adjustment of the lens is known as accommodation. It is similar to the focusing of a photographic camera via movement of its lenses. The lens is flatter on its anterior side. PHYSIOLOGY OF AFFECTED PART The lens, where cataracts form, is positioned behind the colored part of your eye (iris). The lens focuses light that passes into your eye, producing clear, sharp images on the retina the light-sensitive membrane on the back inside wall of your eyeball that functions like the film of a camera. A cataract scatters the light as it passes through the lens, preventing a sharply defined image from reaching your retina. As a result, your vision becomes blurred.

SURGICAL TECHNIQUE TO BE MADE BY THE SURGEON The surgeon uses a microscope to look at the eye. A small cut is made in the eye. The lens is removed. How it is removed depends on the type of cataract. It may be done:

With special tools and suction Using sound waves (ultrasonic energy) that break up the lens and suction to remove the lens pieces. This is called phacoemulsification. It is the most modern method, and can be done using a very small surgical cut. Newer methods involve using lasers to make a more precise cut. This is needed for newer types of lens.

A man-made lens, called an artificial intraocular lens (IOL), is usually placed into the eye next. It will help improve your vision. The doctor will close the wound with very small stitches. Sometimes, a self-sealing (sutureless) method is used. If you have stitches, they may need to be removed later. The surgery usually lasts less than an hour. Most times, just one eye is done. If you have cataracts in both eyes, your doctor may suggest waiting 1 to 2 months between each surgery. ANESTHESIA USED 1. Adults are usually awake for the procedure. Numbing medicine (local anesthesia) is given using eye drops or sometimes a shot. This blocks pain. You will also get medicine to help you relax. Local anesthesia. An anesthetic drug (which can be given as a shot, spray, or ointment) numbs only a small, specific area of the body (for example, a foot, hand, or patch of skin). With local anesthesia, a person is awake or sedated, depending on what is needed. Local anesthesia lasts for a short period of time and is often used for minor outpatient procedures (when patients come in for surgery and can go home that same day). For someone having outpatient surgery in a clinic or doctor's office (such as the dentist or dermatologist), this is probably the type of anesthetic used. The medicine used can numb the area during the procedure and for a short time afterwards to help control post-surgery discomfort.
2.

Children usually receive general anesthesia. This makes them unconscious and unable to feel pain. General anesthesia. The goal is to make and keep a person completely unconscious (or "asleep") during the operation, with no awareness or memory of the surgery. General anesthesia can be given through an IV (which requires sticking a needle into a vein, usually in the arm) or by inhaling gases or vapors by breathing into a mask or tube.

PRE-OPERATIVE NURSING INTERVENTIONS 1. Not eating or drinking anything for 8 to 12 hours before surgery. 2. Not to take aspirin or a medicine that has aspirin in it for a week before surgery.

3. Patients must have a pre-operation eye examination, which will include ultrasound analysis to make sure the retina (the innermost layer of the eye, containing the light receptors) is intact and also to measure eye curvature so that a lens with the proper correction can be implanted. 4. Patient also will have a preoperative physical examination. 5. Patients should start a course of antibiotic eye drops or ointment the day before surgery. POST-OPERATIVE NURSING INTERVENTIONS Proper post-operative care is especially important after cataract surgery: 1. Patients will need someone to drive them home after the surgery and should not bend over or do anything strenuous for about two weeks. 2. They should refrain from rubbing the eye, should wear glasses to protect their eye, and should wear a shield while sleeping so the eye won't be rubbed or bumped accidentally. 3. The patient will usually continue their antibiotic for two to three weeks and will also take anti-inflammatory medication for about the same length of time. 4. If the patient experiences inflammation, redness, or pain, they should seek immediate medical treatment to avoid serious complications. POST-OPERATIVE COMPLICATIONS Possible complications include: 1. Intraocular infection (endophthalmitis) Endophthalmitis is an inflammatory condition of the intraocular cavities (ie, the aqueous and/or vitreous humor) usually caused by infection. Noninfectious (sterile) endophthalmitis may result from various causes such as retained native lens material after an operation or from toxic agents. The 2 types of endophthalmitis are endogenous (ie, metastatic) and exogenous. Endogenous endophthalmitis results from the hematogenous spread of organisms from a distant source of infection (eg, endocarditis). Exogenous endophthalmitis results from direct inoculation of an organism from the outside as a complication of ocular surgery, foreign bodies, and/or blunt or penetrating ocular trauma. 2. Central retinal inflammation (macular edema) Macular edema is swelling or thickening of the eye's macula, the part of your eye responsible for detailed, central vision. Macular edema develops when blood vessels in the retina are leaking fluids. The macula does not function properly when it is swollen. Vision loss may be mild to severe, but in many cases, your peripheral (side) vision remains. 3. Retinal detachment Retinal detachment is one of the most time-critical eye emergencies encountered in the ED. Retinal detachment (RD) was first recognized in the early 1700s by de SaintYves, but clinical diagnosis remained elusive until Helmholtz invented the ophthalmoscope in 1851. 4. Bleeding under the retina (choroidal hemorrhage) Choroidal hemorrhage is a serious ocular condition, which may be associated with permanent loss of visual function. Both limited and massive choroidal hemorrhages may occur as complications of most forms of ocular surgery, as well as from trauma.

5. Tiny lens fragments in the back (vitreous) cavity of the eye, all of which can lead to loss of sight. 6. Post-operative glaucoma REFERENCES: Cionni RJ, Snyder ME, Osher RH. Cataract Surgery. In: Tasman W, Jaeger EA, eds. Duanes Ophthalmology. 15th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2009:chap 6. Davison JA, Kleinmann G, Apple DJ. Intraocular Lenses. In: Tasman W, Jaeger EA, eds. Duanes Ophthalmology. 15th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2009:chap 11.