cataract is a painless, cloudy area in the lens of the
eye. The lens is enclosed in a lining called the lens capsule. Cataract surgery
separates the cataract from the lens capsule. In most cases, the lens will be
replaced with an intraocular lens implant (IOL). If an IOL cannot be used,
contact lenses or eyeglasses must be worn to compensate for the lack of a
Phacoemulsification and standard extracapsular cataract extraction (ECCE) are
surgical methods that remove the cataract as well as the front portion of the
lens capsule (anterior capsule). The back of the lens capsule (posterior
capsule) is left inside the eye to keep the
vitreous gel in the back of the eye from oozing
forward through the pupil and causing problems. The posterior capsule also
supports the IOL and helps keep it in the proper position. These types of
surgery are usually done in an outpatient setting and not in a hospital.
Phacoemulsification (small-incision surgery) is the most common type of cataract
surgery. It is used more often than standard ECCE, even though
they are similar procedures.
During phacoemulsification surgery:
During standard ECCE:
Most cataract surgery is done using a topical anesthetic
(eyedrops) or a local anesthetic. Local anesthetic may involve a sedative for
relaxation followed by an injection beside, under, or inside the eye to deaden
nerves and prevent blinking or eye movement during surgery.
General anesthetic may be needed for:
Before you leave the outpatient center, you will get the
immediate eye care that you need after surgery. The surgeon will review the
symptoms of possible complications, eye protection, activities, medicines, and
required visits (see below). He or she will also tell you what to do for emergency care if you need it.
Portions of the follow-up may be done by another health professional, such as
an optometrist or a community health nurse.
The eye that was operated on may be bandaged for 1 night after
surgery. You will wear a protective shield over the eye at night for about a
week. There is normally no significant pain after surgery.
You most likely will need to see the doctor for checkups 1 or 2
days after surgery, and again within a few weeks after surgery. If any complications occur, visits should be sooner
and more frequent.
Checkups following cataract surgery include:
Most people get a new eyeglass prescription about 6 weeks after surgery.
Contact your doctor promptly if you notice any signs of
complications following cataract surgery, such as:
The decision to have this procedure is based on whether:
The surgeon may need to do standard extracapsular cataract extraction (ECCE) instead of phacoemulsification if the cataract is too hard to be broken up by sound waves (ultrasound).
Cataract surgery is successful for 85 to 92 out of 100 adults. Surgery may also improve vision in infants who have
large study, 95 out of 100 adults were satisfied with the results of their surgery.
The people who were not satisfied were older adults who had other eye problems
along with cataracts.1
People who have surgery for cataracts usually have:
Studies done with adults 1 year after surgery show that phacoemulsification works better than standard extracapsular cataract extraction (ECCE) to improve vision.2 Also, recovery of sight occurs sooner
after surgery with phacoemulsification. And it is less likely that you will
need glasses for distance vision after phacoemulsification surgery.
Fewer than 5 out of 100 people have complications from cataract surgery
that could threaten their sight or require further surgery. The rate of
complications increases in people who have other eye diseases in addition to
Although the risk is low, surgery for cataracts does involve the
risk of partial to total vision loss if the surgery is not successful or if
there are complications. Some complications can be treated and vision loss
reversed, but others cannot. Complications that may occur with
cataract surgery include:
Complications that may occur some time after surgery
Before you have surgery
for cataracts, tell your doctor all of the medicines you are taking.
That way, your doctor can be prepared to handle any problems that arise. For example, alpha-blockers (such as terazosin) and blood thinners (such as warfarin) can cause problems during the surgery.
Removing cataracts using phacoemulsification is preferred over
standard extracapsular surgery because:
of vision is the same for both procedures. But the healing process is quicker
The more experience your surgeon has, the less likely you are to have problems. Ask your family doctor or optometrist to suggest a surgeon.
People usually need reading glasses (glasses for near vision) after
cataract surgery, no matter which type of surgery is done. But some people
may choose to have different lens implants (intraocular lens, or IOL) in their
eyes so that one eye can be used for distance vision and the other for near
vision (monovision). A type of IOL that allows you to see both distance and near vision
is available. Talk to your doctor about the pros and cons of each type of IOL.
In some children, surgery to remove a cataract that causes
a lot of vision loss may be very important in preventing blindness. The most
critical period for the development of sight is from birth to 3 months. The
earlier cataracts in children are diagnosed and treated, the more likely it is
that their eyesight will be protected.
Infants have the highest risk (almost 100%)
for cloudiness in the back portion of the lens capsule following cataract
surgery. If posterior capsule opacification develops after cataract surgery, a
laser procedure or a vitrectomy that removes the posterior capsule may be
needed. For that reason, most pediatric cataract surgeries remove the central
portion of this posterior capsule during the first operation. This may allow
better sight and reduce the need for laser surgery.
If a child has cataracts that are causing a lot of
vision loss in both eyes, surgery on the second eye needs to be done within a few weeks. As
in adults, only one eye is operated on during each surgery. This decreases
the chance of complications occurring in both eyes at the same time.
Because of infants' rapid eyeball growth and for other reasons, some surgeons don't use IOLs in infants. Instead, an
infant will wear a contact lens to replace the lens that is removed from the
eye. If surgery can be delayed until the child is 1 to 2 years old, the surgeon may be able to use an IOL to replace the lens in the child's eye. Surgery cannot always be
delayed, though, because of the risk of
amblyopia and permanent vision loss.
Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.
CitationsAmerican Academy of Ophthalmology (2006).
Cataract in the Adult Eye. Preferred Practice Pattern.
San Francisco: American Academy of Ophthalmology. Available online:
http://www.aao.org/ppp.Allen D (2011). Cataract, search date May 2010.
Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.Other Works ConsultedRiaz Y, et al. (2006). Surgical interventions for age-related cataract. Cochrane Database of Systematic Reviews (4).
August 24, 2011
Adam Husney, MD - Family Medicine & Carol L. Karp, MD - Ophthalmology
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