"So typically, when patients arrive in the preoperative area, we meet and make sure that the plan is correct. And then the nurses will put a small IV in your hand through which we can administer a very, very gentle sedative. We also give you many eye drops to prevent infection and to dilate the pupil as widely as possible before we take you to the operating room.
Once in the operating room, we make sure that you're positioned comfortably on the table. There is a large microscope that goes between your face and my eyes. It's quite large and it's in between us (I take it for granted now) and so my view of your eye is quite magnified. And with the foot pedals, I'm able to focus in and out and zoom the microscope- and that's the right foot. And with the left foot, I'm able to control the irrigation, the aspiration and the fluidics of that machine that breaks up the cataract. Both feet and both hands. And my hands are hovering right above the patient's face. And then your neck has to be extended enough that you're looking through the microscope and able to see everything. The surgeon is sitting at the patient's ear. So right eye? I'm sitting by your right ear. Left eye, we switch the room around, move the pedals and sit on the other side.
We cleanse the area around the eye with antiseptics again to prevent infection. And then we put a sterile sheet over your face and open just the area for the eye that we're going to work on. We put a metal speculum, a little holder, in between the eyelids so that if you would happen to fall asleep during your surgery I'll still be able to do the work and continue on. And then we make two very small incisions into the eye. We gently open the front of the capsule of the cataract in a perfectly round fashion. And then we use a phacoemulsification hand probe which pulverizes and aspirates the debris from breaking up the cataract. So we remove the hard, nut-like aspects of the cataract. Then we use a different hand-piece to tease out the sticky bits leaving the capsule of your own tissue open, clear and intact. Then we fold the lens implant and put it into the capsule and let it unfold in place. Then it's just a matter of removing some of the gel that we had used to smooth the entry and exit of instruments in and out of the eye.
We inject a little bit of antibiotic into the eye, make sure the wound is secure, and take away the drape. And then we put a few more drops in, put a protective shield on the surface of the eye and take you to the recovery room. And within about 20 minutes you're able to get up and go.
The eye is a moving target. there is nothing at all that paralyzes or stills the human eye. So we need to just talk you through it and make sure that you are kind of playing our game to hold still and to look straight up at the light. When you're looking through the microscope, the view is so magnified that the tiniest of movements looks large which is very helpful in what we need to be doing. But also it's a problem if the patient is moving because even one millimeter is too much. There's not a lot of wiggle room within the anterior chamber of the eye. There's between two and five millimeters of depth we have to work within.
Amy E. Weber, MD