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Cataract Surgery

What is cataract surgery?

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Cataract surgery is an outpatient procedure performed in the operating room. Most cases take only about ten minutes, and are typically performed under intravenous sedation (not general anesthesia). The cataract is removed with ultrasound, and is replaced with an intraocular lens implant (IOL). In most cases, sutures or patches are not needed; this is often referred to as No-Stitch, No-Patch cataract surgery.

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What are the different intraocular lens implant (IOL) options?

In years past, there was little choice as to what IOL to use in cataract surgery. Older IOL models are referred to as “monofocal IOLs” and focus vision at a single distance; if a patient chooses a monofocal IOL to correct for far distance vision, reading glasses are required after surgery to focus up close. Recent technological advances have resulted in “Premium IOLs” that have advantages over monofocal IOLs. Premium IOLs include multifocal and accommodating IOLs, which help focus vision for both far distance and up close, resulting in less dependence on glasses after cataract surgery. Toric IOLs help correct astigmatism, again resulting in less dependence on glasses after cataract surgery. During your eye exam, Dr. Wolff can let you know if you are a candidate for one of these exciting Premium IOLs.

ReStor, Symfony, Toric and Tecnis IOLs

What happens after cataract surgery?

Recovery after cataract surgery is usually very quick. Most patients are back to near normal activity the day after surgery. Vision typically returns quickly, though in some cases may take several days or longer to improve. Eye drops are used for several weeks, and patients are seen within a day of surgery, one week after, and 3-4 weeks after.

Intraocular Medication Treatment (Tri-Moxi and Dex-Moxi)

A new, non-FDA approved, method of medication administration during eye surgery is available. This involves the placement of a compounded mixture of a steroid medication (triamcinolone or dexamethasone) with an antibiotic (moxifloxacin) into the eye during the surgery. This mixture has been intensively tested for sterility and potency. A cannula is used to infuse the mixture into the eye, usually after a cataract is removed. It is your choice whether to use this method of medication administration or to use traditional eye drops after cataract surgery.

Advantages & Benefits

  • Reduced or eliminated need for using eye drops after surgery. Without intraocular medication, 2-3 different eye drops are typically used for 3-4 weeks; this may require instilling as many as 12 drops a day.
  • Less cost to the patient since fewer eye drop medications will need to be purchased. The cost of eye drop medications usually totals $100 to $400. There is no extra charge to the patient for the use of intraocular medication.
  • Reduced need of the patient from trying to instill eye drops or to have someone do it for them. It can be difficult as well as inconvenient for some patients to put drops in the eye.
  • Possible reduced risk of infection compared to the use of eye drops. Because the intraocular medication is given directly in the eye, it is thought the antibiotic will be more effective in preventing endophthalmitis (a very serious infection inside the eye).

Disadvantages & Risks

  • Because the medication is cloudy, the vision will be very blurry during the first 24 hours after surgery.
  • Because of the medication particles in intraocular medication the patient may notice many floaters or swirls in their vision for the first few days. Vision may not be as clear initially until the intraocular medication is absorbed into the body, causing the floaters to diminish. In some cases, some of the floaters may persist.
  • The procedure may cause transient bleeding inside the eye; this is uncommon and usually resolves
  • The patient may still need additional eye drops if, during the healing phase after surgery, the doctor finds the eye to be inflamed or more prone to infection.
  • In certain patients, especially those with glaucoma, the steroid part of the medicine may cause the eye pressure to increase. It may be necessary to be placed on a pressure lowering drop or, in extreme cases, to have further surgery to lower the eye pressure.
  • No peer reviewed studies have yet been done to identify all of the side effects, risks, or the degree of effectiveness of this medication.
  • In certain cases during surgery, the surgeon may opt not to inject intraocular medication. In such cases the patient will have to use eye drops after the surgery.

The doctors of Sierra Nevada Eye Center strongly believe in the benefits of intraocular medications. Dr. Wolff is proud to be the first surgeon in Nevada to bring intraocular medication to his patients.

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