its help in to plan cataract surgery for the patients

1. Cataract is opacification of natural lens in the
eye. When it disturbs patient’s vision it should be
removed.
After proper diagnosis and medical tests for
preoperative fitness, biometry is performed to
decide the power of the lens(IOL) to be
implanted in the eye after removal of cataract.
It is believed that cataract surgery is one of the
most advanced surgery in medical science.
It started ages ago by Sushruta by couching
where he pushed white cataracts in the posterior
segment with the help of a needle, before 600
B.C.
Modern Cataract surgery

2. It will be worth mentioning name if Dr Harold Ridley who
thought of putting a glass designed, to be inserted in the
eye after removal of opaque human lens, to eliminate
necessity of thick glasses.
Modern cataract surgery aims minimal anaesthesia,
smallest incision, minimal surgical damage , use of modern
latest generation IOL , avoidance of infection , faster
recovery and best quality of vision with least dependence in
glasses.
We will discuss modern trends in cataract surgery.
SICS ( Small incision cataract surgery)
Small frown incision is taken on sclera, 5.5 mm size, cataract
removal by creating positive pressure inside the eye, putting
PMMA non foldable IOL ( intraocular lens ) in place of cataract.
Phacoemulsification
Small incision on cornea / limbus
2.2 to 2.8 mm in size
Cataract is divided and aspirated by a small pencil like
instrument by ultrasound technique.

3. Foldable IOL is inserted with help of injector.
Here we have better control over post operative astigmatism,
faster recovery, no sutures, less infection.
FLACS ( Laser assisted cataract surgery)
In this technique Femto laser is used to cut cornea, capsule and
nucleus of cataract precisely avoiding heating of cornea that can
happen in very hard cataract removal by phaco technique. Rest
of the steps are same as Phaco surgery.
Material used for Intraocular lenses
Optic materials
1. Non Foldable IOL
• Polymethyl Methacrylate(PMMA)
2. Foldable IOL
• Silicone
• Hydrophilic acrylic
• Hydrophobic acrylic
3. Rollable/ultra-thin IOL
• Hydrogel
Haptic materials
• Polypropylene
• PMMA
• Acrylic

4. IOL can be made of various material like PMMA , Acrylic, Silicon.
PMMA lenses are non foldable , requires incision of 5.5 mm for surgery. These lenses are
time tested, inert, ultraviolet protective in the eye.
Acrylic lenses are foldable lens available in hydrophilic and hydrophobic property.
Hydrophobic lenses are better in prevention of after cataract formation.
Silicon lenses are not much in use due to their opacification when silicon oil is used for
retinal surgeries.
Another development in IOL technology is IOL design. Monofocal
lenses give good clarity at one point. They give good contrast.
New monofocal IOL have aspheric surface giving better quality of
vision during dull light, at night time. Yellow lenses (chromatic)
are in market, they filter harmful rays entering eye, preventing
retinal damage. Square edge lens design makes optic of IOL
complete square edge, prevents migration of equatorial epithelial
cells posteriorly thus preventing PCO(posterior capsular
opacification )
We will Discuss about newer intra ocular lens implants.

5. Then came concept of multifocality.
Multifocal IOL have concentric rings on the back surface of IOL,
with smooth steps. This is known as diffractive type of multifocal
Lens. It gives better distant and near vision. Here there can be
some loss of contrast in vision due to design.
These IOL are not recommended for night drivers or skilled
professional like surgeons.
Latest is Trifocals, having less number of rings in optic. Less glare and
haloes. They are better for computer users, as they give better
intermediate vision.
To compensate for astigmatism toric IOL are designed. With use of
toric IOL we can reduce post operative astigmatism.
Heparin coated lenses can prevent pigment deposits on IOL
surface in long run.

6. Monofocal Multifocal Toric
Multifocal
Toric Trifocal
Good distance
vision
Good distance
and near vision
Corrects for
astigmatism after
cataract surgery
Good distance
and near
vision as well
as correct
astigmatism
Provide good
distance and
intermediate
vision
Glasses
required for
reading

7. There are some common questions asked by patients frequently,
1. What is the life of lens you will use in my eye?
All lenses implanted are usually for life long period .
2. Will I have to remove the lens regularly to clean them?
No, this lens is implanted inside the eye. It is not required to remove or clean them .It
will not give any feeling or irritation after surgery.
3. Which is the best lens for me?
You should discuss best lens with your surgeon. Surgeon should know patient’s
requirements and profession.
There is no one best Lens for all .
4. Costlier lens is always best?
Not always. If a night driver wants to go for a multifocal lens it will not be a good idea . He
can opt for any good monofocal lens.
5 . Are imported lenses better than Indian lenses?
Indian lenses are good. Imported lenses are manufactured by advanced technology giving
better finish and quality control.

8. 6 . will I need glasses after my cataract surgery?
Even if we use best multifocal lens , patient may require glasses for some specific
activities like doing fine work. e.g. stitching, needling, computer work . There can be
development of astigmatism requiring glasses.
7. will cataract develop again after surgery?
No. Cataract is your opaque natural lens, it can never develop once removed . Some
times there is development of posterior capsular opacification behind lens . It requires yag
laser cleaning only once.
8 . Will you remove my cataract with laser? Will there be cut on my eye?
Lasers are used for putting cuts precisely. There is always a manual surgery involving
cutting in even modern cataract surgery.
9 . Cataract surgery is so simple that patient can join his regular activity on next day
Like any surgery cataract surgery can have some mild to serious complications . Patient
has to take care and follow all the instructions given to them properly . Any problem if
occurs , it should be informed to attending doctor immediately.

9. Dr Tushar D.Muni
MS, FRF
consulting ophthalmologist
DHRUSHTI EYE CLINIC AND MICROSURGERY CENTRE
Mathadi trust hospital
Ubaid Guttigar
D.optomety/B.optomety
Consulting optometrist
DHRUSHTI EYE CLINIC