Post Operative
This section provides more information about the care of the eye after a Lens Exchange operation and what to expect during the recovery period. It includes information about:
• Posterior Capsule Opacity ("after cataract")
Post-op experiences
During the recovery period the eye should become progressively less red, more comfortable and have improving vision. If the opposite happens, i.e. if the eye becomes more red, more painful or the vision becomes worse then the patient should seek urgent review by their surgical team.
The morning after surgery the lids may be slightly crusted. This is the dried residue from the watering of the previous day and night. This crusting should be wiped away by simple bathing of the eyelids with cotton wool wetted with sterile saline. If the patient is returning to the eye unit on the first post-op day this will be done by nurse there. If not, the patient may easily and safely do this for themselves at home. A small dressing pack and instructions may be provided for this purpose. No undue pressure should be put on the eye. Once the lids have been cleaned the post-operative eye drops should be commenced.
One or two drops should be placed just inside the lower lid. It is easier if some one can do this for the patient. The patient should look slightly upwards and the lower lid should be pulled slightly downwards. This will create a gutter between the lower lid and the eye and the drop should be placed here. The eye should then be gently closed and dabbed lightly with a tissue to absorb any excess of drops that spill from the eye. It may be helpful to keep the eye closed gently for a minute or two.
The patient may wash their face, bath and shower and wash their hair as necessary but pressure on the eye must be avoided. It is sensible to try to avoid getting soap or splashes in the eye. It is unlikely to do any harm, as long as the eye is not rubbed, but may cause more irritation than normal in the early days following surgery.
Post-op Do's & Don'ts
These apply whilst the eye is healing and are particularly important in the first few days after the operation.
Do
- Use the eye drops as instructed.
- Use the eye shield as instructed.
- Keep all outpatient follow up appointments.
- Be up and about, though avoid strenuous activities.
- Use your vision.
- Contact your surgical team promptly if problems arise.
- Bath and shower, though avoid spray and soapy water from getting into the eye.
- Wash your face and hair, though avoid face down positions.
Don't
- Rub the eye.
- Put yourself in a situation where you might get hit in the eye.
- Drive until your surgical team gives you the go ahead to do so.
- Undertake strenuous exertions that make you catch your breath or go red in the face.
- Resume employment until your surgical team gives you the go ahead to do so.
Post-operative recovery
Following Lens Exchange surgery the eye may initially be a little red and light sensitive. This is normal. Sometimes there is a bruise overlying the white of the eye. This is called a subconjunctival haemorrhage. It can make the eye look quite red and alarming but is of no consequence. Like a bruise elsewhere it will clear over a week or two.
The speed of improvement in vision varies from patient to patient. Many patients obtain good vision within a few days. For others the vision may require longer to settle even when the surgery has been entirely straight forward. For most cases of small incision Lens Exchange the eye will be recovered from surgery in about 3 weeks. If a larger incision has been used, requiring stitches, full recovery may take 2 to 3 months.
The focus of the eye may change a little during the healing process. If a follow on procedure (Bioptics) or new spectacles are required following Lens Exchange the surgical team will advise on the optimal timing for this. As mentioned above if a small sutureless incision (most cases) has been used the focus of the eye is usually stable about 3 weeks after surgery. For larger incision surgery with stitches it may take 2 to 3 months.
If both eyes are to have Lens Exchange surgery it may not be necessary to wait for full recovery of the first eye before proceeding to surgery on the second. It is sensible to be sure that the first is making good progress in recovery before committing to the second eye.
Posterior Capsule Opacity
One technical aspect of Lens Exchange surgery is to retain the thin outer membrane of the natural lens of the eye. Eye surgeons call this the capsular bag. It provides support for the plastic lens implant. During surgery the back layer of the capsular bag remains intact. This layer is called the posterior capsule. It is extremely thin and delicate. Preserving this layer during the operation keeps the vitreous jelly that fills the main cavity of the eye in place. If the posterior capsule breaks the vitreous may move forwards into the front part of the eye and complicate the surgery. Eye surgeons therefore make every effort not to rupture the posterior capsule.
At the end of the operation the posterior capsule is usually perfectly clear and transparent. In some patients in the months following surgery it may become less clear and hazy. This is called posterior capsule opacity. This can cause a reduction in vision not correctable with spectacles or contact lenses. Posterior capsule opacity occurs because some microscopic lens cells are inevitably left in the recesses and lining of the capsular bag at the end of surgery. In the weeks and months after the operation these cells proliferate and migrate across the posterior capsule surface. They may change character and lay down material which is not transparent. The posterior capsule then becomes hazy sometimes resembling thin tissue paper. This progressively obscures vision.
The treatment for posterior capsule opacity is to use a laser to zap a small hole in the centre of the membrane to clear the line of vision. The laser concerned is called a YAG laser and the procedure is known as a YAG laser posterior capsulotomy. It is very simple to perform and is an outpatient procedure. It takes just a few minutes to do and is completely painless. A special contact lens may be placed onto the eye to hone the laser beam. Short acting anaesthetic eye drops are used to numb the surface of the eye so that this contact lens can be tolerated.
There is a small risk, perhaps of the order of 1%, that a YAG laser posterior capsulotomy may cause a disturbance to the retina at the back of the eye, e.g. a retinal tear or retinal detachment. Eye drops are sometimes used for a short period after the procedure to prevent a pressure rise and inflammation within the eye.
