Complex Cataract Surgery

Cataract Surgery in Special Situations

Cataract surgery is perhaps one of the most rewarding and successful surgical procedures available. In the majority of cases though there may be unique individual issues the surgical procedure is likely to be fairly straightforward. However there are many scenarios that demand a much greater degree of interaction between surgeon and patient. Cataract surgery can be made more complex and more challenging by a range of scenarios that are outlined below. The major issues that make cataract surgery more complex fall into the following groups;

Co-existent eye problems
Co-existent medical problems
Type and severity of cataract
Cataract surgery in setting of previous LASIK/LASEK surgery
Cataract surgery in setting of previous Radial Keratotomy (RK)

Co-existent Eye Problems
There are a number of issues related to the eye itself that can make surgery more challenging. Anatomical issues such as size of the eye and pupil can present technical challenges for the surgeon. There are well established methods of managing most such scenarios and the personal experience of your surgeon can be very helpful in maximising outcomes in these cases.

Other conditions such as previous Iritis / Uveitis or other inflammatory eye conditions also require specific measures to help minimise risk and improve the prospects for an excellent outcome.

Pseudo-exfoliation of the Lens capsule

Certain medical eye problems will also need careful individual assessment before surgery – such as the health of the cornea and presence of conditions such as pseudo-exfoliation syndrome. A careful preoperative evaluation is mandatory in helping to manage these issues properly. At Bettersight we have accumulated a wealth of experience in dealing with such complex eyes to help ensure optimal outcomes.
co-existent Medical Issues
Carefully managed, existing medical problems should not become a significant problem with cataract surgery. Diabetes is one of the more common coexistent issues and really does require expert eye evaluation and sometimes post operative treatments to help ensure optimal outcomes.

At Bettersight we have extensive experience of managing many patients with diabetes who are undergoing cataract surgery. All of this experience is brought to bear when we treat such patients.
Severity and type of Cataract

Dislocating natural lens

As previously indicated – not all cataracts are the same ! A wide variety of cataract types is described. Cataracts that are particularly severe require specific expert techniques to optimise outcomes. In addition cataracts arising from previous trauma can also present special challenges that require very careful assessment and sometimes quite bespoke techniques. Cataracts arising in patients with conditions such as Marfans syndrome or Ehlers Danlos syndrome can have unique problems such as partial pre-existing lens dislocations that also require very expert attention.

Super dense cataract

Once again at Bettersight we have specific experience of managing these often unique scenarios.
Cataract Surgery after previous LASIK / LASEK
Patients who have previously undergone Laser vision correction even if done decades ago do require particular input. Though there are some potential surgical issues in such cases the more common problem arises because previous laser vision correction alters the architecture of the cornea (the clear window of the eye). Such alterations make it more difficult to measure the cornea accurately.

This is because the instruments used to measure these parameters generally assume no previous surgery. Once we know that a patient has had previous laser correction then we can, at Bettersight, carry out some calculations that can reliably adjust for these discrepancies. Using our unique approach to this, now increasingly common problem, allows us at Bettersight to minimise the impact of less than perfect measurements on the eventual outcome of the procedure.
Cataract Surgery after previous Radial Keratotomy

Radial Keratotomy

Patients who have previously undergone RK vision correction even if done decades ago require specialist input. In previous RK there are similar challenges related to accurate preoperative measurement of the eye that require really thorough computations. This is because the incisions used to change the vision state of the eye also alter the accuracy of subsequent measurements. In addition however there is also the potential for surgical complications arising due to the much weaker state of the eye after a previous RK.

At Bettersight we have gained specific experience in handling such situations with great success.