The day of cataract surgery and lens implantation

What is most often discussed in Hong Kong is phacoemulsification together with a lens implant. Whether to operate depends on how daily life is affected (reading, driving, night glare, falls) and on the examination, and an ophthalmologist decides. It is not an advertisement, and it is not a timetable of “wait until it is fully ripe” or “everyone must have it now”. Education about a hypermature lens, and about “not needed yet”, stays on the existing cataract page.

The implant is named only by class: monofocal, enhanced monofocal, extended depth of focus (EDOF), multifocal. Toric for astigmatism is an add-on that can sit on any of those four classes, not a fifth class you pick instead. No product names. No class suits everyone. The comparison stays on Choosing an intraocular lens — detail. The optical demo stays on Lens vision demo. This page does not change that tool.

Femtosecond-laser assistance is another option. Not everyone needs it. The published-trial education stays on Phacoemulsification and intraocular lenses. This page does not copy it, and does not write it as an upgrade.

Most people go home on the day of surgery. Vision often takes days to weeks to settle. It is not instantly “perfectly clear”. Whether the aim is mainly distance or mainly near is discussed before surgery. This page does not promise that you will not need glasses.

Whether to pause a blood thinner is decided by the operating doctor and the doctor who prescribed it. This page does not tell you to stop it yourself. Tell the doctor about allergies, whether you can lie flat, and whether you can look at the light.

The order of the day

1. A separate visit measures the length of the eye and the cornea, to calculate the implant power. The formula depends on the length of the eye. That step is usually not done for the first time on the day of surgery.
2. On the day, dilating and numbing drops are used. Most people have surface anaesthetic (drops). Sometimes more anaesthetic is added inside the eye. If you are anxious or find it hard to cooperate, the doctor may discuss sedation. General anaesthesia is considered for children, for people who cannot cooperate, or for unusual anatomy.
3. The area around the eye is cleaned, a drape is placed, and the lids are held open. You lie under a very bright microscope light. You see light, and you often hear the machine.
4. During it you often feel coolness, water or pressure. There should not be ongoing severe pain. If it hurts, say so at once. The doctor can add more anaesthetic. You do not need to know how large the incision is, or how ultrasound breaks the nucleus.
5. The cloudy lens is removed. A folded implant is placed in the original capsular bag and unfolds. What you choose is an optical class (monofocal, enhanced monofocal, extended depth of focus or multifocal), not a particular product. Toric for astigmatism is an add-on that can sit on any of those four, not a class you pick instead.
6. Most wounds close by themselves. A few need one stitch. Some centres use an antibiotic inside the eye, then anti-inflammatory drops afterwards. The dose and the number of days follow the prescription only. This page has no drop timetable.
7. A shield or guard. Most people go home the same day. Blur that day is common. Do not judge the final result from how clear it is that day.

The less-used extracapsular operation (a larger wound, stitches) is only a class note on the existing topic. The diagrams here are the commonly discussed phacoemulsification plus implant, and they note that not everyone has the same operation.

Diagrams

Risks and complications

No new percentages on this page. Phacoemulsification and intraocular lenses already has education figures, and already says they cannot predict one person and are not a clinic success rate. The source for endophthalmitis prevention is the ESCRS multicentre trial. The posterior-capsule summary is cited on that page. This page stays qualitative. Some risks are higher with a harder nucleus, previous eye injury, high myopia, a hypermature lens, or vitreous surgery at the same time. That is still not your personal probability.

• Posterior capsule rupture, vitreous coming forward: uncommon.
• Lens fragments falling into the vitreous: uncommon, and retinal surgery may be needed.
• Suprachoroidal haemorrhage: extremely rare, but it can be very serious.
• Endophthalmitis: uncommon, and an emergency.
• Macular oedema can happen. The doctor watches more closely in diabetes, or if the posterior capsule ruptures.
• Retinal detachment: uncommon. High myopia, younger age, or a posterior capsule rupture means flashes and floaters need closer attention.
• Corneal endothelial failure: uncommon. The risk is higher if the endothelium was already low.
• Temporary corneal swelling, grittiness, light sensitivity: common for a few days.
• A short rise in eye pressure can happen.
• The power may differ from what was expected: glasses may be needed. Not everyone is free of glasses.
• Multifocal and extended-depth designs more often have glare and halos. People with macular disease or a clear field defect are usually not suited to a multifocal.
• A shadow toward the temple: some people notice it early. It often eases over weeks to months.
• Wound leak, or an implant that sits off centre: uncommon.
• Posterior capsule opacity: not uncommon years later. It is not the cataract returning. See The day of posterior capsulotomy.
• Sterile inflammation of the front of the eye: rare, and it must be distinguished from endophthalmitis.

Afterwards: which path

Expected: blur that day, light sensitivity, grittiness, a red eye, watering. Vision changing over days to weeks is a common course. It is not “you must reach a particular line on the chart within a week”.

New flashes or many new floaters, without a curtain, without sudden blindness and without severe pain: prompt ophthalmic assessment (same day if possible).