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«CATARACT SURGERY UNDER GENERAL ANAESTHESIA Information Leaflet Your Health. Our Priority. Stockport Eye Centre | Stepping Hill ...»

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Information Leaflet

Your Health. Our Priority.

www.stockport.nhs.uk Stockport Eye Centre | Stepping Hill Hospital

Page 2 of 11


You are likely to have recently been told that you have a cataract and been referred to the Eye

Department at Stockport NHS Foundation Trust.

What is a Cataract?

A cataract is a clouding of the eye lens. The eye lens is usually transparent to allow light into the back of the eye. A cataract means that you may experience some problems with your eyesight in your day to day life.

The diagram above will help you to understand where the lens is within the eye.

What problems can I expect?

 Reduced eyesight  Blurred eyesight  Loss of brightness of colours  Double vision  Difficulty seeing to read, watching TV, crossing the road and driving the car  Glare and dazzle becoming unbearable www.stockport.nhs.uk Stockport Eye Centre | Stepping Hill Hospital Page 3 of 11 What can be done about cataracts?

This depends on how much of a problem your vision is to you. Your ophthalmic surgeon (eye doctor) will discuss this with you on an individual basis.

Changing your spectacles (glasses) can sometimes help improve focussing. However, spectacles may have to be changed much more frequently.

Surgery is the only option for getting rid of cataracts completely; there is no other way to remove them.

You may choose to avoid having an operation and put up with your symptoms/problems.

However cataracts do inevitably progress, although the rate of deterioration may vary between individuals.

You and your surgeon will discuss the best way forward for you. If left untreated your vision may deteriorate until you can see very little.

What does a surgical cataract removal operation involve?

Prior to any surgical operation a number of pre-operative tests are performed.

A special test will be performed to determine the strength of the “lens implant” required for your eye. This involves measurements of the eye being taken. Whilst as accurate as possible, the calculation of the “lens implant” power cannot be done with 100% certainty.

You may have to wear glasses for distance and reading following a cataract operation even if you did not do so previously.

The operation involves having a small cut made in the eye. Using up to date surgical equipment/technology, the cataract is removed through this small cut and an artificial lens implant is inserted into the eye in the majority of patients.

Is this operation likely to improve my eyesight?

In most patients, it is likely to improve eyesight. However, if in addition to a cataract you have other eye problems your final visual result may not be as good as someone who does not have other eye problems. This will be discussed with you.

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Are there any risks with this operation?

As with all surgery, there are some risks and complications. These will be discussed with you in advance of any operation.

Major complications are rare, occurring in less than 1 in 1000 operations.

Possible problems include:

Common Bruising: bruising around the eyeball and/or eyelids is quite common. This will usually settle after a week or two.

Posterior capsular opacification: clouding of the membrane behind the plastic lens implant occur in up to 30% of patients afterwards. Sometimes a Laser procedure is required to deal with this, even months or years after the original cataract operation.

Optical Aberrations: for example glare and star bursts in bright conditions. Whilst these often resolve, they can cause ongoing problems.

Less Common Allergy: this may be caused by any drugs used before, during or after the surgery. This can make the eye itchy and swollen. It usually settles within a few weeks.

Post operative pressure problems: raised pressure in the eye can occur which may require treatment to prevent damage to the Optic nerve.

Cystoid Macular Oedema: may occur in the Macular area (central area of the Retina). This may occur without any reason at all and can cause a reduction in vision. It may be mild or severe and may require prolonged treatment, such as tablets or anti-inflammatory eye drops.

Iris damage: this can be cause by a variety of different factors and may lead to pupil irregularities which may be permanent.

Posterior capsule rupture and/or vitreous prolapse: this is a split in the membrane holding the lens (behind the cataract). If this occurs during your surgery, more time will be required to complete the surgery. The total time will exceed the usual 15 to 20 minutes. There is a higher risk of infection, inflammation, glaucoma and reduced vision after surgery. Further surgical procedures may therefore be required.

Refractive surprise: unexpectedly larger (or different from expected) refractive error, resulting a greater need for spectacles (glasses).

–  –  –

Uncommon Ptosis: droopy eyelid. This can be surgically corrected if this occurs.

Dropped nucleus: the lens or part of the lens may fall to the back of the eye. Further and more complex surgery may then be required.

Dislocation of the lens implant: movement of the new lens position which may require further surgery.

Detached Retina: peeling off of the light sensitive layer at the back of the eye, this usually requires further surgery to repair.

Endopthalmitis: a thankfully uncommon but very severe complication. This is a painful infection inside the newly operated eye which may lead to blindness. The likeliest time for this to occur is within the first 2 weeks after your operation. This is why a good standard of hygiene is essential in the aftercare of the eye. Rubbing of the eye is strictly prohibited. The eye becomes painful rapidly along with a big drop in vision. This is treated with antibiotics into the eye, but the outcome is often poor and may lead to loss of the eye.

Rare Suprachoroidal haemorrhage: bleeding inside the eye which may require further surgery.

There is a risk of blindness/loss of eye if this occurs. This is why we insist on a reasonable level of blood pressure and blood test results (if you take warfarin) on the day of your surgery.

Corneal Decompensation: clouding of the clear front window of the eye. The condition can be painful and may require a corneal graft operation to restore vision and comfort. More common in some individuals, whose corneas may have an inherent weakness or tendency to decompensate.

Sympathetic Ophthalmitis: Inflammation occurring in the fellow eye in `sympathy` with the operated eye.

It is possible on rare occasions that you may lose all sight in the eye if you get one of these complications.

Death: is incredibly rare with modern anaesthetic techniques.

If you wish to discuss the possible complications in greater detail, please let us know. Please note: there is no guarantee that a particular surgeon will perform your operation.

–  –  –

What happens at the Pre-Operative Assessment Clinic?

Your pre-operative assessment visit to Stockport Eye Centre usually takes one to one and a half hours. Here you will be seen by one of our nurses. You will be asked about your general health and what medication you are taking.

The nurse will discuss which of your medications to take on the day of your operation at the preoperative assessment appointment. The nurse may need to carry out a blood test. A heart tracing (ECG) may be required.

It is very important that you discuss any travel/holiday plans with the nurse as this will impact on your proposed surgery date.

Please write below any questions you may want to ask at Pre-Operative Assessment Appointment.

What happens before my operation?

Please have a bath or shower on the day before or the morning of your operation.

It is important for you to stop eating and drinking in plenty of time before your operation (Nil by Mouth). This is essential if you are having a general anaesthetic and if not adhered to your operation will be cancelled.

You can eat and drink until midnight if your operation is in the morning. No food, tea or coffee, chewing gum or sweets may be consumed for 6 hours prior to your operation. You can take your regular medication with sips of water before leaving home unless advised differently.

You can have a light breakfast (tea and toast) by 7am if your operation is in the afternoon. No food, tea or coffee, chewing gum or sweets may be consumed for 6 hours prior to your operation. You can take your regular medication with sips of water before leaving home unless advised differently Alcohol and general anaesthetics do not react well together. Please avoid alcohol for 24 hours before your operation What should I bring with me on the day of the operation?

Please bring medication, eye drops/ointments, spectacles, reading material, dressing gown, slippers and overnight bag.

–  –  –

What happens before I go to theatre?

You will be given a gown to wear.

All jewellery must be removed wherever possible. This includes earrings, tongue studs, and other body piercings. A wedding ring can be worn and this will be covered with tape.

Nail polish/false nails must be taken off as they can interfere with important routine monitoring equipment.

What happens in theatre?

You will have your blood pressure and pulse monitored- this is routine.

A `finger peg` will be placed on your finger to measure the amount of oxygen in the blood- this is known as a pulse oximeter.

A plastic needle known as a cannula will be introduced into a vein. This enables us to give you the general anaesthetic medication, commonly known as `putting you to sleep.

What happens after my operation?

After your surgery, you will be taken into the recovery room. When you are awake you will go back to the ward area.

For some operations you may have a `drip` (fluid from a tube) in your arm. This is to prevent you from becoming dehydrated.

You may be able to go home on the same day as your operation. This will be assessed on an individual basis.

A responsible adult must be available to stay with you overnight if you go home the same day.

You must not go home by public transport. You can go home by taxi, but must be accompanied by a responsible adult.

Before you go home you must be awake and orientated, eat and drink, and have passed urine.

Do not take alcohol or work machinery for 24 hours following surgery.

–  –  –

What happens when I go home?

You will be wearing a protective eye shield when you leave the Eye Centre. This can be removed the next day.

You will be given eye drops to take home. These are to reduce inflammation after surgery and are to be started the day after your operation. You may also be given antibiotic eye drops. The eye drops you have been given need to be instilled four or more times a day.

It is important that you instil these eye drops as prescribed You may have some discomfort following your operation. Please take simple pain killers such as Paracetamol.

You will be sent an out patients appointment which can be up to 4 weeks following your operation. This could be in Stockport Eye Centre or OPD B. If you do not receive this appointment within 4 days following your operation please telephone 0161 419 5797/5236.

Occasionally you may need to be seen the day after your surgery. This will be arranged on the day of your operation.

We will discuss with you about when to return to work and when you can resume driving.

Generally you can carry on your normal lifestyle, but please follow the advice overleaf on the back page of this booklet.

Please expect a courtesy telephone call the day following your operation.

You will be asked to visit your optician for testing for new spectacles (glasses) following your operation. This will be discussed at your follow up appointment.

Information about your eye drops Please ensure you use the eye drops regularly until your first outpatient appointment when we will give you further instructions. Please remember to bring the eye drops with you each time you attend Stockport eye Centre or OPDB.

The eye drops will be clearly labelled for you.

Please wash your hands before putting the eye drops into the eye or bathing the eye.

Is it necessary to bathe the eye If you wish to bathe the eye please use cooled boiled water. Wipe from the inner to the outer corner using cotton wool pads.

–  –  –

How do I use the eye drops?

You will find it easier to put your eye drops in whilst sitting or lying down. With one hand pull the lower lid down and look up to reduce discomfort. Put the eye drop in with the other hand. One to two drops is sufficient. You can use an Auto Dropper. Please ask about this.

When do I use the eye drops?

As long as you space the eye drops out evenly during the day, you can put them in at a time which suits you. If you are using more than one eye drop at a time, leave a few minutes between each instillation. If you cannot feel the drop going into the eye, please repeat the drop until you do. You cannot overdose on eye drops this way.

How long do I use the eye drops?

This varies from patient to patient. The nurse or the doctor will tell you when to stop using them.

Dangerous symptoms requiring an urgent telephone call to the eye department Increasing pain which is not relieved by the pain relieving tablets recommended.

A sudden fall in vision from that achieved within hours of the operation.

Increase of redness and/or blurring of the eye after the first day.

Nausea /vomiting.

Please telephone OPD B 0161 419 5689 8am-1800hrs. If outside of these hours, please contact the main emergency department on telephone number 0161 483 1010.

Useful telephone numbers

–  –  –

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