Cataract – From Diagnosis to Recovery – Chapter 2: Day of Surgery

Cataract – From Diagnosis to Recovery – Chapter 2: Day of Surgery

The day of surgery has arrived. You are excited and nervous, and this is completely natural.

Most cataract surgery is performed under local anesthetic (anesthetic drops are administered), and therefore there is no need for fasting. You can eat a light meal a few hours prior to surgery, and of course take your regular medicines (including blood thinners, unless your doctor has advised you otherwise).

It is important to remember to bring with you:

  • Drops that you bought in advance for after surgery (according to the doctor’s instructions)
  • Documents: ID card and payment commitment if necessary.
  • A chaperone – It is advisable not to come to surgery alone.

Coming with a chaperone is requested for surgery of this kind even though it is quite a simple procedure performed under local anesthetic, because it is for vision (our primary sense) and there are cases where you are not able to see from the eye that is not operated on. Vision does not come back immediately post-surgery, and therefore it is advisable that someone accompanies you and makes sure that you get home okay. Aside from that, in my opinion, the feeling that someone is with you and cares about you, is far nicer. There is no need to arrive two hours before your appointment in the hope that maybe you will be seen earlier. All you will get from early arrival is a longer wait. The appointments at government-run and private hospitals take into account that it takes time to prepare before surgery and therefore, the time on your letter of appointment is not the time for surgery but the time of arrival. Upon arrival, you must go to the reception desk, identify yourself and provide the secretaries with the required documentation.

You will then be asked to go to the surgical preparation room. You will be received by a nurse, who will ask you some questions such as whether you are sensitive to any medication, which eye is to be operated on (right or left) and what surgery you are due to undergo. Be patient and answer the question.

The nurse will measure your vital signs: pulse, temperature and blood pressure. You will receive a cloak, hat and overshoes, and be asked to change your clothes. It is with these clothes that you will enter the operating room. Their purpose is to maintain sterility and prevent infections. After changing clothes, you will be asked to wait in the waiting room before entering surgery.

An additional part of preparation before surgery is receiving a tablet sedative (to relax you) and drops to dilate the pupils. The process of administering the drops is very similar to what you experienced at the examination before surgery. The difference is that it is a larger quantity of drops and of different kinds which you will receive in several rounds. This time too you need to look up during administration of the drops and not rub your eyes afterwards. The burning sensation passes within a few seconds.

This preparation and organization take time, so you need to take into account that fort minutes to two hours will pass from the time of arrival at the secretaries until the start of the surgery itself.

It is recommended that you arrive without jewelry on the day, as before surgery you need to remove it. Additionally, it is recommended that you do not apply makeup on the day, as before entering surgery you must remove it. The face must be without makeup or any kind of cream.

Hearing aids – If it is on the side of the eye due to be operated on, you will need to remove it. In this case, ask the doctor before you remove the hearing aid about the surgical process and check that the doctor remembers that you have removed your hearing aid.

Sometimes the wait can be longer due to the arrival of emergency cases for surgery. Remember that these are people, and it is not always possible to stick to the precise schedule. I warmly recommend that you are well prepared in advance that it is possible for the waiting time to be longer than you expected, and thereby try to reduce the level of stress. Further, stressful conditions and increased irritability can reduce the success of the operation. The surgical team and nurse do all they can to look after you.

You are asked to enter the operating room. Make sure you use the bathroom beforehand, and if you have forgotten or did not have time, ask to do so before entering surgery (for your own comfort). There will be another questionnaire in the operating room regarding the side of the eye is to be operated on, and it will be marked with a marker pen above the eyebrow, your ID number, sensitivities to medicines. All this is done to prevent, Heaven forbid, a mistake.

Upon entering the operating room, you will be asked to open the cloak from behind so that it will not put pressure on the neck while lying on your back, and you will be given a warming and pleasant covering as it is cold in the operating room. If you are uncomfortable lying on your back due to back problems or breathing issues, now is the time to say so, and they will take care to place you in a comfortable position. It is not possible to conduct the surgery while seated. If there are problems which do not permit for lying on your back, surgery will be conducted under general anesthetic and therefore you need to state that during the pre-surgical examination.

After lying on your back, you will be hooked up to monitoring devices which check blood pressure and ECG. These devices do not hurt or irritate, the only thing you will feel is the pressure on your arm when blood pressure is measured (something that you are familiar with already).

You will be tied to the bed. It sounds terrible, but it is done so that you do not fall off the narrow bed that you are lying on during surgery. It is done routinely in all kinds of surgeries. A strap is passed from one side of the bed to the other, at chest level. Tying is not strong or pressurizing, so there is nothing to worry about. Attachment to Oxygen is performed (to the nose or the chin area) so that you can breathe normally throughout surgery as even the face is covered.

From this moment you need to listen and carefully follow the doctor’s instructions and remember that surgery is of short duration and will be over before you know it.

A few more drops will be administered (and maybe gel as well, as the doctor sees fit). This time the drops are for sterilization and anesthesia. Again, a burning sensation is possible, perhaps a little more than on the previous occasions, but it will pass within a few seconds. After that, the doctor sterilizes the skin with Polydine solution, used for wound sterilization. Sensitivity to iodine injection, the contrasting matter in CT scans does not prevent external sterilization with iodine. During sterilization with Polydine, you will be asked to close your eyes (not tightly, rather, as if you are sleeping). In the next stage you will be covered with a sterile sheet. In the eye area, the sheet has a transparent and sticky window that will adhere to the skin around the eye to prevent bacteria from contaminating the surgical area. You will be asked to look up or down, according to the type of sheet. During this stage as well, and until the end of surgery, you must keep the muscles of the body and especially the eyelids in a relaxed state and try not to close your eyes. I have seen cases here the patients felt like they were suffocating when the sheet was placed. This phenomenon is completely psychological. It is not without cause that I chose to write this article, it is very important for me to reduce the worry and symptoms of anxiety experienced by the public who are undergoing surgery.  Do not forget that you are attached to Oxygen and can breathe freely. It is possible to share your feelings with the doctor and sometimes he can slightly lift the lower part of the covering (like a tent) so that you will not feel it so close to your mouth, something that can relieve the sensation.

After completion of covering, the device which separates the eyelids will be placed. During the first moments, you will feel mild pressure on the eyelids. It is important not to resist or try to close the eyes so that you do not cause yourself unnecessary pain. Think about relaxing the body all the time and remember that there is nothing that is supposed to hurt during the surgical procedure and as long as you are relaxed and calm, surgery will be completed faster and more successfully. The doctor will be assisted by a microscope which he will place opposite the eye. You will be asked to look at the light from the device without moving until the end of surgery (approximately 15 minutes). If you feel that the light is very blinding to you, tell the doctor. It is possible to reduce the intensity of the light or alternatively to look downwards slightly and not directly at it (around 1-2 mm under the light). You need to keep both eyes open, even though the eye not being operated on is covered.

Up till now, these are the things you will be asked to do. From this moment, surgery begins. Focus on a certain point and be relaxed. Usually, the doctor will talk to and calm you for the duration of surgery. During surgery, water will be dripped onto the eye, and therefore you will feel it on the skin around the eyes. It is possible you will see lights and shadows. All these things do not hurt and are not scary. There are rare cases where pressure in the eye is felt at certain stages of the surgical procedure.

Occasionally there is a need to either cough or sneeze. It is important to inform the doctor of this so that he can stop surgery until the attack passes. Do not wait until the last moment where you cannot hold it. Know that it is possible to stop surgery at almost every stage. It is possible to speak for the entire duration of surgery and so you must not worry about informing the doctor about pain which would require a top-up of anesthetic, or about the need to cough etc. It is important to speak without moving (do not lift your hand or move your head).

Surgery is completed. The doctor informs the patient of this, removes the eyelid separator (there is still a need to keep the eye open) and removes the covering from you. The stage where the covering that is stuck to the skin around the eye is the stage that is the least pleasant. During this stage, you must keep the eye open. Thereafter, a few more drops will be administered (Again, a burning sensation is possible.) and the monitoring devices will be disconnected. You will receive assistance in being brought from a lying down position to a seated one and then to standing. It is a good idea to sit for a few seconds before you get up, and in the event that there is dizziness upon getting up, it is recommended that you look upwards and breathe deeply.

You walk out of the operating room to the recovery room (with help, obviously), where the person who accompanied you on arrival is waiting. The doctor informs that the surgery was successful (as this happens in the vast majority of cases) and either he or a nurse then explains the recovery process and treatment post-surgery. For the majority, the eye will not be covered with a dressing. Remember that it will take time for vision to improve.

After you have recovered, you can get dressed and go home.

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