Presentation of the intraocular lens

Hearing your eye doctor use the word pseudophakia to discuss what can happen with cataract surgery can be a bit confusing, but don’t worry. This means that an artificial or fake lens, also known as an intraocular lens (IOL), will be placed in your eye in place of the clouded lens, with the cataract removed.

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What is a pseudophakic IOL?

Pseudophakic lenses can be made of plastic composites, silicone or acrylic material. Just like your glasses or contact lenses, IOLs can compensate for most vision problems you might have, such as nearsightedness or farsightedness.

They are also selected in strengths specifically for your eyes. There are four different types of glasses that can be offered to you. These include:

  • Monofocal IOLs: These are the most commonly implanted lenses and are all single power. This means that they are clearer when you focus in a certain range. Most often they are adjusted for distance vision, with reading glasses used for near vision.
  • Multifocal IOL: Some prefer the idea of ​​pseudophakic correction for both proximity and distance simultaneously, which multifocal lenses allow. Like bifocal glasses, different areas of the lens provide different levels of correction.
  • Accommodative IOL: These can make different corrections because they are attached to the ciliary body of the eye. The movement of this muscle changes the shape of the lens to create clear near, intermediate, and far vision.
  • Toric IOLs: A toric lens can correct the mistakes of people with astigmatism caused by an uneven cornea.

It is not uncommon to still need glasses sometimes with pseudophakic IOLs. Talk to your practitioner about which lens will best suit your needs and lifestyle.

Purpose of IOL surgery

Cataract surgery removes a cloudy lens and replaces it with a transparent pseudophakic IOL. While the practice of removing such a lens dates back to the ancient Egyptians, it wasn’t until the 1940s that ophthalmologist Harold Ridley invented the first phakic IOL.

An artificial IOL helps you see after removing your own cloudy lens. When light enters the eye, a lens focuses it. When the light is focused at the right strength, you can see clearly. The pseudophakic lens will be clear just like your natural lens once was.

Age-related cataracts tend to occur when proteins in the lens start to break down and stick together in places, interfering with the clear transmission of light to the retina at the back of the eye.

With the most common type of cataract surgery, a small wand is inserted into the eye through a small incision. This emits sound waves that separate the cataract into tiny pieces, which can then be sucked out of the eye. The pseudophakic lens can then be placed in the area to replace the original lens.

Another approach sometimes used for removal is extracapsular cataract surgery, where a larger cut is made. This can be used if it appears that the cataract may be difficult to separate. Your natural lens can then be removed in one piece and the pseudophakic lens inserted.

The IOL can be placed in the anterior chamber (between the iris and the cornea) or the posterior chamber (between the usual location of the lens and the iris).

Procedure

The surgery itself is an outpatient procedure. Here’s an idea of ​​what to expect.

Pre-surgery

Before surgery, be sure to tell your practitioner about any chronic illness you may have, such as heart disease, high blood pressure, or diabetes, to make sure it is under control.

Also discuss any medications you are taking. Although cataract surgery does not usually cause a lot of bleeding, it may be suggested that you temporarily stop any blood thinners. But discuss it first with the prescribing doctor.

Be sure to also mention if you are taking alpha agonists such as Flomax (tamsulosin), Uroxatral (afuzosin), Hytrin (terazosin), Cardura (doxazosin) or Rapaflo (silodosin), as they can potentially interfere with the procedure. .

Before surgery begins, your eyes will be biometrically measured to help you determine which power pseudophakic lens is right for you. You will probably also need to take eye drops to prepare yourself.

During surgery

On the day of surgery, expect to spend about two to three hours at any facility where your procedure is taking place. The procedure itself will only last about 30 minutes and you will be awake the entire time.

You will probably be given a sedative first to relax you. You will also be given a local anesthetic to block any pain. The doctor may give antibiotics or other drops right before surgery and again right after.

After the operation

After the surgery is finished, your eye will be bandaged and the staff will teach you what you need to do to take care of your eye over the next few weeks while you recover.

After about half an hour of rest, you can go home. But be sure to secure a ride in advance as the surgery will prevent you from driving.

Result

Over the next few months, you will be asked to return for postoperative visits. These usually start just a day after surgery. During the visit, the practitioner will examine your eyes, test your vision, and make sure that your eye pressure has remained more or less constant.

To avoid infection and reduce inflammation, you will also be asked to take drops for a while. Your vision will be somewhat blurry for the first few days after surgery, but it will start to clear up in the first few weeks.

In almost all cases, vision improves after cataract surgery. However, you may also be prescribed glasses or contact lenses. This prescription will probably be different from any previous one.

Complications

In most cases, the placement of the pseudophakic lens goes smoothly, but occasional complications can occur. These may include:

  • Your vision is corrected too much or too little.
  • The lens is incorrectly positioned or moving.
  • The shape of the pupil may be oval.
  • Fluid can build up on the retina causing Irvine-Gass syndrome, also known as cystoid macular edema (CME). This can cause macular swelling and result in blurring of central vision.

Additionally, cataract surgery itself can sometimes lead to complications such as:

  • Infection
  • Bleeding
  • Retinal detachment
  • Loss of vision
  • Glaucoma
  • Requiring a second surgery

A word from Verywell

The implantation of a pseudophakic IOL after cataract surgery is a very common and very successful procedure. With this technique, most people have excellent vision, much like what they liked before the development of cataracts.


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