Complex Cataract Surgery in Jalandhar

Most cataracts are straightforward. The cloudy lens is soft enough to break up and remove through a tiny opening, and the artificial lens sits neatly in the natural capsule. A complex cataract is one where something makes this harder: the cataract is rock-hard, the eye has been injured, the support holding the lens is weak, the pupil will not open, or the eye already has a retinal or glaucoma problem. These cases carry a higher chance of trouble during surgery, and they need extra planning, extra techniques and a surgeon who can handle the back of the eye if needed.

At Drishti Eye Care & Retina Centre in Lambra, Jalandhar, Dr Nalini Saxena takes on complex cataracts. She has performed over 5000 cataract surgeries and is a fellowship-trained vitreo-retinal surgeon, with two months of advanced training in complex cataract and vitreo-retinal surgery in Germany.

What makes a cataract “complex”?

A cataract is the natural lens of the eye turning cloudy. The surgery to remove it is one of the safest in medicine. But some eyes are harder to operate than others. Common reasons include:

• Very hard (mature or “white”) cataracts. When a cataract has been left for many years, the lens becomes dense and brown or white. It needs more energy to break up, and the capsule around it is more fragile.
• Cataract after injury. A blow to the eye, or a penetrating injury, can crack the lens and damage the threads that hold it, so it may be loose or tilted.
• Weak or missing lens support. Some conditions people are born with, very high short-sightedness, previous eye surgery, and some older cataracts weaken the fine threads (zonules) that hold the lens. The lens may wobble or shift during surgery.
• A small pupil. Diabetes, long-term use of some medicines, and past inflammation can stop the pupil from opening wide, leaving very little room to work.
• Other diseases in the same eye. Diabetic retinopathy, glaucoma, a previous retinal surgery, or silicone oil in the eye all change how the cataract surgery must be planned.

Symptoms

The symptoms are those of any cataract — blurred, dim or hazy vision, glare at night, faded colours — but often more severe. With a mature cataract, the pupil may look white or grey, and vision may be reduced to seeing only light and hand movements. With a loose lens, the image may shake or double.

When to see a doctor

Do not wait for a cataract to “ripen”. That old advice is exactly what turns a simple cataract into a complex one. A soft cataract removed early is a shorter, safer surgery with a quicker recovery. You should also be seen promptly if:

• You have had an injury to the eye and vision has dropped
• The pupil has turned white — a very mature cataract can cause the pressure in the eye to rise
• You have been told elsewhere that your cataract is too risky to operate
• You have diabetes, glaucoma or a retinal problem and are developing a cataract

How Dr Nalini approaches a complex cataract

The most important step is planning. Dr Nalini Saxena examines the lens, the strength of its support, the pupil, the cornea and the retina before surgery, so that nothing comes as a surprise on the table. Her training covers both halves of the problem: an MS in Ophthalmology from Maulana Azad Medical College, a vitreo-retinal fellowship at Venu Eye Institute and Research Centre, New Delhi, the examination of the Royal College of Surgeons, and advanced training in Germany.

During surgery

The surgery is still stitchless wherever possible, but with adjustments for the eye in front of her: special dyes to see a fragile capsule, small devices to hold a small pupil open or to support a loose lens, and gentler techniques to break up a very hard lens without stressing the capsule.

If the support fails

Sometimes, despite every precaution, the capsule cannot hold a lens, or a piece of the cataract drops to the back of the eye. In many hospitals this means a second surgery at a different centre with a retina surgeon. Here, Dr Nalini is that retina surgeon. She can remove the dropped piece through the back of the eye and place a lens by scleral fixation in the same sitting.

Combined planning

Where the eye also has diabetic swelling, glaucoma or a retinal problem, treatment of both is planned together — for example, an intra-vitreal injection around the time of cataract surgery in a diabetic eye — so you see one doctor and follow one plan.

What to expect on the day

• Before surgery: eye measurements for the lens power, blood tests and a fitness check. Sugar and blood pressure should be under control. Have a light meal and bring someone with you.
• Anaesthesia: drops or an injection around the eye. You are awake but should not feel pain. Children have general anaesthesia.
• The surgery: longer than a routine cataract — often 30 to 60 minutes — because of the extra steps.
• Going home: the same day in most cases, with a shield over the eye, drops and instructions.

Recovery

Recovery is usually a little slower than after a simple cataract surgery, and the eye may be more inflamed in the first week:

• Vision often improves within days but may take a few weeks to settle fully, especially if the retina was also treated.
• Use the drops as prescribed — usually for a longer period than after routine cataract surgery.
• Do not rub the eye, avoid heavy lifting and dusty places, and wear the shield at night.
• Follow-up visits are closer together so that the pressure, the lens position and the retina can be checked.
• New glasses are prescribed once the eye has settled.

Cost of complex cataract surgery in Jalandhar

Complex cataract surgery costs more than a routine one, because it takes longer and may need extra devices and steps. The main factors are:

• How hard the cataract is and whether special devices are needed for the pupil or the capsule.
• The type of lens — standard, premium, or a lens designed for scleral fixation.
• Whether a retinal step is needed, such as removing a dropped lens piece or fixing the lens to the sclera.
• Treatment of other conditions at the same time, such as an injection for diabetic swelling.

You receive a written estimate after the examination, before anything is booked.

Frequently asked questions