If you’ve ever cut your finger and needed sutures, you know that they can be a real pain. The sutures can irritate you and you have to go through the extra inconvenience of getting the sutures removed later as well. Are you going to have to go through the same routine after cataract surgery as well?
Fortunately, is almost all cases, cataract surgery doesn’t require the use of any stitches. Modern cataract surgery is designed so that all the micro incisions are self-sealing. This allows for a quicker more comfortable recovery and improved vision!
Cataract surgery didn’t always use to be this way. Years ago, sutures were essential for cataract surgery to be a success. But cataract surgery evolved over time to get to where we are today.
How Cataract Surgery Used to Be
Long ago, cataract surgery wasn’t as “clean" as it is today.
Cataracts were removed intact from the eye. This doesn’t sound like much of a problem... except that the cataract lens is a large structure!
The lens; image by File:Three Internal chambers of the Eye.png: Artwork by Holly Fischer derivative work: Pixelsquid, CC BY 3.0, via Wikimedia Commons / cropped from original
A cataract occurs when the natural lens inside our eye becomes cloudy. As you can see from the image above, the lens inside our eye is quite large. (In total, the lens is close to a centimeter in diameter; huge when talking about small structures such as the eye)
To remove this large lens / cataract from the eye, a very large incision must be made. Because of how large this incision was, it needed to be closed and repaired with sutures.
A large incision does pose some problems. Having a large incision can increase the risk of bacteria getting into the eye and causing an infection (however good suturing of this incision does decrease this risk).
A large incision will also change the curvature of the cornea. The area of the cornea where the incision is will become flatter than the rest of the cornea. When one part of the cornea is steeper or flatter than another part of the cornea, this results in astigmatism. This astigmatism will create blurred vision and require glasses or contact lenses to fix.
Cataract Surgery Evolves
A crucial invention for cataract surgery was phacoemulsifcation. This allowed surgeons to use ultrasound energy to break up the cataract into smaller pieces. The cataract no longer had to be removed in one piece. Smaller incisions were used.
But there still was one big problem. The incisions had to be enlarged in order to put in the new artificial lens after the cataract was removed. This negated a lot of the benefits of the phacoemulsification.
So the next big invention for cataract surgery was foldable artificial lenses. Improvements in material research led to artificial lenses that were flexible enough so that they could be folded but firm enough so that when they unfolded they could predictably correct vision.
Modern artificial lens used in cataract surgery; image by Frank C. Müller, CC BY-SA 3.0, via Wikimedia Commons
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Now we had a cataract surgery technique that allowed for small incisions and a way of correcting vision afterwards that could take advantage of those small incisions.
These smaller incisions dramatically altered the way cataract surgery was performed. The recovery after the procedure was shortened and these smaller incisions also allowed for improved vision.
A new cataract surgery revolution was born.
Cataract Surgery Today
In today’s modern cataract surgery, sutures aren’t necessary.
Over time, the microincisions for cataract surgery have become smaller and smaller. In addition, these incisions are created to be self-sealing. No sutures are necessary!
Because no sutures are necessary, there are some initial activity restrictions after cataract surgery.
Restrictions
Cataract surgery incision are self-sealing without sutures, but they can still leak. They don’t leak on their own, but they can leak in certain situations.
In physics, fluid flows from high pressure to low pressure. That is, unless there is some resistance blocking that flow.
The eye follows this law of physics. The fluid inside the eye is at a higher pressure than the air outside the eye. The self-sealing incision, however, provides that resistance to prevent the fluid from spontaneously leaking out.
But if one were to raise the pressure in the eye, some fluid could potentially leak out of the incision. Fluid leaking out of the incision can increase the risk of an infection developing.
Thus, there are restrictions after cataract surgery which are designed to prevent the pressure of the eye going up. Vigorous activity, bending over or picking up heavy objects can cause the pressure of the head and eyes to increase. This can increase the risk of the incision leaking after the surgery. Until the incision becomes stronger (approximately one week after cataract surgery), these activities should be avoided.
Sometimes Sutures Are Still Used
Occasionally, a cataract surgeon will still want to place one or a few microscopic sutures after cataract surgery.
- If the incision is irregular and is not sealing on its own, a suture will close off the incision.
- If the surgery is complex or complicated and there is an increased risk of infection, a suture can be used to decrease this risk more.
- If the incision has to be enlarged for any reason, stitches may be required in order to close the incision.
Stitches used in cataract surgery are literally microscopic! The diameter is approximately 3x smaller than that of an average human hair! The knot of the stitch is buried beneath the surface in order to prevent you from feeling the suture as much as possible.
This suture can temporarily influence the amount of astigmatism in your vision and is typically removed one month following cataract surgery. This is done painlessly at the clinic microscope. Once the stitch is removed, you can have some irritation on the eye for about a day.
But fortunately, situations where stitches are needed after cataract surgery are quite rare.
Summary
Modern cataract surgery has come a long way. In the past, stitches were required for all cataract surgeries. Advancements in techniques and materials have allowed cataract surgeons to safely remove cataracts through small self-sealing incisions that don’t require any sutures. This has been instrumental in improving vision and recovery after cataract surgery.
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