Pre op Cataract Surgery

As the time for your surgery approaches Dr. Piemontesi's office staff will contact you regarding the date and time of arrival to the hospital. Make a note of these. Discontinue Aspirin 5 days prior to surgery. Should you take Warfarin, Coumadin, Plavix or Pradaxa, your family doctor needs to be consulted prior to discontinuing any of these medications. Certain patients are placed on an alternative medication, if they are at risk when discontinuing Warfarin, Coumadin, Plavix or Pradaxa. Discontinue all Prostate medications 14 days prior to surgery, unless instructed otherwise.
An instruction sheet detailing the drops to begin instilling into your operative eye 3 days prior to surgery will be provided. As with all eye drops instill 1 drop into the lower lid pouch and close your eye afterwards for 1 minute. Wait 3 minutes before instilling the next drop and repeat this for the 3rd drop. Each drop has an important function in not only preparing your eye for surgery but in the healing process afterwards. You will be taking the drops for 1-4 weeks after surgery according to the simple to follow schedule. It is VERY IMPORTANT that the schedule be followed and that the drops NOT be instilled one right after the other without waiting as then washout occurs and the full benefit of the medication is not realized.
The night before surgery try to get to bed early. Re-read the section below on what to expect on surgery day. Remember, this is a highly successful procedure that is routinely simple for patients to undergo.

Surgery Day:

  • On the morning of the surgery, you may have a small breakfast, but NO DAIRY PRODUCTS.
  • Bring all your medications that you normally take with you to the hospital, unless instructed otherwise.
  • Pre-operative eye drops are taken the morning until you arrive at the hospital.
  • Take all your eye drops to the hospital.
  • Arrive at the hospital at the time given provided by Dr. Piemontesi's staff.
  • It is urged to have a driver on the day of the surgery as well as the following day for the post operative appointment.
  • Cataract surgery takes between 8-25 minutes, but be prepared for at least a 3-4 hour stay at the hospital. The preparations before surgery, the surgery, and post surgery management.
  • After intake at the hospital special instructions are given and preparatory eye drops are instilled. These eye drops dilate the pupil, so the cataract (lens of the eye) can easily be accessed.
  • A relaxation tablet, ativan, is offered to help relax during surgery. Ativan is not meant to make you fall asleep during the surgery.
  • Either in the O.R. or just before a sticky gel will be placed on your eye. This is to anesthetize or ‘freeze’ the surface. This prevents any discomfort from the incision.
  • During the procedure it is important to LIE STILL to keep your eye RELAXED
  • Resist the urge not to squint or tightly close your eye when the gel is being applied. This allows good coverage and prevents stinging when the eye is cleaned before surgery.

    In the O.R.:
  • You will then be brought into the O.R. and positioned on the bed. Follow the nurse’s instructions closely. You will be wrapped in a blanket for comfort and to minimize movement. There is a cushion for your head but lateral movement of your head is still possible. It is important for the duration of the procedure to try very hard NOT to move your head nor arms or legs as that moves the head secondarily.
  • The eye will then be prepped with a cleaning solution. This may sting slightly in some cases. After it is washed off the drape will be applied to the area around your eye. At first it will be close to your face but quickly it will be pulled up and a ‘tent’ will be made allowing you ample breathing space. For some whom dislike confined spaces this may initially make you uneasy but remember there is lots of room under the drape and it is open at the end near your chest so you are not being ‘suffocated.’ Under the drape there will be an oxygen pipe which will bring in a mixture of fresh oxygen continuously during the surgery.
  • The drape is then opened over your eye and a lid speculum is placed to hold your eye open. Once again, it is important to keep your eye relaxed for this and at all times during the surgery. If you try and close your eye forcibly it will roll up under your upper eyelid preventing the surgeon from effectively performing the surgery.
  • The surgery will then begin. Water is dripped onto the eye at the beginning and during the surgery. This may be startling at first and you will feel the water. Try not to be startled by it. It is important to keep the eye moist throughout the procedure.
  • The surgeon will bring down the operating microscope which has a bright light on it. You will be instructed to look into the light and may see two filments from the bulb.Fixate with the eye straight up at the microscope light.
  • If the microscope light moves just keep looking at where it was, and do not follow it. The most important thing is to keep your eye in a neutral position during the surgery to allow the surgeon to operate safely.
  • Do not look up, down, left or right, but straight ahead. It is also very important to look straight up with the non-operative eye and to blink normally. The two eyes are wired together and if the non operative eye looks away the operative eye will also follow. Both eyes have to always look straight up together.
  • As the case progresses the fixation lights may disappear and then the fixation targets will reappear when the intraocular lens is implanted near the end of the case. Always keep looking straight up with both eyes.
  • You may experience many visual sensations such as a kaleidoscope of colours while the cataract is being removed.

    Important Reminders:
  • Try your best to follow the surgeon's instructions and to remain as still as possible during the surgery
  • Coughing should minimized during surgery, but if necessary, warn the surgeon.
  • Refrain from squinting during the surgery, a relaxed eye is a comfortable eye.
  • A pressure feeling and a brief pinching is felt during the surgery, this is normal. The gel applied to the eye prior to surgery numbs the surface, but patients can still feel the lid speculum (holds the eye open), as well as water being dripped into the eye. Pressure can be felt during certain parts of the surgery.
  • Everyone's experience's the surgery differently, and patients may even experience a difference between their own two eyes. Some may feel no discomfort, while others may find certain parts uncomfortable.
  • Each eye surgery is different. Typically patients experience more discomfort during their second surgery. This is typical in medicine and is felt to be due to neurological pathways that were never used during the first surgery, but the brain has learnt these by the second surgery. This is not an indication that something went wrong during surgery.
  • The memory can be poor during stressful situations and the Ativan given to patients can also affect memory during surgery. It is normal to experience something new during the second surgery
  • A typical cataract can take between 8-25 minutes,depending on the severity of the cataract. Any complicating factors may require extra steps to remove the cataract.

    After the Surgery:
  • Once the surgery is completed, the drape will be removed. This is OFTEN the most uncomfortable part of the procedure It is similar to a band aid being pulled off from the skin.
  • A clear shield will be applied to the eye with paper or micropore tape. It is ok to open the eye.
  • Vision will be blurry and it is normal to experience a pink colour or hue for the first day following the surgery.
  • You will be then taken back to the waiting room, where the nurses ensure your recovery from the procedure. When the nurse deems it appropriate, you'll be discharged into the care of a friend or family member.
  • Patients are urged to go home directly and rest after the surgery.
  • Mild analgesics such as Tylenol may be taken if you experience mild discomfort.
  • The eye may feel scratchy, especially for the first night or it may feel like something is in the eye. This is normal.
  • The vision will not be clear, especially the first day.
  • Depending on the severity of the cataract or any complicating factors that may have occurred during the cataract surgery, it may take take days for the vision to improve.
  • It is important not to compare the experience to other patient's experiences, as everyone's cataract surgery is different
  • It is advised to wear the eye shield when sleeping or napping for 1 week after. The shield should be lifted for the first 24 hours when instilling drops.
  • A post operative appointment will be scheduled at the office after surgery, usually the following day. Patients will be advised of the time of this appointment by Dr. Piemontesi's staff, an appointment card will be also given to the patient at the hospital prior to discharge.