Surgical treatment of cataracts
Phacoemulsification technique (PHACO)

• Size of the incision from 1 to 2.75 mm.
• A probe is used to break the lens in microscopic pieces, which are then gently vacuumed up.
• It does not require sutures (“stitch-free” cataract surgery).

For patients over 40 to 45 years old with high degrees of refractive errors or with some degree of cataracts, the most recommendable surgical technique is extraction of the lens using the phacoemulsification technique and then implanting an intraocular lens.

The extraordinary evolution in the design of modern intraocular lenses, which incorporate biocompatible material, provides surgeons with an array of options that enable excellent clinical results to be obtained and make it possible for many patients to recover reduced dependence on glasses for seeing different distances.

• The cornea is the transparent and curved part of the eye that performs two-thirds of the eye’s focusing tasks.
• It refracts or curves rays of light when they enter the eye, which makes it possible to focus them toward the retina.
• If the clarity or the curvature of the cornea is affected by injury or disease, vision can be drastically affected.

Cornea transplant (also known as keratoplasty) is advisable when vision has diminished to a certain degree and is irreversible.
It is the organ transplant procedure with the highest success rate, greater than 90%.
The affected cornea is extracted using a microscope and microsurgical instruments; then, the new cornea is sutured in its place.
A new technique has recently been incorporated that makes it possible to delay transplanting the cornea when the pathology causing diminished vision is Keratoconus. It is the intraocular ring implant technique (Keraring, Ferrara, INTACS).

Who can it affect?
Glaucoma affects over 3% of the population and it is, together with diabetes, the main preventable cause of blindness in Spain. It primarily affects people over 40 and those with a family history of glaucoma.

Symptoms
The pain felt by a patient varies depending on the type of glaucoma that he/she has.

Chronic glaucoma is the most frequent type, and in its beginning phases no sort of pain is felt. If the pressure continues to be high for a prolonged period of time, the optic nerve is affected and peripheral vision deteriorates slowly. In advanced stages, vision is reduced to the central area of the visual field, making the patient feel as though he/she were looking through a tube, and it may lead to total vision loss.

Acute glaucoma is much less frequent. It is characterised by intense pain, which suddenly begins around the eye area, and by a decrease in vision. In some cases, it can be accompanied by headaches, nausea and vomiting. If you have these symptoms, you should immediately call/visit an ophthalmologic specialist.

Detection of glaucoma
Intraocular pressure can be measured using quick and painless tests. The condition of the retina and optic nerve can also be evaluated in a non-intrusive manner.

In the event of a family history of glaucoma and/or when such procedures show some sort of anomaly, a computerised perimetry test should be carried out.

Treatment
The best treatment for glaucoma is early diagnosis in those situations in which intraocular pressure is high and/or the optic nerve is beginning to be damaged. Due to the fact that most cases of blindness caused by glaucoma occur without symptoms and that it can be prevented, it is essential to perform checks every one or two years in any person over 40.

Therapeutic options
Medical treatment
The most common way to treat glaucoma is by applying drops. The aim is to decrease intraocular pressure. If the treatment is done correctly, in most cases it is possible to stop glaucoma from getting worse.

Laser
If the pressure is not controlled with medical treatment, the next option is to use a laser. This procedure aims to help ocular fluid leave the eye and thus reduce intraocular pressure.

Surgery
This is the last step in the treatment of glaucoma. It consists of expanding the zone where intraocular fluid leaves the eye by making an exit valve or by implanting an artificial drain valve.

The surgery is performed using local anaesthesia. When glaucoma is associated with the presence of cataracts, the two procedures can be done at the same time.

What happens afterward?
It is not possible to know if the glaucoma is controlled according to how the patient sees or feels, since there is no type of pain that indicates such information. Making periodic visits to the ophthalmologist is the only way to know if the glaucoma is correctly controlled.

Nonetheless, once glaucoma has been detected and treated and the pressure on the eyeball returns to normal levels, deterioration of the optic nerve is not very common.

Until today, all lens implants were rigid, so it was necessary to make a wide incision (5-6 mm) to implant them and then to use two or three sutures to close the incision. In addition, this practice also made it necessary to use local or general anaesthesia, which induced astigmatism and slowed visual recovery.

Since 1997, the procedure has been carried out in Spain using flexible epicapsular lenses (Implantable Contact Lens – ICL) that are placed between the crystalline lens and the iris.

The ICL are implanted using a 3 mm incision that is not necessary to stitch, which makes it possible to correct refractive errors with causing astigmatism. Other important advantages include the fact that it is performed using topical anaesthesia (drops), it lasts about 15 to 20 minutes and it is not necessary to be admitted or to cover the eye after the surgery, so visual recovery is practically immediate. The ICL make it possible to correct up to 18-20 dioptres of myopia and 9-10 dioptres of hyperopia.

• Eyeglasses in the first stage.
• Contact lenses when eyeglasses are no longer effective.
• Cross Linking: cross linking is the only process able to create new unions or bridges between the corneal collagen fibres in order to significantly increase the rigidity of the cornea. This makes it so the cornea resists ocular pressure and does not deform, thereby detaining visual deterioration.
• Intracorneal rings: when it is evident that the keratoconus has progressed. The rings used may be keraring, ferrara, corneal ring or intacs.
• Cornea transplant, necessary in the most advanced stages when other options will not cause improvements. (Corneal scars, very advanced keratoconus, holes.)

This type of surgery aims to eliminate or reduce sight problems (Myopia, Hyperopia, Astigmatism) in order to achieve good vision without the need to wear glasses or contact lenses.

To do so, and depending on the dioptre to be corrected, the visual acuity and the patient’s age and the condition of his/her eyes, it is possible to use techniques the Excimer Laser or with lens implants.