Cataract Surgery nowadays is usually performed under 'topical anaesthesia' that involves instillation of drops of the anaesthetic agent on the eye surface. The patient retains the power to close the lids and move the eyeball during surgery, feel no pain but touch and pressure sensations are unaffected. A peribulbar block anaesthesia may be used at times on surgeon's discretion that involves an injection of anaesthetic agent around the eyeball with a short needle. This takes away lid and eye movements to a large extent but some control may remain with the patient.
Operating Surgeon expects the patient to follow the instructions for a smooth surgery. It is important to have a surgical counselling session with the doctor to understand the procedure and expected sounds/conversation during the operative procedure. The sequence of events should be understood and played in your mind while you move through the surgical suite.
- You should be wearing loose, comfortable hospital pyjama suit. Do not hesitate to change it if it is tight around your neck. Some hospitals have the policy to allow you to wear your own loose clothes and give you a hospital gown over them. Please ensure you are not wearing tight fitting clothes and your neck is free. Ladies to tie their hair in a ponytail with a band or a soft bun with no clips or clasps
- Sit quietly in the pre-operative area and use the washrooms before going to the OR. You may take sips of water if your mouth feels dry but do not hydrate yourself too much.
- You may be given a cap and eye marked for surgery. The antiseptic solution will be painted around the eye. Let the solution dry and do not touch your eye.
- OR assistant will help you lie down on the OT table with a rubber ring under the head to prevent rolling from side to side. You should be comfortable and be able to breathe rhythmically while lying down. Ask for a head raise if neck extension is hurting you and get the ring adjusted to your comfort and if it is hard for you to ask for a softer ring.
- When you are comfortable allow the staff to put monitoring devices which could be a pulse oxygen meter alone or additional cardiac electrodes. Breath rhythmically and try to relax.
- Sterile Drapes will be placed around your head and an adhesive eye drape on the eye to be operated upon. Please maintain your head in a position as required and adjusted by the surgeon. Do not move your head or lower your chin. The surgeon works under a microscope and any movement shifts the focus and obstructs in smooth surgery.
- There will be several sounds in the OR that you should ignore-beep of monitors, hum of air circulation unit, trolley wheels, the doctor would be giving instructions to staff and asking for instruments etc. Try to keep your attention focused towards surgery only.
- Coughing and snorting during surgery can create complications, always ask the surgeon to stop the surgery if you feel like doing so. Do not try to suppress a cough or sneeze by holding breath. Do not bear down or move.
- Follow instructions of a surgeon and do not start a conversation. Answer only when a question is directed towards you. The surgeon may ask you to look in a particular direction. You have to follow the command by moving your eyes and not head unless the specific instruction is made.
- The first touch of the instrument will increase your confidence. Do not wince, squeeze your lids or make a jerky movement if you feel some pain. Inform the doctor, who will reinforce anaesthesia.
- Cataract Surgery machines also produce different types of sounds during different phases of surgery and also have synthesised verbal outputs. Do not get distracted by the same.
- You will see movements in front of the eye during surgery and also perceive vibrations. Light intensity will increase towards the end of surgery.
A calm patient who is having a regular rhythmic breathing and a regular normal pulse rate makes a surgeon's job easy.
(In case of specific problems additional monitoring and specialised anaesthetic cover may be required which the operating surgeon will discuss before hand).