Procedures and Surgeries

What is it?

• A medicine is injected into the jelly inside the eye to dry up swelling and stop leaky, abnormal blood vessels [1].
• A common medicine is bevacizumab ("Avastin"). Others include aflibercept, ranibizumab and faricimab.

Why is it done?

• Wet age-related macular degeneration (wet AMD)
• Diabetic macular oedema (swelling of the centre of the retina from diabetes)
• Retinal vein occlusion (a blocked vein in the retina)

On the day

• Numbing drops go in first, then an antiseptic (iodine) to clean the eye.
• The injection uses a tiny needle and takes only a few minutes. Most people feel pressure, not pain.
• You usually need a course of injections, often monthly at first, then spaced out if the eye is stable.

Afterwards

• A gritty feeling for a day or so is common (often from the iodine).
• A red spot on the white of the eye is common and harmless. It fades in 1 to 2 weeks.
• Some floaters for a few days can be normal.

Possible risks

• Infection inside the eye (endophthalmitis): rare but serious.
• A short rise in eye pressure, or rarely retinal detachment.

Animation

Cataract surgery, step by step

What the surgeon sees through the microscope, while you are awake under local anaesthetic

1. You stay awake: numbing drops (sometimes a small injection) make the eye comfortable, then it is cleaned and held open gently.
2. A tiny cut is made at the edge of the cornea, the clear front window of the eye.
3. A small round opening is made in the thin front skin of the lens (the lens capsule).
4. An ultrasound probe gently breaks up the cloudy lens and suctions it away.
5. A new clear artificial lens, folded small, is slipped in and unfolds into place.
6. Done! Usually no stitches are needed; you go home with an eye shield and your vision clears over the next days.

What is it?

• The cloudy lens is broken up with sound waves and removed (phacoemulsification, or "phaco"), and a clear artificial lens is put in [2][3].

Why is it done?

• When a cataract makes your vision cloudy or dim and affects daily life. You do not need to wait for it to be "ripe".

On the day

• Done as a day case under local anaesthetic (you are awake, but the eye is numb).
• The operation itself usually takes about 20 to 30 minutes.

Afterwards

• Use your antibiotic and steroid drops for about 4 weeks. Do not stop early.
• Wear the eye shield at night, do not rub the eye, and keep water and soap out of it.
• You will usually be seen three times:

1. Day 1

   The day after surgery. Vision, eye pressure and the wound are checked.

2. Day 7

   About one week later. Healing is checked and drops may be changed.

3. Day 30

   About one month later. Final vision is checked, drops are usually stopped, and you are told when to get new glasses.

Possible risks

• Infection, inflammation or raised eye pressure.
• Retinal detachment (rare): sudden flashes, many new floaters or a dark curtain need checking the same day.
• Months or years later, the lens bag can turn cloudy (posterior capsule opacification). It is fixed with a quick, painless YAG laser.

Animation

Pterygium surgery, step by step

What the surgeon sees through the microscope, while you are awake under local anaesthetic

1. You stay awake: numbing drops and a small local injection make the eye comfortable, then it is held open gently.
2. The pterygium, the fleshy wing-shaped growth from the nose side, is gently lifted off the cornea and removed.
3. The surface of the cornea is smoothed so it heals clear.
4. A thin piece of healthy conjunctiva (the clear skin over the white of the eye) is taken from under the upper eyelid.
5. This graft is laid over the bare area and held with tissue glue or tiny stitches.
6. Done! You go home with an eye pad; the graft heals over a few weeks and lowers the chance of the pterygium growing back.

What is it?

• The pterygium is removed, and a thin piece of healthy tissue from under your upper eyelid is used to cover the area (conjunctival autograft) [4].

Why is it done?

• When the pterygium grows towards the centre of the eye, affects your vision, or is very uncomfortable.

On the day

• Done as a day case under local anaesthetic. You go home with an eye pad.

Afterwards

• Use steroid drops for several weeks, reduced step by step, as they help stop regrowth.
• The eye feels gritty and looks red for 1 to 2 weeks. This is normal.
• Do not rub the eye, as rubbing can move the graft.

Possible risks

• The pterygium can grow back. Wear sunglasses and a hat outdoors, for life.
• Steroid drops can raise eye pressure, so keep every check-up.

What is it?

• Many tiny laser spots are placed on the outer parts of the retina. This makes the abnormal new blood vessels shrink and stop growing [5][6].

Why is it done?

• Proliferative diabetic retinopathy, where fragile new vessels grow and can bleed.
• Some retinal vein occlusions.

On the day

• Done in the clinic. After numbing drops, a special contact lens is held on your eye.
• It can feel uncomfortable or achy. You may need several sessions.

Afterwards

• Vision is blurry and dazzled for a few hours. Do not drive that day: bring someone with you.
• A mild ache can be eased with simple painkillers like paracetamol.

Possible risks

• Some loss of side vision and night vision.
• PRP protects against severe vision loss. It does not usually make your vision better.

What is it?

• Months or years after cataract surgery, the thin bag holding the new lens can turn cloudy (posterior capsule opacification). Vision becomes blurry or glary again, like the cataract has come back [7].
• A YAG laser makes a small opening in the cloudy bag so light can pass through clearly. The cataract does not really come back.

On the day

• Done in the clinic. Dilating drops widen your pupil first, and you sit at a machine like the one used for eye checks.
• It takes only a few minutes and is painless. You may hear clicks and see flashes of light.

Afterwards

• Vision is often clearer within a day or so. Blurriness from the drops wears off in a few hours, so do not drive that day.
• A few new floaters are common at first and usually settle.
• Your doctor may give anti-inflammatory drops for a short time and may check your eye pressure afterwards.

Possible risks

• A short rise in eye pressure or mild inflammation.
• Retinal detachment (rare): sudden flashes, many new floaters or a dark curtain need checking the same day.

What is it?

• A laser makes a tiny hole near the edge of the iris (the coloured part of the eye). This gives fluid inside the eye another path to drain, so the drainage angle is less likely to block [8].

Why is it done?

• Narrow drainage angles, found at an eye check, to prevent a sudden attack of acute angle-closure glaucoma.
• After an attack, to treat that eye, and usually the other eye too, because it is also at risk.

On the day

• Done in the clinic. Drops are used to make the pupil small and to numb the eye, and a special contact lens is held on the eye.
• It takes a few minutes. Most people feel a brief sting or a tap with each pulse.

Afterwards

• Vision may be blurry for a few hours, so do not drive that day.
• You may use steroid drops for a few days. Your eye pressure is checked, sometimes about an hour after the laser.
• The tiny hole is usually hidden under the eyelid. A few people notice glare or a faint line of light.

Possible risks

• A short rise in eye pressure, mild inflammation, or a little bleeding in the eye that clears by itself.
• Sometimes the hole closes and the laser needs to be repeated.