Eye surgery

Eye diseases have serious consequences for those affected: reduced visual acuity, halo effects, reduced contrast vision and a narrowed field of view can even lead to accidents.

If glasses and contact lenses don't even help anymore, the only thing left to do is surgery. Eye operations are also absolutely necessary for degenerative eye diseases (cataracts or glaucoma) and emergencies (retinal detachment).

What is eye surgery?

Eye operations are surgical interventions that restore the full functionality of the eyes. For example, parts of the eye are removed and foreign material is transplanted. Sometimes misalignments (strabismus) also have to be corrected.

Eye operations are performed under general or partial anesthesia with twilight sleep. General anesthesia is usually used for anxious patients and children. Elderly patients and people with heart and blood pressure problems are only anesthetized locally. Before the operation, a non-binding consultation takes place in which the patient is informed about all the details of the operation and the surgical procedure indicated for the disease is determined.

In the preliminary examination, the corneal thickness and corneal surface are checked. The pupil size and visual performance are also carefully examined. Any pre-existing conditions such as high blood pressure and diabetes mellitus are taken into account when choosing the surgical procedure.

Function, effect & goals

Eye operations should enable the patient to do without visual aids as much as possible. Movement disorders and misalignments of the eyes are also corrected.

If the patient has to undergo surgery on both eyes, one eye is treated first and then the second after restoration of full vision. The choice of the surgical method depends primarily on the type of eye disease present. For refractive errors between -10 and +4 diopters, the LASIK (refractive surgery) procedure is usually used. With the very gentle laser procedure, the patient can usually see clearly just a few hours after the surgical procedure. The small bruises on the eye usually go away soon afterwards. If the patient has cataracts, the clouded lens is removed and replaced with an artificial lens (clear lensectomy).

In another method that is frequently used today, the artificial eye lens is integrated into the existing lens capsule. The natural lens is destroyed and removed beforehand using ultrasound. Most cataract surgeries are performed with the femto-second laser. It enables the most precise cuts ever. After the operation, however, the person affected must wear slightly corrective glasses (near and far-sightedness). Glaucoma operations (glaucoma) should preserve the remaining eyesight. If both eyes are affected, the procedure must be carried out under general anesthesia. If the slowly progressing degenerative disease is not operated on in time, the excessively high intraocular pressure will damage the retina and the optic nerves.

In narrow-angle glaucoma, the eye surgeon creates a tiny opening in the irid (iridotomy) so that the aqueous humor can better circulate and the intraocular pressure is reduced. An iridectomy is used to cut the edge of the cornea and remove a tiny piece of the iris to create a flow of aqueous humor. In corneal surgery, the clouded cornea is replaced by a donor cornea (penetrating keratoplasty, PK). Sometimes only one layer is replaced by the donor cornea: The damaged lamella is vaporized with the laser (phototherapeutic keratectomy, PTK). Corneal transplants are one of the most frequently performed eye operations today. In certain cases, an operation must be performed immediately: If the retina becomes detached or if there is diabetic retinopathy, the retina must be sutured again so that the patient does not go blind.

This is the case, for example, with macular degeneration. The macula is the retinal area with the highest concentration of sensory cells. The detached retina is attached by sewing on a silicone seal. Another method is to fix it to the wall of the eye with a laser. Eye muscle surgery is required if the patient is cross-eyed, has trembling eyes, or has an eye-induced head posture. The entire eyeball is removed when a blind patient experiences severe eye pain. Before an artificial eye is inserted, a guide seal must be sewn in. If there is a malignant tumor on the eye, additional connective tissue and fat are removed.

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Risks, side effects & dangers

After an eye operation, there may be reduced night vision and increased sensitivity to glare in the first few weeks. These after-effects are completely normal and usually go away without any action on the part of the patient.

Although most eye operations today are routine operations and are performed by experienced specialists using the latest technology, many patients are afraid of such an operation. They fear that they will never be able to see properly again afterwards. Your fears are not entirely unfounded, as eye surgery is associated with a risk of 1: 1,000. Permanent damage cannot be completely ruled out. Therefore, the operating doctors are always available even after the surgical procedure. The most common complications include retinal detachment, cystoid macular edema, decreased visual acuity, infections, decreased contrast vision, halos around light sources and increased sensitivity to glare.

Follow-up treatment is required if these surgical consequences occur. To reduce the risk of complications, it is advisable not to wear contact lenses for several weeks before the surgery and to use the prescribed eye drops after the procedure. In addition, under no circumstances should the patient put their hands in their eyes or rub them. Rooms where people are smoking are best avoided, as tobacco smoke delays the wound healing process. In addition, the scheduled follow-up controls must be observed.