Though constantly flushed and renewed, the overall pressure of aqueous is constant in a healthy eye’s anterior chamber. Too little or too much fluid can cause permanent damage. The physician places an ocular speculum in the patient’s eye, and accesses the anterior chamber through an incision through the limbus (the corneal-scleral juncture). To promote better drainage of fluid, the physician removes a partial thickness portion of the ring of meshlike tissue at the iris-scleral junction (the trabecular meshwork), and a scleral trap door is left open so that aqueous may flow through the new channel into the space between the conjunctival and the sclera or cornea (bleb). The physician closes the incision with sutures and may restore the intraocular pressure with an injection of water or saline. A topical antibiotic or pressure patch may be applied.
YAG laser treatment
The patient initially had extracapsular cataract surgery in which the posterior shell of the lens was not removed from the eye. But the capsule and/or the membrane adjacent to it (the anterior hyaloid) has since become opaque and must be destroyed in this new surgery. After a topical anesthetic is applied to the eye, the pupil is dilated. A number of YAG laser shots are focused to a point on the capsule, cutting it. Bursts from the YAG open a flap in the capsule, resulting in immediate improvement in vision. Multiple sessions may be needed to create an adequate opening in the lens capsule
Cataract removal with insertion of intraocular lens prosthesis
Extracapsular cataract extraction (ECCE) is when the anterior shell and the nucleus of the lens capsule are both removed, leaving the posterior shell of the lens capsule in place. The physician inserts a lid speculum between the patient’s eyelids and makes an incision in the corneal-scleral juncture (the limbus). To enhance the flow of fluids in the eye, the physician may punch a hole in the iris. Using a cutting and suction or ultrasonic device, the physician removes the lens in parts: first the anterior lens, then the inner, hard nucleus. The clear, posterior capsule remains. The physician injects a bubble of air into the anterior chamber to protect the cornea. The physician guides the intraocular implant into the eye. The haptics (securing attachments) lodge into the ciliary sulcus or the lens capsule, occupying the exact position of the original cataract. The physician may close the incision with sutures and may restore the intraocular pressure with an injection of water or saline. A topical antibiotic or pressure patch may be applied.