Name of the Procedure:

Discission of Secondary Membranous Cataract (Opacified Posterior Lens Capsule and/or Anterior Hyaloid); Stab Incision Technique (Ziegler or Wheeler Knife)

Summary

This procedure involves making a small stab incision to remove the opacified (cloudy) membrane behind the lens implant or in the anterior hyaloid space, typically using a Ziegler or Wheeler knife. It is often referred to as a discission for secondary membranous cataract.

Purpose

The procedure addresses the issue of cloudiness (opacification) in the posterior part of the lens capsule left after cataract surgery. The goals are to restore clear vision and improve visual acuity.

Indications

• Blurred vision post-cataract surgery due to secondary membranous cataract.
• Significant decrease in visual acuity affecting daily activities.
• Patients who have had a posterior capsular opacification (PCO) diagnosed by an ophthalmologist.

Preparation

• Patients may be advised to fast for a few hours before the procedure.
• Avoid certain medications as directed by the healthcare provider.
• Complete any prescribed diagnostic tests such as optical coherence tomography (OCT) to evaluate the extent of the opacification.

Procedure Description

1. The patient is seated in a reclined position.
2. Topical anesthetic drops are applied to numb the eye.
3. A fixation device or speculum is used to keep the eye open.
4. Using a microscope for precision, the surgeon makes a small incision in the opacified posterior lens capsule or anterior hyaloid.
5. A Ziegler or Wheeler knife is used to carefully cut and remove the cloudy membrane.
6. The eye is irrigated and examined to ensure complete removal of the opacified tissue.
7. Antibiotic and anti-inflammatory eye drops are often applied post-procedure.

Duration

The procedure typically takes about 15-30 minutes.

Setting

This procedure is usually performed in an outpatient clinic or a surgical center.

Personnel

• Ophthalmologist or eye surgeon
• Ophthalmic nurse
• Anesthesiologist or anesthesia provider (if sedation is required)

Risks and Complications

• Infection (rare)
• Increased intraocular pressure
• Inflammation or swelling in the eye
• Potential injury to surrounding eye structures
• Incomplete removal of the opacification, requiring additional treatment

Benefits

• Improved visual clarity and acuity.
• Restoration of functional vision, enhancing quality of life.
• Benefits can be realized almost immediately or within a few days post-procedure.

Recovery

• Patients may need to use prescribed antibiotic and anti-inflammatory eye drops for a week or more.
• Avoid strenuous activities and protect the eye from injury or contamination for several weeks.
• Follow-up appointments with the ophthalmologist to monitor healing and vision improvement.

Alternatives

• YAG laser capsulotomy: A laser procedure to remove the opacified capsule.
  • Less invasive but may not be suitable for all types of opacification.
• Observation: Monitoring the condition if it does not significantly impact vision.
  • Delays surgical intervention but may result in prolonged visual impairment.

Patient Experience

During the procedure, the patient may feel slight pressure but should not experience pain due to the anesthetic drops. Post-procedure, mild discomfort or sensitivity to light can be managed with prescribed pain relief and protective eyewear.