Home care instructions after lens replacement surgery

Things to remember before your surgery

• Any general diseases, such as hypertension, heart disease or diabetes, must be at an acceptable level. 
• If you are taking Marevan to thin your blood, it is recommended that the INR value be at your stable medicated level (usually 2–3.5) and controlled during the week before surgery at your health centre. 
• Surgery will not be performed if you have a fever, cough, gastroenteritis, eye inflammation or an inflammation on your facial skin and/or mouth (such as herpes, blepharitis, acute tooth infection or pain).
• If you fall ill before the surgery, please contact our customer service, tel. +358 
• 10 190 200 (nationwide appointment and surgery help line, service hours: Mon–Fri 8 am – 6 pm, Sat 9 am – 4 pm)
• Make sure you are aware of the possible effects of the surgery on your ability to work. For example, there are restrictions on vision and eye surgery in the fields of aviation, shipping and rail transport. 

Other things to note before surgery 

• Do not use soft contact lenses for one week or hard contact lenses for three weeks before the surgery.
• Eyelash extensions are not recommended at the time of surgery. They make it more difficult to clean the eyelid and may come off when the protective tape is removed.
• Permanent eyelash tinting should not be applied in the two days preceding surgery.
• It is a good idea to take a shower and wash your hair on the night before or the morning of the surgery.
• Before the surgery, make sure you have cotton pads at home. You will need them to clean your eyelids after surgery.

Things to remember on the day of your surgery

• Remember: only come for surgery if you are well!
• On the day of surgery, you can take your medication as usual in the morning and eat lightly.
• Wear clean, loose-fitting and comfortable clothes.
• Do not wear any makeup to reduce the risk of infection.
• Reserve about 2–3 hours for the procedure 
• A premedicated patient must be accompanied by an escort (discharge home by taxi is permitted)
• Driving a car after the operation is not permitted

Bring with you to the surgery 

• a completed patient information form
• an identity card 
• your current prescription for glasses
• the pharmaceuticals you need (e.g., asthma spray, insulin, nitroglycerin)
• S-Etukortti card, if you have one

The procedure

Before the procedure, your pupil will be dilated using eye drops. A relaxant may be given to you before the surgery, if necessary.

The procedure will take approximately 10–20 minutes per eye. The procedure is painless. Both eyes will be operated on at the same time to make it as easy as possible for the eyes to become accustomed to the new optics. Sutures are usually not needed, because the surgical wound closes itself. 

After the surgery, we will monitor your condition for about an hour, after which you will be allowed to go home. Driving is not permitted after the surgery. If you do not have anyone with you to drive you home, you can take a taxi. 

The post-operative symptoms and potential risks are described below.

Symptoms and risks after surgery

While lens surgery involves minor risks, there is no such thing as a risk-free surgical procedure. 

Eye surgery carries the following potential risks:

Dry eyes 

Your eyes will be more susceptible to dryness after the surgery. After the operation, you will receive instructions on how to apply moisturising drops, which are useful when applied regularly.

Corrected refractive error

Nearly all patients can stop using glasses, and most of our customers can see without glasses as well as or better than they did with glasses before the procedure. However, we cannot promise with 100% certainty that all patients can stop using glasses, because the response to treatment always depends on the initial refractive error as well as on individual vision requirements. It is advisable to wait a few months after the surgery for the refractive values to stabilise. 

Posterior capsule rupture

The eye’s own lens is located inside a capsular bag. In lens surgery, your own lens is replaced by an artificial lens. During the surgery, a rupture may appear in the back wall of the capsular bag. Intraocular hyaloid (vitreous body) can enter the front of the eye through it. The vitreous body is removed before inserting the artificial lens. Posterior capsule rupture is associated with a slightly increased risk of retinal detachment. With an experienced eye surgeon, the risk is 1–2 promille. A rupture makes it impossible to insert a multifocal or toric lens in the eye. In this case, a single-vision lens is used to get as close as possible to the planned refractive error correction.

Retinal detachment 

There is a slightly increased risk of retinal detachment requiring surgical treatment after a cataract or lens replacement surgery even if there were no problems during the surgery.The risk of detachment is affected by the customer’s age, refractive error, the condition of the retina and vitreous membrane, any earlier eye surgeries, and potential injuries. The customer’s individual risk is assessed during the pre-examination. Overall, retinal detachment is rare, with an occurrence of 10–16 per 100,000 people (people with and without surgery in total).

Intraocular pressure

There may be a temporary increase in intraocular pressure after the procedure. Symptoms may include eye and/or headache, and blurred vision. If symptoms occur, contact the operating unit or the surgeon who performed the operation.

Swelling of the high-acuity vision area

One to two percent of patients that have undergone lens replacement surgery experience swelling in the area responsible for high-acuity vision. This cannot be predicted before surgery. Your ophthalmologist will check it during the follow-up examination. The swelling can be treated by continuing the use of the after-care drops as instructed by your ophthalmologist during follow-up examination.

Corneal swelling

The cornea may become swollen during surgery. As a result, it may take longer for the vision to get clear. The condition is not permanent.

Infection 

The risk of bacterial infection in lens replacement surgery is minimal: less than 1 per 1,000 operations. Infections are prevented by means of aseptic surgical technique with sterile surgical equipment and antibiotic eye drops. After-care drops will be used after the surgery to prevent infections. However, if the eye becomes inflamed, it will be treated with an intraocular antibiotic. At worst, the inflammation can reduce visual acuity.

Secondary cataract

In a few percent of patients who have had a lens replacement operation, the body’s own cells cloud the posterior capsule, which means that the eye develops posterior capsule opacity, also known as a secondary cataract. A secondary cataract causes loss of visual acuity. It cannot be predicted before the surgery. Secondary cataracts are treated on an outpatient basis. The surgeon uses a YAG laser to make an opening in the posterior capsule, allowing light to pass through for clear vision. Secondary cataracts do not cause permanent damage.

Corrected visual acuity

In order to achieve the best possible visual acuity, additional procedures may sometimes be necessary. These include operations to correct astigmatism. Corneal laser surgery may be performed as an additional procedure not earlier than six months after lens replacement surgery.

Light reflections

Around 6% of people who have undergone cataract surgery experience light reflections (halos) from the artificial lens when driving in the dark. Approximately 1% experience such strong reflections that make it very difficult to drive in the dark.

Multifocal lens

Three focus areas: far, the computer screen distance and near distance. Glasses may be needed for some distance to ensure sharp vision.  

Extended depth-of-focus lens

Focus area from the computer screen distance to far distances. Reading glasses will be needed for reading and working with something at a near distance. 

Monofocal lens

The focus area can be selected either far (A) or near (B), and a lens that corrects astigmatism can be used to ensure sharper vision for the selected focus area. Glasses will still be needed afterwards. Choosing a monofocal lens can reduce your dependence on glasses, but it does completely eliminate the need for glasses

You may have foreign body feeling at the outer edge of your eye. This is completely normal and is caused by the incision, which will heal itself in two weeks. Vision in your operated eye may be temporarily blurry in the evening and next morning following the surgery and the eye may be sensitive to light. Your vision will start to become clearer a few days after the surgery.

If you were given an eye shield at the hospital, you should wear it until the next morning. After that, we recommend that you use the eye shield at night for two weeks.

You can start cleaning your eyelids the following morning as follows:

• Always wash your hands first.
• Gently wipe your eyelids with a cotton swab or cotton pads dampened with water.
• Start from the outer edge of your eye and proceed towards your nose.
• Clean your eyelids this way in the morning and evening for two weeks.

Apply eye drops according to the instructions given in the prescription.

• Wash your hands. Tilt your head back and place the drop bottle close to your eye, without touching the eyelashes or the eye.
• Pull your lower eyelid down and look up. Squeeze the eye drop bottle lightly until one drop enters your eye.
• Take a break pause of 5–10 minutes between applying prescription eye drops. Tak a break pause of 30 minutes between applying prescription eye drops and moisturising drops. 
• As your eyes become easily dry after the surgery, we recommend that you use moisturising drops for a few months. 
• Moisturising eye drops will help to reduce dryness and the stinging sensation when applied regularly.

During the first two weeks, avoid:

• touching and rubbing your eyes
• physical exertion, dusty and dirty work 
• sauna, swimming and water gym
• eye make-up (permanent eyelash tinting and eyelash extensions are only allowed one month after surgery at the earliest) 
• visiting a dentist or dental hygienist, unless urgent treatment is required 

You can: 

• do light chores, such as cooking 
• read, watch TV and do crafts
• exercise outdoors. In windy or rainy weather, protect your eyes with glasses, sunglasses or a protective shield.
• when bathing or showering, make sure that water does not get in the operated eye!
• take a painkiller if necessary

Sick leave

Your surgeon will usually give you sick leave for 1–4 weeks depending on the type of work you do 1–3 days, if necessary. Note that, when granting sick leave, the surgeon cannot determine whether you are remunerated or not. Customer is responsible to notify the surgeon before the surgery of possible occupational vision requirements and restrictions to surgical treatmens.

Driving

Be prepared not to drive for a period lasting from a few days to a few weeks. Visual impairment caused by any other reason than cataract or refractive error will not be eliminated by lens replacement surgery. If your eyesight was not good enough to drive a car before surgery, you should have your vision checked by an optician or ophthalmologist before driving again after surgery. The test can be carried out about one week after theoperation.

Follow-up examination 

A follow-up examination will be arranged in connection with the surgery as instructed by your surgeon. 

If you feel an intense ache in the operated eye, your vision deteriorates, or you experience eye discharge or feel pain or nausea: 

• Contact the operating surgeon immediately by phone or text message. The contact information can be found on the business card given to you at the hospital.
• During the night or at the weekend, contact the municipal accidents and emergencies unit.

Silmäasema’s nationwide appointment and surgery help line, tel. +358 10 190 200 (Mon–Fri 8 am – 6 pm, Sat 9 am – 4pm)