A lensectomy is a surgical procedure to remove part of or the entire crystalline lens of the eye when it turns opaque or if attached to scar tissue. The procedure is commonly associated with cataract surgery, which removes an opaque lens by breaking it up using an ultrasound.
A lensectomy is not only useful in cataract surgery. It can also be used to correct a wide range of vitreoretinal conditions such as a complex retinal detachment and intraocular foreign body. Others include:
- Complications related to cataract surgery such as left-over lens fragments from a previous cataract surgery. Another post-cataract surgery complication is a dislocated intraocular lens (IOL).
- Severe refractive error such as farsightedness or nearsightedness that has not benefited from LASIK or various other forms of corneal surgery
- The desire to prevent an impending cataract by performing another type of lensectomy called refractive lens exchange (RLE)
- The presence of other eye diseases that have the potential to cause severe lens problems in future
Refractive lens exchange (RLE) or refractive lensectomy is used to replace the natural crystalline lens with an artificial intraocular lens (IOL) to treat hyperopia and myopia. The IOL is fitted with the correct power of the affected eye. RLE resembles a cataract surgery, the only difference being the purpose. Cataract surgery removes a diseased, opaque lens, while RLE aims to reduce dependence on contact lenses or glasses. The natural lens is then replaced with a mono-focal lens, which provides clear vision at only one focal point.
Pars plana lensectomy involves removing the entire lens within the pupillary region. This region consists of the nucleus, anterior and posterior capsules, and the anterior and posterior cortices. It is mostly used to remove presenile cataracts in patients below the age of 40.
Before the Procedure
The eye specialist will engage in discussions with the patient on the advantages and disadvantages of the procedure to enable informed consent. The patient's medical and ophthalmic history is taken and an eye examination conducted.
The patient is advised to stop wearing contact lenses (soft or hard, and depending on the doctor’s instructions) several weeks before surgery. Medications that might increase bleeding during the procedure should also not be taken. The doctor may administer antibiotic drops a day or two before surgery.
A lensectomy procedure lasts about one to two hours, and the patient should go home after completion. However, the patient should have a responsible adult drive them home after surgery. Patients are advised not to eat or drink 12 hours before a lensectomy.
The patient's eye is numbed with a local or general anesthetic.
In the procedure, the surgeon:
- Creates micro-incisions in the wall of the eye
- Uses a phacoemulsification method that uses sound waves or vibrations to break up the lens if the intention is to remove the entire lens
- Uses a miniature suction device to remove the lens and any fragments that may be remaining
- Injects a saline solution into the eye to restore the pressure
- Makes an incision towards the front of the eye if the purpose is to remove a cataract. S/he breaks up the opaque lens using ultrasound and removes it through the incision before replacing it with a pristine artificial lens
If the surgeon performs an RLE, s/he replaces the natural lens by inserting a mono focal IOL (that has been folded) through the incision. The lens will be unfolded and placed into the bag that once surrounded the natural lens. Micro-incisions usually heal by themselves; therefore, the surgeon does not need to use sutures.
Risks & Complications
Risks and complication may include:
- Retinal tear
- Damage to the iris
- Retinal detachment
- Bleeding from the iris
- Glaucoma, which can be steroid induced
- Perioperative posterior capsule’s rupture
- Soft lens matter forming in the anterior chamber
- Total hyphema (haemorrhage into the eye's anterior chamber)
- Bullous keratopathy which may occur even years after a lensectomy
- The posterior capsule may opacify, requiring a further procedure called a capsulotomy
- Endothelial damage especially when the surgeon encounters a cataract with a hard nucleus
Aftercare & Recovery
Recovery is rapid, with most patients returning to their normal routines in a day or two.
The results will vary from patient to patient, with some reporting improvements in vision almost immediately while others may take longer. The patient may no longer need their prescription glasses or contact lenses.