Cataract Surgery
“Wh-what did you just say? You can fix Marien’s eyes?”
Count Pepper’s eyes went wide at the mention of normalizing Marien’s odd eyes.
“The condition in the lady’s eyes is called heterochromia.”
“Hetero… what now?”
“First off, let me ask you one thing. Were her eyes different colors from birth?”
“…Yes. They’ve been like this—two different colors—since the day she was born.”
I nodded lightly at Count Pepper’s cautious, trembling response.
“I see. Well, ‘fixing’ isn’t quite the right word. If it’s not a change in iris color due to some acquired factor but rather eyes that were different colors from birth, there’s no vision impairment or functional issue.”
Heterochromia occurs congenitally in about 96% of cases, with only around 4% being acquired.
“Y-yes! That’s right! Our Marien never had any problems like mine—cloudy vision or anything like that!”
Count Pepper raised his voice, unable to hide his excitement. The shift from his earlier demeanor spoke volumes of his fatherly love.
Warm paternal affection. The kind that opens wallets wide.
Heterochromia is more common in Caucasians but occasionally appears in East Asians too. It can even happen in animals, especially dogs and cats.
“Count Pepper, I’m sure I explained the iris briefly when I described cataract surgery.”
“Yes, I remember.”
I nodded again at his reply.
“The iris is usually amber, blue, brown, green, or hazel.”
Of course, people with albinism—which causes red, purple, or gray eyes—were an exception I didn’t need to mention. Count Pepper, squinting through his own cataracts, was solely focused on making Marien’s eyes normal.
“In cases like Lady Marien—no, like Countess Marien—”
“Please, call me Marien, Count Gold.”
Even after three years in this isekai life, I still wasn’t used to honorifics shifting based on familiarity or status. Luckily, Marien had just given me the green light.
“Very well. In cases like Marien’s, where heterochromia appears, it’s due to differences in melanin concentration in the iris. Melanin is the pigment in animal tissues, and its amount determines skin, hair, and iris color.”
“Heavens… I’ve never heard anything like this anywhere.”
Count Pepper looked stunned, as expected. In a world ruled by mages who’d chant “Chop it off first, ask questions later” at the slightest infection, no one cared about melanin.
“People usually just think, ‘My eyes are blue like Father’s’ or ‘green like Mother’s,’ without wondering why Father has one color, Mother another, and I have this one.”
“……”
“……”
No reaction. They weren’t particularly curious either.
“The fewer melanin cells in the iris, the bluer the eye. More means green, brown, black. When the concentration differs between eyes, you get heterochromia.”
In Marien’s case, like many with congenital heterochromia, it was genetic. A DNA glitch from birth led to unequal melanin cells, hence different iris colors. Acquired cases could stem from glaucoma meds, eye trauma, iris tumors, diabetes, Horner’s syndrome, or Waardenburg syndrome—but those often involved severe damage risking vision loss or blindness, so prompt medical attention was key. Unlike the congenital kind.
“S-so, my daughter Marien truly has no health issues? No black magic or curses?”
“We’d need a full exam to confirm, but visually, no. It’s just a variation—not even a disease, really.”
“Ahh, Marien. My daughter Marien…”
“Sob… Father.”
I hadn’t even explained the treatment yet, but there they were, embracing and weeping. It painted a clear picture of Marien’s life so far.
In this world, any oddity branded you a heretic. Like Walter with his skin condition—called a monster, a devil, despised. Marien wouldn’t have fared better.
“No need for tears, everyone. I can make both her eyes match.”
“Sniff… Forgive my unseemly display. All the scorn my daughter has endured—”
“Yes, yes, I get it. No more of that once she’s operated on, so don’t worry.”
I cut off the melodrama before it could build.
“So, how much for the lady’s surgery fee?”
“Pardon?”
“Let’s start at five magistones.”
I wasn’t here for tear-jerking tales. This was about survival.
* * *
After some dramatic haggling—not over magistones, but the final surgery price—we ran full exams on Count Pepper and Countess Marien. A day later, it was time for the main event.
“Director, he’s secured.”
“Good. Everyone, pay close attention—this is your first cataract surgery. I’m making the incision now.”
“Wha—? First time? What do you mean?!”
Count Pepper went first. Cataract surgery uses local anesthesia, so he was wide awake. Annoyingly so.
“…Count Pepper. I clearly said no talking or moving once surgery starts.”
“N-no! Didn’t you say you’d done cataract surgeries many times? So why does it sound like—”
“I meant the nurses are seeing it for the first time. It’s quick, so stay quiet. We’re starting.”
General anesthesia is for when patient movement needs controlling, surgeries run long, or pain is severe. Cataracts used to be major ops requiring it—long, complex, inpatient. But modern techniques? Twenty minutes tops, tiny incisions, fast recovery. Usually outpatient now.
“Wait—one last question! It really won’t hurt even with a knife near the eye?”
“Yes, that’s your seventeenth time asking. Keep disrupting, and the bill goes up.”
“Ahem… I leave it in your hands.”
People were so fickle. He’d badgered me endlessly about pain, ears ringing—until extra fees shut his clam mouth.
This guy’s a total scaredy-cat. Tsk.
Pupils dilated with mydriatics, numbing drops in. Whatever I did with a scalpel, he’d see nothing, feel nothing. Zero reason to freak.
Full anesthesia was unavoidable for uncooperative cases: young congenital cataract kids, dementia patients, psych cases. But local was better for outcomes when possible—real-time communication ensured precision.
“Incision commencing.”
““Yes!””
Stab—
Rebecca, Hazel, and Stella held the eyelids and fixed the eyeball. I made a tiny corneal incision.
Schwick—
Tiny cuts at 9 and 6 o’clock for tool entry.
“Gel, please.”
“Here, Director.”
Shooo—shoooo—
Stella handed me the gel syringe; I injected viscoelastic into the incision.
“Watch closely. Injecting gel is simple, but it maintains space and protects the cornea. No slacking just because it’s straightforward.”
““Yes!””
Right eye gel done. Next: circular anterior capsule incision before nucleus removal.
Scritch—scratch—scritch—
Eyes were tiny organs. Needle through the slit, utmost care.
Scraaatch—scratch—scraaatch—
Capsulotomy precision determined IOL stability later. Full focus.
Scritch—scratch—scraaatch—
Repetition opened the capsule, exposing contents.
Schwick—phooosh—phooooosh—
Widened the corneal entry for phacoemulsification, hydrodissected with fluid to separate cortex and nucleus. Safer, efficient removal.
“Ultrasound.”
“Here.”
Scraaatch—scrraaatch—sloooorp—sloooooorp—
Inserted the phaco probe from Stella, emulsified and aspirated the cloudy nucleus delicately.
“Fluid.”
Gurgle—glug—scraaatch—scrraaatch—sloooorp—sloooooorp—
Eyes were fragile; mishandling spelled disaster. Opacities cleared, last fragments gone.
Sluuuurp—sluuuuurp—
Cortex polished clean—over half done.
Quacks like some lazy hacks skip this. Idiots—think of your own eyes, your family’s. Do it right.
Even quacks knew residual cortex caused inflammation.
Sluurp—sluuuurp—sluuurp—
“Cortex clear. Gel.”
“Yes!”
Filled the empty bag with viscoelastic. The pivotal moment: clear IOL insertion for refocus.
Slide—sliide—sloooow—
Inserted the multifocal IOL, centered precisely.
Critical step.
“Inserting IOL, Count. Focus on the light ahead—no talking.”
“Yes.”
“……”
Directing his gaze via microscope light ensured accurate axis. Off-center IOL tanked results. Patient feedback was key—why local over general.
Tsss—tssss—chuuuush—chuush—chuuuush—
Centered, closed 9 o’clock incision. Aspirated remnants via 6 o’clock.
Couldn’t help cursing homeland butchers. Residual viscoelastic spiked IOP—every surgeon knew. But speed demons rushed sloppily… infuriating. Recited Heart Sutra mentally, sealed last site.
“Closing 6 o’clock.”
““Yes!””
Tsss—tssss—
Tiny 2-3mm self-seals, no sutures.
“Right eye done. Moving to left.”
““Yes!””
Left finished, he’d be stunned. A whole new world awaited.