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Dominic McHugh MD FRCS London, UK

Cataract and Implant Surgery. Dominic McHugh MD FRCS London, UK. Cataract Causes. Age Congenital (genetic, metabolic) Trauma Infection Inflammation Surgical Drugs ( eg steroids). Cataract. May be induced by surgical procedure: lens touch; gas; oil. Cataract types. Nuclear sclerosis.

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Dominic McHugh MD FRCS London, UK

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  1. Cataract and Implant Surgery Dominic McHugh MD FRCSLondon, UK

  2. CataractCauses Age Congenital (genetic, metabolic) Trauma Infection Inflammation Surgical Drugs (eg steroids)

  3. Cataract May be induced by surgical procedure: lens touch; gas; oil

  4. Cataract types Nuclear sclerosis Posterior subscapsular Congenital (rubella) Trauma

  5. ECCE (Extracapsular cataract extraction) But longer wound healing time Management of Cataract

  6. Cataract Surgery Small incisionalPhacoemulsification surgery (Developed by Kelman, USA)

  7. Before IOL implantation was developed • Aphakic spectacles • Contact lenses

  8. Pioneer of intraocular lens implant Sir Harold Ridley FRS FRCS

  9. Harold Ridley collaborated with the Rayner company to develop the IOL John Pike, Rayner Company

  10. 1949-1950: First IOL implants

  11. Choice of IOL • Insertion through small incision • High biomcompatilbility • Allows good retinal view • Stable centration • Low PCO (posterior capsular opacification) rate

  12. IOL choiceWhy foldable/injectable?Minimise incision size to reduce healing time and astigmatism • PMMA(rigid) : Non-foldable+large incision • Acrylic: Injectable through 2.2-3.2 mm currently.

  13. Preparation for cataract surgery Biometry: The calculation of required IOL power Keratometry (K) (corneal curvature) Axial length (AL) of eye (ultrasound) IOL power= A constant-2.5xAL-0.9K Eg: 118-2.5x 24-0.9x45=17.5dioptres IOL power

  14. Phacoemulsification with IOL implantation

  15. Phacoemulsification: surgical sequence • Corneal tunnel • CCC (continuous curvilinear capsulorrhexis • Hydrodissection • Phacoemulsification • Aspiration of cortical lens matter • IOL insertion

  16. Phaco parameters

  17. Phaco+IOL surgeryHydrodissection

  18. Phaco+IOL surgeryPhacoemulsification

  19. Phaco+IOL surgeryAspiration of cortex

  20. Phaco+IOL surgeryFoldable IOL insertion

  21. Typical injectable IOL Superflex lens: 6.25mm x 12.50mm C-Flex lens 5.75mm x 12.00 mm

  22. Cflex/Superflex injector

  23. Loading the Superflex IOL

  24. Superflex insertion

  25. Superflex insertion

  26. Superflex insertion

  27. Insertion of injectable IOL

  28. Endoscope view of Superflex

  29. Cataract surgery Postoperative management Eye pad overnight Antibiotic+steroid drops for up to one month Change glasses at one month

  30. Complications of cataract surgery (many!) Posterior capsular rupture and vitreous loss Dropped nucleus IOL dislocation Endophthalmitis Retinal detachment

  31. Cataract surgery complications

  32. Cataract surgery: complications

  33. Thank you!

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