cataract postoperative care

1. cataract postoperative care • Liana Al-Labadi, O.D.

2. complications • Cataract surgery is the most commonly performed operation worldwide • Technological progress has enables major advances in this procedure • As with any surgery there are inherent risks, some of which are related to the increased complexity of the operation • Intraoperative complications • Postoperative complications

3. IntrA operative complications • ICCE • Was the main cataract surgery performed at the beginning of the 20th century • Method: • 180 degree limbal incision was created • The lens & the capsule were removed together by breaking the zonular ligaments • No IOL was inserted- patients wore aphakic spectacles; or an ACIOL was inserted • Operative complications: • Vitreous loss • Haemorrhage • Chronic cystoid macular edema • High astigmatism

4. IntrA operative complications • ECCE • Involves a smaller limbal incision- less operative complcations • Operative complications: • Reduced risk of vitreous loss • Remaining undetected cortical material not removed • Results in server post operative inflammation & significant PCO (= posterior capsular opacification)

5. IntrA operative complications • PE (Phaco) • Method of choice • Incisions required are smaller • Procedure much safer • time of recovery, the stabilization of post-operative refraction & amount of induced astigmatism is less • However the technique itself is more complicated • Requires extensive training & manual dexterity

6. IntrA operative complications • Operative Complications: • Tear/rupture of the posterior capsule • Can result in vitreo-retinal tractions & eventually RD • Increases risk of endophthalmitis • Nuclear fragments falling into vitreous--> severe inflammatory reaction • Increased risk if weak zonules • PXF, hypermature cataracts & CT disease • Dislocation of nucleus • Loss of lens fragments • Pupil constriction • Small non-dilating pupil can cause visibility issues • Use iris hooks or iris expanders • Useful in patients with floppy iris syndrome • Bleeding • Rare • Anterior capsule tear • Wound leak

7. Posterior Capsular Tear http://homepage.mac.com/omca/somca/foldersusa_files/image086.jpg http://www.baltimore-eyecare.com/the-expert-opinion/uploaded_images/A35-722627.jpg

8. The Routine • Routine Postoperative Care: • F/U visit schedule • Examination components • Medication Schedule • Early & late post-operative complications • Management of complications

9. Post-op instructions • The norm- May remain for 6-8 weeks • Blurry, fluctuating, shimmering vision • Mild discomfort • Drops may sting • Drops may leave harmless white residue in the corner of the eye • Eye may feel scratchy or dry- provide patients with AT • Slight redness • Watering • Mild irritation • Glare • Slight drooping

10. Post-op instructions • The DOs: • Wash hands before and after using eye drops • Wear your glasses during the day and wear the eye shield at night x 7 days • Unless doctor instructions specify otherwise • Wear sunglasses when out x 1 week during daylight • To protect the eyes from sunlight & injuries • Shake the drops and use as instructed • Only use clean tissues to wipe the eye • Make sure eyelids are always clean after surgery • Use warm compresses at least twice a day • Use OTC reading glasses until Rx is finalized 4-6 weeks after surgery • If any minimal pain use two Tylenol tablets for relief • Severe pain should be reported to the doctor immediately • Report to the doctor ASAP if: • Persistent pain- not relieved by Tylenol • Redness • Discharge • Unexpected loss of vision &/or field vision • Flashes or floaters

11. Post-op instructions • The DONTs: • Activity: Normal activity except heavy labor or sports can be resumed immediately • No heavy lifting (anything over 5 pounds) or bending (below waistline) x 1 week • No driving the day of or after surgery • At 4 weeks all normal activities can resume • Avoid hard rubbing or squeezing eye x 1 month • straining, squeezing or a blow to eye can result in disastrous complications • Face wash: For the first few days, close your eyes when washing face • Bathing: • Avoid any water splashing into the eye x 1 week • Can bathe with head tilted backwards or keep eyes closed during shower • Games: • Avoid strenuous activities like jogging, lifting weights, swimming, gardening, aerobics, contact sports x 2 weeks • Normal daily activities including walking, reading and watching TV may be resumed immediately following the surgery • Makeup: Avoid eye makeup x 2 weeks • Diet: No dietary restrictions • Driving: You should not begin driving until indicated by your doctor • Job: Can resume 2 days s/p surgery • Travel: • Can travel 1 week after surgery • Keep eyes well lubricated during flight • Avoid aspirin

12. F/U Schedule 1 Day *Case Hx: status since surgery? pain? dry? discomfort? sleep? sick? vision? *VA (s) *SLE: Wound site (&sutures); K; AC; IOL condition & centration * IOP Review Postoperative instructions 1 week *Case Hx: status since surgery? pain? dry? discomfort? vision? review of complaints & instructions *VA (s) + SLE + IOP *DFE: IOL centration & position; Posterior capsule; macula; peripheral retina *AB drops usually stopped after this visit *Case Hx: status since surgery? dry? discomfort? vision? *VA (s) + Refraction/Keratometry + SLE + IOP *Rx released at this visit *Steroids & NSAIDs- almost done 1 month 3-6 month Complete Eye Exam

13. Medication Schedule 3 Days Before AntiBiotic QID NSAID BID-QID **ATs PRN Week 1 P.O. AntiBiotic QID x 1 week NSAID QIDx 1 week Steroid QIDx 1 week **ATs PRN Week 2 P.O. AntiBiotic Discontinued NSAID TIDx 1 week Steroid TIDx 1 week **ATs PRN NSAID BIDx 1 week Steroid BIDx 1 week **ATs PRN Week 3 P.O. NSAID QDx 1 week then discontinued Steroid QDx 1 week then discontinued **ATs PRN Week 4 P.O.

14. Medication Schedule Vigamox Zymar Besivance

15. Medication Schedule Acular Acuvail Xibrom

16. Medication Schedule PredForte