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Action on cataract

Action on cataract. Whipps Cross Hospital Harold Wood Hospital North East London Eye Partnership. Cataract surgery. Indications for surgery Surgical plan Surgical procedure Postoperative care Discharge. Indications. Visually significant cataract Affecting quality of life Work Driving

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Action on cataract

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  1. Action on cataract Whipps Cross Hospital Harold Wood Hospital North East London Eye Partnership

  2. Cataract surgery • Indications for surgery • Surgical plan • Surgical procedure • Postoperative care • Discharge

  3. Indications • Visually significant cataract • Affecting quality of life • Work • Driving • Reading • Hobbies • Activities of daily living • No Snellen acuity limit! (except driving)

  4. Surgical plan • Mode of anaesthesia • Surgical procedure • Refraction • Additional surgery • Lens implant: power & material

  5. Anaesthesia • Local • Topical • Regional • Peribulbar • Retrobulbar • Sub-Tenons • sub-conjunctival • General

  6. Surgical procedure • Pupil dilation cyclopentolate 1% + phenylephrine 2.5% • Surface cleansing povidone iodine 5% • Draping disposable self-adhesive waterproof drape • Lid speculum • Cataract removal • Lens implantation

  7. Cataract - phacoemulsification • Section: cornea or scleral • Viscoelastic instillation • Capsulorrhexis • Phacoemulsification • Soft lens removal • IOL implantation • Viscoelastic removal

  8. Additional surgery • Pupil enlargement • Refractive surgery • Glaucoma • Vitreoretinal • Macular hole • Epiretinal membrane peel • Retinal detachment • Vitrectomy for vitreous haemorrhage

  9. Surgical section • Self-sealing - sutureless • Astigmatically neutral • Position • Temporal • Superior • on-axis • Size: limited by IOL size – 3 to 3.5mm

  10. Capsulorrhexis • T Neuhann 1987 • Theory and surgical technic of capsulorhexis • Klin Monatsbl Augenheilkd 1987;190:542-5 “Kapsulorhexis is a surgical technique for opening the anterior lens capsule with a circular, smooth-edged and continuous margin. Basically, the technique consists of a precisely controlled continuous capsular tear (rhexis), using only a sharp disposable needle with a bent tip. The method is reproducible, requires minimal instrumentation, is compatible with all current techniques of extracapsular surgery, and can be learned at no risk.”

  11. Dense cataract without red reflex: Vision Blue

  12. Phacoemulsification • Charles Kelman 1967 – Cavitron • Ultrasound fragmentation of lens • 1967 - no capsulorrhexis or foldable IOLs • Techniques • Divide & conquer • Nucleus chopping

  13. Phaco – “divide and conquer”

  14. Intraocular lens implants • Rigid • PMMA • Foldable • Silicone • Acrylic – hydrophobic e.g. Acryosof • Acrylic – hydrophilic e.g. Hydroview, Centerflex

  15. Complications – intra-operative • >92% no intra-operative complications • Posterior capsule rupture - around 4-5% • Zonule dehiscence • Vitreous loss • Iris trauma & bleeding • Corneal endothelial damage • Thermal corneal burns • Dropped nucleus or lens fragments

  16. Post-operative care • Clinic review: Next day unnecessary • 7-14 days post-operative clinic review • Topical therapy e.g Maxitrol x 4/3/2/1 per week • Post-operative refraction • Stability • Attainment of target refraction • Dispensing for non-emmetropic eyes e.g -3D target • Laser capsulotomy

  17. Discharge to Optometrist • Refract & dispense at 4-6 weeks • Refraction feedback for audit • Visual outcome • Target refraction & biometry precision • Planned surgery on second eye • Capsule opacification & Laser capsulotomy

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