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Dealing with the scariest complication in cataract surgery Ian Francis Surfing : Leonardo era un pittore straordinario First : the most important word in the English language : Ontological : do you believe what you just saw ?? ONTOLOGICAL : “ The way things really are …”

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Presentation Transcript
slide3
Leonardo era un

pittore straordinario

first the most important word in the english language
First : the most important word in the English language :

Ontological

: do you believe what you just saw ??

ontological
ONTOLOGICAL :

“ The way things really are …”

FOR EXAMPLE :

1. Life

2. Your spouse

3. Your children

4. God

5. Surfing

6. Medicine

7. Optometry

8. Ophthalmology

9. Refractive surgery

10. Neuro-ophthalmology …………

all ophthalmology and optometry is neuro ophthalmology
All Ophthalmology and Optometry is Neuro-ophthalmology

Why ?? ….

because much as anyone

may or may not like it :

The eye bone is connected to

1. the brain bone

2. the body bone

slide7
Dealing with the

scariest

complication in

cataract surgery

slide9
E :

Only happens because someone has been operated !!

anthony pane neuro ophthalmologist extraordinaire
Anthony Pane : Neuro-ophthalmologist extraordinaire

Everyone in Medicine should read this….

slide11
Med J Aust October 2008

“ Misdiagnosis of acute eye diseases by

primary health care providers: incidence and implications “ ….

1. Michael O. Statham: RMO: MB BS(Hons), BAppSci(Optom)(Hons)

2. Anamika Sharma : Registrar : BmK BS(Hons), BMedSci(Hons)

3. Anthony R. Pane : VMO : MB BS(Hons), MMedSc, FRANZCO

for e
For E :

It is of supreme importance not to

1. underdiagnose E

2. misdiagnose E

3. treat E as of little consequence

slide14
E

1. Is either local or metastatic

2. May requires lots of medical work to confirm

3.May be life-threatening….

diagnosing e
Diagnosing E :

YOU MAY BE IN

THE BOX SEAT

slide18
E :

1. Vast majority have had cataract surgery

2. Within a few days of the operation, things head south,

often rapidly

3. Day 1: vision 6/4 or 6/12 vision

4. Vision on day 4 : HM or worse

5. Pain

6. Loss of the red reflex

7. Hypopyon

slide20
E :

Is getting the instructions for the postoperative drops correct really important ?……

e story
E story

Don : DOB 280726

280704: R phaco Wednesday : uneventful

290704 : Thursday : Day 1 pop : VAR : 6/4

020804 : Monday 7.40pm : Day 5 pop :

VAR : PL

All stops pulled out by the VR team ……..

endophthalmitis following cataract surgery the sucking corneal wound
Endophthalmitis following cataract surgery : the sucking corneal wound

Athena Roufas MBBS (Hons), MM (Ophthal Sci)

Vivek B. Pandya MBBS (Hons), MM (Ophthal Sci)

Edwin C. Figueira MBBS, MSc, MS (Ophthal)

Shahriar Amjadi B Sc (Hons), MBBS

Gaurav Bhardwaj BMed

Josh Baker

Katherine Masselos MPH, MB, BS (Hons)

Fiona Stapleton PhD

Sarosh Batliwalla BEc, MEc, MIntS, FIAA

Katherine E. Francis BE (Hons)

Rahul Dubey MBBS (Hons)

Jeanie Chui B Med Sci (Hons) MBBS PhD

Ian. C. Francis FASOPRS, PhD

is e important
Is E important ?
  • What is the world “accepted” rate of E
  • It is said to be 0.1% : 1/1000
is e important in oz
Is E important in Oz?

NSW has a rate (1998-2004)

of 0.823%: >8/1000

Is this really true ??

slide34
Risk factors for acute endophthalmitis after cataract surgery: a population-based study.

Hatch WV et al

Ophthalmology.

March 2009

116:425-30.

slide36
April 2009
april 200938
April 2009
  • Nick Mamalis
  • Editor JCRS
  • Professor of Ophthalmology
  • Nick.Mamalis@hsc.utah.edu
  • (John A.) Moran Eye Center :0011 1 801 581 23520011 1 801 581 2121 (Emergency Switch : the best number; they will contact his home)Office : 801 581 6586Pager : 801 339 0763
1 st may 2009
1st May 2009

Emanuel Rosen FRCSE

Editor JCRS

Manchester , England