Action on cataract

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Action on cataract

• Whipps Cross Hospital
• Harold Wood Hospital
• North East London Eye Partnership

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Cataract surgery

• Indications for surgery
• Surgical plan
• Surgical procedure
• Postoperative care
• Discharge

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Indications

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

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Surgical plan

• Mode of anaesthesia
• Surgical procedure
• Refraction
• Additional surgery
• Lens implant power material

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Anaesthesia

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

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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

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Cataract - phacoemulsification

• Section cornea or scleral
• Viscoelastic instillation
• Capsulorrhexis
• Phacoemulsification
• Soft lens removal
• IOL implantation
• Viscoelastic removal

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Additional surgery

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

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Surgical section

• Self-sealing - sutureless
• Astigmatically neutral
• Position
• Temporal
• Superior
• on-axis
• Size limited by IOL size 3 to 3.5mm

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Capsulorrhexis

• T Neuhann 1987
• Theory and surgical technic of capsulorhexis
• Klin Monatsbl Augenheilkd 1987190542-5
• 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.

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Dense cataract without red reflex Vision Blue
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Phacoemulsification

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

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Phaco divide and conquer
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Intraocular lens implants

• Rigid
• PMMA
• Foldable
• Silicone
• Acrylic hydrophobic e.g. Acryosof
• Acrylic hydrophilic e.g. Hydroview, Centerflex

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Complications intra-operative

• gt92 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

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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

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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