II. Definition
- Surgical removal of lens
III. Indication: Visual Impairment secondary to Cataract
- Prevents Activities of Daily Living (ADL)
- Significantly interferes with patient's life-style
IV. Efficacy
V. Preparation
- Preoperative exam
- Medical conditions stable
- No current infectious disease
- No current Skin Infections
- Medication history of any Alpha Adrenergic Antagonists
-
Topical Antibiotic used preoperatively
- Cleanses the lids
VI. Technique: General
- Outpatient 1 hour procedure under Local Anesthesia
- Techniques
- Extracapsular (95%)
- Lens nucleus removed through anterior lens capsule
- Phacoemulsification used on younger patients
- Soft lens fragmented with Ultrasound
- Lens components aspirated
- Phacoemulsification used on younger patients
- Posterior lens capsule polished and left intact
- Causes less derangement of surrounding tissue
- Provides chassis for new lens implant
- Lens nucleus removed through anterior lens capsule
- Intracapsular
- Older technique, used up until the mid 1980's
- Entire lens and capsule removed
- Lens frozen to cryoextractor tip and removed
- Extracapsular (95%)
VII. Technique: Lens Replacement
- Background
- Types
- Intraocular lens Implant (95%)
- Implanted at time of Cataract surgery
- Lens implant can be delayed years after surgery
- Contact Lenses
- Difficult to handle for many elderly
- Requires sufficient eye tearing
- Aphakic Spectacles (least desirable)
- Intraocular lens Implant (95%)
VIII. Precautions: Floppy Iris Syndrome
- See Floppy Iris Syndrome
- Current or prior use of Alpha Adrenergic Antagonists can have a significantly increased risk of intraoperative complications
IX. Management: Postoperative follow-up
- Ophthalmology follow-up:
- 24 hours after surgery
- 2-4 days after surgery
- Periodic exams until lens prescribed at 2-3 months
- Urgently for change in eye appearance or Sensation
- Precautions
- Avoid Eye Trauma
- Avoid Increased Intraocular Pressure
- Strenuous Physical Activity
- Bending
- Use eye-shields or glasses all the time
- Management
- Eye patch
- Worn continuously for first week after surgery
- Worn only at night After first week
- Activities
- After first week, normal activities performed
- Patient may drive after first week if Vision ok
- Medications
- Topical Antibiotic and steroid for first 3-4 weeks
- Suture
- Small enough (10-0 nylon) to not require removal
- Suture removed at 6-8 weeks if necessary
- Healing
- Completely healed by 3 months after surgery
- May obtain final Refraction at that time
- Eye patch
X. Complications (5% Incidence of major complication)
- See Floppy Iris Syndrome
- Fulminant Endophthalmitis (0.1% Incidence)
- Infection inside eye occurs within first week
- Caused by Staphylococcus and Streptococcus
- Vision Loss can occur in 24 hours (0.02% Incidence)
-
Glaucoma
- Occurs in first 4 days
- Hemorrhage
- Suture breakage
- Intraocular lens displacement
- Iritis
- Clouding of Posterior Capsule
- Occurs in up to 50% of patients
- Follows extracapsular extraction within several years
- Treated by Neodymium YAG laser
- Causes breakdown of posterior capsule