Types of cataracts & general desc

Types of cataracts & general desc • posterior subcapsular (PSC) • located in middle posterior lens near nodal point • progresses rapidly • smaller pupil significant • nuclear • middle part of lens • graded on color (yellow or white; white more difficult to detect) • myopic shift (2nd sight) • polar • located on posterior capsule • require more extensive surgery—cataract removed “from behind”

symptoms of cataracts • rapid or gradual onset • decreased VA • glare and/or halos • double vision (monocular) • reduced color discrimination (esp. blues) • reduced contrast sensitivity • progressive nearsightedness • difficulties with night vision, seeing road signs at dusk, recognizing familiar faces at a distance.

Overview of cataract surgery • outpatient procedure • takes ~15 minutes (at surgery center ~ 2 hours) • local anesthesia; lidocaine gel or sometimes retro-bulbar injection • small incision—2.8mm; angled to be self-sealing • no stitches; no patching • “phacoemulsification”—ultrasound waves used to break-up lens. Particles are then vacuumed out of the eye. • One eye at a time; 3-4 weeks between eyes.

considerations for cataract surgery on glaucoma patients • continue glaucoma medication use before surgery • removing cataract can increase space  can decrease IOP • do not perform surgery until IOP is under control (low 20s at most).

benefits of cataract surgery • reduce need for glasses • increase visual function • enhance visualation of the retina in certain eye conditions

IOL options for cataract surgery • refractive error can be corrected in the lens—also discussed elective surgery for patients who cannot have LASIK. • haptic (hook that secures lens in place)—to—haptic distance ~13mm; lens diameter ~6mm • monofocal—lens has one power • monovision—one eye focused at distance; other focused at near • multifocal lenses—different points of focus (far, intermediate, near) • ReZoom® (Dr. Bias recommends) • ReStore®

considerations for multifocal IOL cataract surgery • both eyes should be done (but not on same day) • both eyes healthy • pupil size—necessary to use concentric rings of IOL

Things patient should expect after cataract surgery: • irritation • eye drops to be used for a month after surgery • change in Rx / new glasses

post-op co-management of cataract patients • medications: • PredForte® or EconoPred 1% gttsqid for 1 month • Zymar® or Vigamox® (4th generation flouroquinolone) • Acular® until bottle is gone • eye shield worn at night for 1 week • no heavy lifting nor straining for 1 week • no swimming; no hot tubs for 1 week • Educate patient to RTC immediately for: • decreased vision • pain • redness • Follow-up Exams: • 1 day • 1 week • 1 month • Be sure to ask: • How is your vision? • Any pain? Nausea? Vomiting? (signs of high IOP) • Are you using the drops? shield? • Do you have any double vision?

cataract co-management exam: 1-day post surgery exam • VAs: • without correction • with pinhole • IOP—Goldmann • SL exam • wound • cornea • AC depth • cells? flare? • pupil shape • IOL assessment • Reinforce instructions for drops, shield, etc.

normal day 1 post cataract surgery signs/symptoms • periorbital bruising/echymosis • ptosis (mild) • FB sensation/scratchiness • subconjunctiva hemorrhage • corneal epithelial defect • corneal edema • 1+ to 2+ cells • smallhyphema • iris stromal atrophy (trauma) • posterior capsule striae

abnormal day 1 post cataract surgery signs/symptoms • pain especially with nausea & vomiting • IOP < 8 • IOP > 30 • narrow or flat AC • 3 to 4+ cells • large hyphema • ANYhypopyon • corneal infiltrate • circumferential ciliary flush (Red Hot Eye)

cataract co-management exam: 1-week post surgery exam • VA’s (without correction & with pinhole) • IOPsGoldmann • SLE (wound, cornea, AC depth, cells, pupil shape, IOL) • reinforce instructions • refract • discontinue antibiotic drops & shield • continue steroid gtts until gone • call to schedule 2nd eye

normal day 7 post cataract surgery signs/symptoms • quiet AC • clear cornea

abnormal day 7 post cataract surgery signs/symptoms • pain • significant conjunctival injection • elevated IOP • 2+ or higher cell • reduction in vision from day 1 post surgery exam • DFE should be done for cases where VA lower than expected • CME • macular issues • posterior capsule issues

general cataract surgery complications • complications may occur 1 day to several months after surgery • early complications  more virulent (gram -) organisms  very serious infection; refer to surgeon immediately • later complications  low virulent organisms  most commonly Staphylococcus Epidermidis from lids & lashes

“early” post cataract surgery complications • IOP spike (> 30) • more frequent in glaucoma patients; reason to continue drops • treat with aqueous suppressants (Alphagan P®) • IOP drop (< 8) • wound leaking • check for Seidel’s sign at both wound sites • treat with bandage CL, pressure patch, stitch, or rehydration.

“late” cataract surgery complications • cystoid macular edema • can see ~1 month post surgery • more likely: • “bad” dense cataract • DM • surgical complications • treat with NSAIDs, peri-orbital steroids, time • posterior capsule opacity • can happen any time • refer back to surgeon • fixed out-patient with YAG • pseudo-phakicbullouskeratopathy (PBK) • RARE • too much endothelial damage or pre-existing corneal endothelial condition like Fuch’s • treat with Muro128 • patient may eventually require PK

Types of cataracts & general desc