29 - Cataract Surgery Postoperative Care

Question 1

What are some signs and symptoms requiring urgent referral to an eye doctor?

Answer 1

• post-op infection
• glaucoma
• inflammation or any suspected issues in healing

Question 2

We talk about 4 types of meds in this chapter. What are they?

Answer 2

• Meds to prevent infection
• Meds to prevent a rise in IOP
• Meds to prevent cystoid macular edema
• Meds to improve healing

Question 3

Inflammation more common within ___ hrs of surgery

Answer 3

48

Question 4

Infection most common how long after surgery?

Answer 4

between 3 and 7 days

Question 5

If someone complains of itching of the eye, it indicates what?

Answer 5

either an allergy to meds or dry eye

Question 6

How long do you give antibacterials for?

Answer 6

7-10 days post surgery

Question 7

A bunch of different antibiotics can be used, can do antibiotic/steroid combo to improve ______

Answer 7

adherence

Question 8

Intracameral administration of vancomycin linked with rare disorder called what?

Answer 8

HORV (hemorrhagic occlusive retinal vasculitis)

Question 9

How long do we give glaucoma meds for (these are being given to decrease IOP)?

Answer 9

as long as IOP is elevated

Question 10

How long do we give anti-inflammatory agents for?

Answer 10

3-4 weeks

Question 11

Why do we use anti-inflammatory meds?

Answer 11

-Used for a few weeks post-op to decrease inflammation and the risk of developing cystoid macular edema

Question 12

What drugs can we use to decrease inflammation?

Answer 12

-NSAIDs and/or corticosteroids

Question 13

What meds are used to improve healing?

Answer 13

-opthalmic dilators and cycloplegics

Question 14

How long are opthalmic dilators and cycloplegics used for?

Answer 14

for first few weeks after surgery

Question 15

How do opthalmic dilators and cycloplegics work?

Answer 15

These meds are used to keep the iris away from the implant during early healing period and to improve comfort by decreasing ciliary muscle spasm

Question 16

Examples of opthalmic dilators and cycloplegics

Answer 16

• cyclopentolate
• phenylephrine
• tropicamide

Question 17

Separate eye drops by at least ___ mins

Answer 17

5

Question 18

How do patients who have a systemic CI to one of the eye drops deal?

Answer 18

Tell them to block inner canthus (put pressure on it) to prevent the drop from being systemically absorbed

Reassure them that the eye drop post-surgery is more important than the very slight risk of some small systemic absorption of the drug

Question 19

Signs of endophthalmitis

Answer 19

• vision worsening
• floaters
• eye redness

Question 20

What types of meds may be stopped prior to surgery?

Answer 20

insulin, or SU, meglitinides - doses may be modified or med may be held day before or day of surgery due to risk of hypoglycemia

Question 21

_____ may be held due to risk of lactic acidosis

Answer 21

metformin

Question 22

More frequent monitoring of ____ ____ may be required

Answer 22

blood glucose

Question 23

What are some classes of glaucoma meds used to decrease IOP?

Answer 23

• alpha agonists
• beta blockers
• carbonic anhydrase inhibitors (oral or topical)
• prostaglandin analogues

Question 24

Examples of alpha 2 agonists

Answer 24

brimonidine, apraclonidine

Question 25

Examples of beta blockers

Answer 25

timolol, betaxolol

Question 26

Examples of carbonic anhydrase inhibitors (topical)

Answer 26

brinzolamide, dorazolamide

Question 27

Examples of prostaglandin analogues

Answer 27

latanoprost, bimatroprost

Question 28

Examples of carbonic anhydrase inhibitors (oral)

Answer 28

acetazolamide, methazolamide

Question 29

Don’t use carbonic anhydrase inhibitors in patients with a ____ allergy

Answer 29

slufa

Question 30

OD =

Answer 30

right eye

Question 31

OS =

Answer 31

left eye

Question 32

OU =

Answer 32

both eyes

Question 33

Discard eye drops ___ weeks after opening

Answer 33

4

Question 34

What is the pathophys of cataracts?

Answer 34

proteins called crystallins clump and cloud the lens of the eye

Question 35

What is a common s/e after surgery?

Answer 35

mild foreign body sensation

Question 36

When do antibiotics need to be started?

Answer 36

immediately after surgery

Question 37

Close eye and wait how long between adding another drop of the same med?

Answer 37

1 minute