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KMK Part II > Case 16: Cataract Surgery > Flashcards

Case 16: Cataract Surgery Flashcards

1
Q

ICCE (intracap)

A

The crystalline lens & the capsule are removed in one piece, resulting in aphakia, a secondary surgery can be performed to inset an ACIOL or iris-sutured IOL. This surgery is no longer performed.

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2
Q

A ____ ____ _____ is required in ICCE to prevent vitreous prolapse & subsequent pupillary block & angle closure

A

Surgical peripheral iridectomy

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3
Q

If a secondary ACIOL is not inserted in ICCE than what is required of the pt?

A

Cataract glasses (very high plus +12 D), greater distortion of images

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4
Q

ICCE is assoc. w/ a higher risk of _____ ____

A

Retinal detachment

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5
Q

ECCE (extracap)

A

The crystalline lens is removed, but the capsule remains. Similar to ICCE, ECCE requires a large incision (9-11 mm) as the entire crystalline lens is removed in one piece.

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6
Q

Phacoemulsification

A

Form of ECCE where the crystalline lens is removed & capsule remains in place, crystalline lens is fragmented w/ ultrasound prior to removal. Small corneal incision (1-3 mm) can be used

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7
Q

Astigmatic IOL

A

can correct up to 4 D of corneal astig

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8
Q

Sulcus-fixed IOL

A

typically used if the capsule is lost during surgery

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9
Q

Anterior chamber IOL

A

used in ICCE, or if complications occur during phacoemulsification

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10
Q

Iris-fixed IOL

A

IOL stitched to the iris at the pupil margin, no longer performed

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11
Q

Secondary IOL

A

a second surgery is performed to inset an IOL in aphakic pts

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12
Q

IOL exchange

A

if complications develop w/ the current IOL, it can be replaced w/ a new IOL

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13
Q

Never dilate an ______ IOL

A

Iris-fixed

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14
Q

70% of enophthalmitis cases are secondary to what?

A

Gram positive bacteria (MC staph epidermis)

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15
Q

Signs/sx enopthalmitis

A

Severe pain, loss of vision, corneal edema, conjunctival injection, severe anterior chamber rxn w/ possible hypopyon, fibrinous exudate, vitreous cells, mucus discharge, eyelid swelling

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16
Q

Enopthalmitis tx

A

Immediately refer back to the surgeon for a vitreous tap (to culture to determine the infecting agent), aggressive anti-infective tx (may include topical , intravitreal, subconjunctival, or IV ruotes of administration), possible vitrectomy

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17
Q

Choroidal detachment

A

Occurs secondary to fluid accumulation in the suprachoroidal space (between the choroid & sclera) in hypotonous eyes. The choroid will appear elevated w/ distinct borders

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18
Q

Choroidal detachment tx

A

If mild, topical opthal steroids & cycloplegic are indicated

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19
Q

Wound leak Tx

A

Pressure patch w/ cycloplegia (to deepen the anterior chamber & prevent posterior synechiae)

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20
Q

Positive Seidel sign increases the risk of the following early post-operative complications:

A

Endopthalmitis, hypotony, choroidal detachment, iris prolapse

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21
Q

IOL subluxation tx

A

Observation, topical opthal miotics, surgical repair

22
Q

What is the MC cause of IOL subluxation?

A

Trauma

23
Q

How does ptosis occur after cataract surgery?

A

Secondary to post-op swelling or use of local anesthesia; permanent ptosis may be due to levaotr dehiscence by the eyelid speculum

24
Q

How does diplopia occur after cataract surgery?

A

Decompensating pre-existing strab, EOM restriction/paresis, monocular diplopia, central dusion disruption, idiopathic

25
Q

Common causes of corneal edema post-op cataract surgery?

A

Elevated IOP, hypotony, surgical trauma, pre-existing corneal disease, haptic rubbing on the corneal endothelium

26
Q

Signs of corneal edema

A

Microcysts and/or stromal thickening w/ Descemet’s folds. Bullous keratopathy occurs later in the post-op period. More common in aphakia & anterior chamber IOLs

27
Q

Where does suprachorodial hemorrhage occur after cataract surgery?

A

Rare complication characterized by accumulation of blood between choroid & sclera during intraocular surgery

28
Q

Toxic anterior segment syndrome (TASS)

A

Sterile inflammatory rxn results in toxic damage to the anterior segment structures. Typically result of chemical exposure during surgery

29
Q

TASS presentation

A

12-48 hours after surgery w/ decreased vision, mild to no pain, diffuse limbus to limbus corneal edema, hypopyon, fibrous membrane, no vitritis or mild spillover, & elevated IOP

30
Q

TASS tx

A

Topical opthal steroids

31
Q

Which IOP lowering drug is contraindicated immediately after cataract surgery?

A

Prostaglandin analogues- risk of increased inflammation

32
Q

When is laser peripheral iridotomy indicated after cataract surgery?

A

Only if IOP is elevated due to angle closure secondary to pupillary block

33
Q

Irvine-Gass CME

A

Cystoid macular edema after cataract surgery. Posterior inflammation results in a breakdown of the blood retinal barrier, w/ subsequent leakage & edema w/i Henle’s fiber layer (outer plexiform of macula)

34
Q

What is the peak incidence of Irvine-Gass CME?

A

6-10 weeks following cataract surgery

35
Q

Irvine-Gass CME Tx

A

Topical opthal steroid QID w/ topical opthal NSAID QID. Most cases resolve w/ tx w/i 6 mo.

36
Q

Causes of CME

A

Diabetic ret, retinal vein occlusion, uveitis, RP, ARMD, ERM, retinal vasculitis (sarcoidosis, Behcet’s syndrome, Coats’)

37
Q

Although all cases of CME are characterized by petaloid leakage at the macula, only ___ ____ presents w/ additional leakage around the optic nerve, as noted on fluorescein angiography

A

Irvine-Gass CME

38
Q

What causes monocular diplopia post-op cataract surgery?

A

Uncorrected refractive error, IOL dislocation, dry eye disease, induced astig, macular disease, corneal irregularity

39
Q

What are some additional late cataract surgery complications?

A

Ptosis, Diplopia, elevated IOP, corneal decompensation, chronic anterior uveitis, PCO, RD, uveitis-glaucoma-hyphema syndrome (UGH)

40
Q

What is the MC post-op comlication following cataract surgery?

A

PCO

41
Q

When does opacification usually occur?

A

2-6 mo after surgery

42
Q

What is a type of PCO that is MC in children undergoing cataract surgery?

A

Elschnig pearls

43
Q

PCO Tx

A

YAG capsulotomy, wait 3-6 mo. post-op

44
Q

Risks of YAG

A

transient IOP elevation (MC), pox marks and/or pitting of the IOL, CME, iritis, & RD

45
Q

What pts are at increased risk of post-op RD?

A

Axial length >25 mm, previous retinal tear or detachment in either eye, FHx of RD, lattice

46
Q

Uveitis-glaucoma-hyphema syndrome (UGH)

A

most often secondary to a poor-fitting anterior chamber IOL that rubs on the iris, resulting in hyphema & uveitis. Accumulation of red & white blood cells leads to an obstruction of aqueous outflow thru the TM w/ subsequent increase in IOP. Rare now that ACIOLs are less commonly used

47
Q

UGH Tx

A

Topical opthal steroids, ocular hypotensive agents, cycloplegic agents & possible IOL exchange

48
Q

What drops are used in the post-operative period?

A

Antibiotic (typically 4th gen fluoroquinolone- Vigamox), steroid tapered over course of 1 mo., NSAIDs may also be prescribed, pts should continue all ocular hypotensive drops during the post-op period (except prostaglandin analogues)

49
Q

Cataract surgery FU

A

1 day, 1 week, 1 month, 3-6 months

50
Q

When are glasses rxed after cat surgery?

A

1 mo. visit

KMK Part II (10 decks)

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