Case 16: Cataract Surgery Flashcards by Julie R

ICCE (intracap)

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.

How well did you know this?

Not at all

Perfectly

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

Surgical peripheral iridectomy

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

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

Retinal detachment

How well did you know this?

Not at all

Perfectly

ECCE (extracap)

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.

How well did you know this?

Not at all

Perfectly

Phacoemulsification

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

How well did you know this?

Not at all

Perfectly

Astigmatic IOL

can correct up to 4 D of corneal astig

How well did you know this?

Not at all

Perfectly

Sulcus-fixed IOL

typically used if the capsule is lost during surgery

How well did you know this?

Not at all

Perfectly

Anterior chamber IOL

used in ICCE, or if complications occur during phacoemulsification

How well did you know this?

Not at all

Perfectly

Iris-fixed IOL

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

How well did you know this?

Not at all

Perfectly

Secondary IOL

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

How well did you know this?

Not at all

Perfectly

IOL exchange

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

How well did you know this?

Not at all

Perfectly

Never dilate an ______ IOL

Iris-fixed

How well did you know this?

Not at all

Perfectly

70% of enophthalmitis cases are secondary to what?

Gram positive bacteria (MC staph epidermis)

How well did you know this?

Not at all

Perfectly

Signs/sx enopthalmitis

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

How well did you know this?

Not at all

Perfectly

Enopthalmitis tx

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

How well did you know this?

Not at all

Perfectly

Choroidal detachment

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

How well did you know this?

Not at all

Perfectly

Choroidal detachment tx

If mild, topical opthal steroids & cycloplegic are indicated

How well did you know this?

Not at all

Perfectly

Wound leak Tx

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

How well did you know this?

Not at all

Perfectly

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

Endopthalmitis, hypotony, choroidal detachment, iris prolapse

How well did you know this?

Not at all

Perfectly

IOL subluxation tx

Observation, topical opthal miotics, surgical repair

What is the MC cause of IOL subluxation?

Trauma

How does ptosis occur after cataract surgery?

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

How does diplopia occur after cataract surgery?

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

Common causes of corneal edema post-op cataract surgery?

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

Signs of corneal edema

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

Where does suprachorodial hemorrhage occur after cataract surgery?

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

Toxic anterior segment syndrome (TASS)

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

TASS presentation

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

TASS tx

Topical opthal steroids

Which IOP lowering drug is contraindicated immediately after cataract surgery?

Prostaglandin analogues- risk of increased inflammation

When is laser peripheral iridotomy indicated after cataract surgery?

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

Irvine-Gass CME

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)

What is the peak incidence of Irvine-Gass CME?

6-10 weeks following cataract surgery

Irvine-Gass CME Tx

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

Causes of CME

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

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

Irvine-Gass CME

What causes monocular diplopia post-op cataract surgery?

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

What are some additional late cataract surgery complications?

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

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

PCO

When does opacification usually occur?

2-6 mo after surgery

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

Elschnig pearls

PCO Tx

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

Risks of YAG

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

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

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

Uveitis-glaucoma-hyphema syndrome (UGH)

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

UGH Tx

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

What drops are used in the post-operative period?

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)

Cataract surgery FU

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

When are glasses rxed after cat surgery?

1 mo. visit