Cataract Surgery

Question 1

Risk factors for cataracts:

Answer 1

diabetes, long term steroid use, history of ocular surgery, environmental factor (UV light exposure)

Question 2

Diagnosis for cataracts

Answer 2

routine exam, glare test (on indication), DFE, symptomatic scores

Question 3

What do you need in you routine exam for cataract assessment?

Answer 3

• History: symptoms, ocular/medical history, medications
• Exam: cornea, lens, retina, optic nerve / visual pathways, refraction, entrance test, Biomicroscopy and DFE
• Identify any potential obstructions to good prognosis (e.g. astigmatism, AMD)
• Any glaucoma need to be treated before cataract surgery

Question 4

When should you refer for cataract surgery?

Answer 4

• Patient is symptomatic.
• VA worse that 6/12
• Social factors (reduced quality of life)

Question 5

What are the components for lens calculation?

Answer 5

AL + Corneal curvature + IOL formula = lens calculation

Question 6

Pre biometry requirements

Answer 6

Cease CL use 1 week before assessment (soft CL), or 1 month before for hard CL.

Question 7

What is procedure for cataract surgery?

Answer 7

1. Small incision phacoemulsification at the corneoscleral junction
2. Viscoelastic gel injected into the AC to protect the endothelium.
3. Capulorhexis (removal of anterior capsule of the lens followed by emulsification of the nucleus)
4. Debris is aspirated out (using dual irrigation – aspiration)
5. Capsular bag remains and foldable IOL is implanted.

Question 8

what is post cataract sx therapeutics?

Answer 8

• Antibiotic (e.g. chloramphenicol 0.5% QID)
• Steroid eye drop (e.g. pred forte QID) or NSAIDs
• Continuation of glaucoma drops.

Question 9

Post Cat Op Care

Answer 9

1. Day 1 post op: VA usually 6/7.5 to 6/18, possible mild IOP elevation (<25mmHg), small ptosis, possible residual dilation, sore eye, headache, conjunctival injection, corneal striae or oedema, cells, and flare in AC, good IOL position
2. Week 1 post op: Reduced inflammation, vision stabilising, would integrity, gonioscopy: for any AC inflammation, rule out corneal descments folds, pupil normal and normal IOP.
3. Month 1 post op: Refraction (should be stable), cornea should be fully healed, normal pupils, no media opacity, IOL well positioned, no AC activity, DFE – normal findings.

Question 10

Possible Cat Sx Complications

Answer 10

Iris prolapse, TASS, Endophthalmitis, Posterior Capsular rupture, - Sequelae: malposition of IOL, vitreous strands in AC/wound, CMO

Question 11

Diagnosis for CMO

Answer 11

OCT, FA, some may not be clinically significant

Question 12

Tx for CMO

Answer 12

1. Observation – especially if not clinically significant
2. NSAIDs – QID to 2 hourly for several days to month
3. Steroids – in severe cases
4. Consider oral NSAIDs or steroids if not resolving, or even oral CAI.
5. Review 1 – 3 weekly until resolved.

Question 13

Endophthalmitis Signs

Answer 13

hypopyon, AC activity, vitritis, corneal haze, lid oedema, conjunctival chemosis, sluggish pupils

Question 14

Tx for Endophthalmitis

Answer 14

1. EMERGENCY REFERRAL
2. Acute case: Intravitreal broad-spectrum antibiotics (not 3rd or 4th line fluoroquinolones)
3. Vitreous Biopsy → hospital admission and daily review

Question 15

Retinal Detachment Symptoms

Answer 15

large amounts of floaters, flashes, blurred vision, certain over vision

Question 16

RD signs

Answer 16

subretinal fluid, retinal hb, tobacco dust, pigment granules in the anterior vitreous

Question 17

DDx of RD

Answer 17

PVD, posterior uveitis, retinoschisis, choroidal effusion

Question 18

Tx of Lens dislocation

Answer 18

1. No symptoms or inflammation: observation only
2. Infrequent symptoms: Miotic
3. Surgical: refer to lens reposition / exchange

Question 19

Tx for PCO

Answer 19

Refer for YAG laser capsulotomy

Question 20

Refractive surprise Tx

Answer 20

1. Find aetiology.
2. Treat what you can – glasses, dry eye, PCO etc
3. Consider Surgery: corneal refractive surgery if cause my corneal astigmatism, or piggyback sulcus IOL