Cataract Sx Flashcards
Vision with cortical cataracts
Pretty good vision, can be 20/20, problems with glare
Vision problems with NS
Myopic shift
Can be white
PSC vision problems
Central VA decrease, problems reading
DiffDx for TID in midperiphery
PDS
Young myope
When can the abx be stopped post op cataract surgery
1 week if things look good
If a patient presents with a postindustrial siedel sign post op cat sx, what is there an increased chance of
Endophthalmitis Hypotony Iris prolapse Choroidal detachment Shallow AC
How to perform Seidels test
Touch a NaFL strip to the surgical incision site.
- (+) sign appears as a dark stream of Aq humor within the green NaFL dye in the tears; use cobalt blue for analysis
- indicates a wound leak, which most commonly occurs in Rotherham early post op period due to trauam, suture failure, or valsalva maneuver.
Endophthalmitis post op cat sx
- 0.02-0.05%
- 50% of patients become legally blind
- as early as day 1 post op (bacterial 2-4 days post op) or several months post op (fungal)
- 70% are from gram + bac, most commonly staph epidermidis then staph aureus
- usually more the normal bacteria on the eyelids, surgical contaminants can be responsible
Signs and symptoms of endophthalmitis
Severe pain, loss of vision, corneal edema, conjunctival injection, severe AC reaction with a possible hypopyon and fibrinous exudate, vitreous cells, mucus discharge, and eyelid swelling
Management of endophthalmitis
Immediately refer back to the surgeon for a vitreous tap (culture), aggressive anti-infective treatment (topical, intravitreal, subconjunctival, or IV), and possible vitrectomy
Hypotony
- Loss of Aq humor through the open wound, can causes shallow AC
- IOP that is low enough to cause physiological and/or anatomical changes to the eye. For most patients, an IOP < 6mmHg results in hypotony, however IOP can be lower in older patients without causing complications because the sclera is more rigid and is thus able to maintain the shape of the eye
Choroidal detachment
Occur secondarily to fluid accumulation in the suprachoroidal space in hypotonous eyes. The choroid will appear elevated with distinct borders. Severe chorodial detachments are referred to as kissing choroids.
DiffDx
- RD
- retinoschisis
Management of choroidal detachment
If mild, topical ophthalmic steroids and cycloplegics are indicated. If severe, the patient should be immediately referred back to the surgeon for possible drainage
Iris prolapse
The iris may be pulled up into the wound site, resulting in a peaked pupil (will point towards the wound leak)
Treatment options for a wound leak
Pressure patch with cycloplegia (to deepen the AC and prevent posterior synechiae), and consulting with the surgeon regarding additional sutures
Post op pupillary block
Develops if the IOL or vitreous blocks the pupil, preventing the flow of AqH from the posterior to the AC, and resulting in angle closure and acutely elevated IOP. Mid dilated pupil, shallow AC, vitreous prolapse, displaced IOL.
Pressure spike post op cat sx
WBCs from inflammation can block the TM, mostly from 4+ cells, not something like 1+ cells.
Steroids post op cat sx
May cause increased IOP
pseudoexfoliation syndrome and cat sx
Increased rate of complications with cat sx due to weakened lens zonules, there is a greater risk of IOL dislocation with subsequent pupillary block and acutely elevated IOP. IOP may also be elevated if PXF deposits obstruct AqH outflow through the TM
When would you expect a steroid response post op
1 week and on
What is the most common cause of unilateral glaucoma
PXF
Retained visco and cat sx
Acutely raised IOP
1 day PO
-visco material is the fluid injected into the eye during cat sx in order to protect the corneal endothelium during phacoemulsification. It must be removed before completion of the surgery. If accidentally left, it may obstruct AqH outflow through the TM. Retained visco is one of the most common causes of IOP elevation in the early post op period
Goes away in 3 days
What is the most common cause of raised IOP in the early post op period
Retained visco
RBCs and increased IOP post op cat sx
May be released from the iris vessels during the surgery and can obstruct the TM
Early cataract post op complications
IOL subluxation Ptosis Diplopia Corneal edema Subchoroidal hemorrhage TASS (1-2 days) Endophthalmitis (2-4 days) Hypotony Choroidal detachment Iris prolapse
IOL subluxation
Rare, caused by pupillary capture and poor capsular support, findings that are common in conditions with weak zonulse including PXF and Marfans
Treatment for IOL subluxation
Observation, topical ophthalmic miotics, or surgical repair
Most common cause of lens or IOL subluxation
Trauma
-ED, Weill-Marchesani, and homocystinuria are systemic causes
Ptosis after cat sx
Temporary ptosis may occur secondary to post op swelling or use of local anesthesia; permanent ptosis may be due to levator dehiscence by the eyelid speculum
Diplopia post op cat sx
Occurs in appx 3% of cases; may be secondary to a decompensating, pre-existing strab, EOM restriction/paresis, monocular diplopia, central fusion disruption, or idiopathic. Usually occurs i the patient had retrobulbar anesthesia, which is rarely used now
Corneal edema post op cat sx
Most common occurs in the early post op period: common causes include
- elevated IOP (microcystic corneal edema)
- hypotony-classically causes descemets folds
- surgical trauma-results in edema due to shock waves from the phacoemulsification; this is less common with the intraoperative use of visco
- pre-existing corneal disease (fuchs)
- haptic rubbing on the corneal endothelium-results in endothelial cell damage and subsequent edema
