Cataracts

Question 1

What is the normal function of the lens or the eye?

Answer 1

Focus light onto the retina, adjust focus for objects close or far away – provides clear vision

Question 2

What is the lends made of?

Answer 2

Water and proteins, arranged in a way that keeps lens clear and lets light pass through

Question 3

What are cataracts?

Answer 3

Clouding of the crystalline lens

– crystalline proteins clump together and start to cloud a small area; can grow and obstruct more vision

Question 4

What is a subcapsular cataract?

Who is at greater risk of developing one?

Answer 4

Occurs at back of the lens

Diabetes and steroid medications are at higher risk

Question 5

What is a nuclear cataract?

What is it associated with?

Answer 5

Forms deep in the central zone.

Associated with aging

Question 6

What is a cortical cataract?

Answer 6

Characterized by white, wedge-like opacities that start in the periphery of the lens and work their way to the center in a spoke-like fashion.

Question 7

What are the causes associated with cataracts?

Answer 7

Aging (most common)
Prolonged corticosteroid use
Statins
Phenothiazines
Inflammation
Trauma
Radiation exposure
Systemic disease (diabetes, Wilson's

Question 8

What are the clinical symptoms of cataracts?

Answer 8

Reduced vision
Glare while driving during day, and at night with headlights
Dulling colors
Double images

Question 9

What are the 4 pre-op eye drops used, and what are their functions?

Answer 9

Diclofenac 0.1%: anti-inflammatory
Tropicamide 1%: Mydriatc-cyclopegic
Cyclopentolate 0.5-2%: Mydriatic-cycloplegic
Phenylephrine 2.5%: Mydriatic

Question 10

What are the 3 classes pf post-op care medications?

Answer 10

Antibiotic (moxiflox, cipro, gatifloxacin) QIDx1wk
NSAID (diclofenac, ketorolac): QIDx1wk
Corticosteroid (prednisoone): QIDx1wk then BIDx2wks

Question 11

What is extracapsular surgery?

Answer 11

Remove the lens from the capsule

Question 12

What is phacoemulsification?

Answer 12

Probe into lens through capsule, high frequency top dissolves lens

Question 13

What is intracapsular surgery?

Answer 13

Remove whole capsule and lens; lens put in front of iris

Question 14

What are the 3 post-op complications?

Answer 14

Uveitis
Infectious endophthalmitis
Post-op intraocular pressure spikes

Question 15

What is uveitis?

When is it not typical?

Answer 15

Some inflammation in the anterior chamber is expected

Persistent inflammation past 4 weeks or unusual severity early post-op is not typical

Question 16

What are the causes of uveitis?

Answer 16

Infectious endophthalmitis
Phacoanaphylaxis
Abrupt taper to steroids
Patient non-adherent to steroid drops
Pre-existing uveitis
Use of prostaglandin hypotensive drops

Question 17

What is infectious endophthalmitis?

Answer 17

Most serious and feared complication - can quickly and irreversibly devastate vision.
Incidence <0.1%
Can present first few days post-op, or delayed onset - weeks or years.

Question 18

How does infectious endophthalmitis present?

Answer 18

Worsening redness
Pain
Photosensitivity
Decreasing vision

Question 19

What is used to treat infectious endophthalmitis?

Answer 19

IV:
Vanco
Ceftazidime

Drop (after IV):
Moxifloxacin (Q1H)
Prednisolone (Q1H)
Homatropine (BID)

Question 20

What are the signs of post-op intraocular pressure spikes?

Answer 20

Redness
Pain
Photophobia
IOP > 35 mmHg
N/V

Question 21

What are the drug of choice for post-op IOP spikes?

What drugs should be avoided?

Answer 21

Beta blockers - drug of choice

Avoid prostaglandins

Question 22

What is the most common complication following cataract surgery?
what is the treatment?

Answer 22

Posterior capsule opacification (risk increases with time after surgery)
Treatment: YAG capsulotomy - create hole in posterior opaque membrane

Question 23

What is crucial to having success after cataract surgery?

Answer 23

Patient adherence to eye drop instructions