cataract postoperative care

Liana Al-Labadi, O.D.

complicationsCataract surgery is the most commonly performed operation worldwide

• Technological progress has enables major advances in this procedure• As with any surgery there are inherent risks, some of which are related to the increased

complexity of the operation• Intraoperative complications• Postoperative complications

IntrA operative complications

ICCE• Was the main cataract surgery performed at the beginning of the 20th century• Method:

• 180 degree limbal incision was created • The lens & the capsule were removed together by breaking the zonular ligaments• No IOL was inserted- patients wore aphakic spectacles; or an ACIOL was inserted

• Operative complications:• Vitreous loss

Haemorrhage • Chronic cystoid macular edema• High astigmatism

IntrA operative complications

ECCE• Involves a smaller limbal incision- less operative complcations• Operative complications:

• Reduced risk of vitreous loss• Remaining undetected cortical material not removed

• Results in server post operative inflammation & significant PCO (= posterior capsular opacification)

IntrA operative complications

PE (Phaco)• Method of choice• Incisions required are smaller

• Procedure much safer• time of recovery, the stabilization of post-operative refraction & amount of induced astigmatism

is less• However the technique itself is more complicated

• Requires extensive training & manual dexterity

IntrA operative complications

Operative Complications:• Tear/rupture of the posterior capsule

• Can result in vitreo-retinal tractions & eventually RD• Increases risk of endophthalmitis• Nuclear fragments falling into vitreous--> severe inflammatory reaction• Increased risk if weak zonules

• PXF, hypermature cataracts & CT disease• Dislocation of nucleus

Loss of lens fragments• Pupil constriction

• Small non-dilating pupil can cause visibility issues• Use iris hooks or iris expanders

• Useful in patients with floppy iris syndrome• Bleeding

• Rare• Anterior capsule tear

Wound leak

Posterior Capsular Tear

http://homepage.mac.com/omca/somca/foldersusa_files/image086.jpg http://www.baltimore-eyecare.com/the-expert-opinion/uploaded_images/A35-722627.jpg

The RoutineRoutine Postoperative Care:• F/U visit schedule• Examination components• Medication Schedule• Early & late post-operative complications• Management of complications

Post-op instructions

The norm- May remain for 6-8 weeks• Blurry, fluctuating, shimmering vision• Mild discomfort• Drops may sting• Drops may leave harmless white residue in the corner of the eye • Eye may feel scratchy or dry- provide patients with AT• Slight redness • Watering

Mild irritation • Glare• Slight drooping

Post-op instructions

The DOs:• Wash hands before and after using eye drops• Wear your glasses during the day and wear the eye shield at night x 7 days

• Unless doctor instructions specify otherwise• Wear sunglasses when out x 1 week during daylight

• To protect the eyes from sunlight & injuries• Shake the drops and use as instructed• Only use clean tissues to wipe the eye

Make sure eyelids are always clean after surgery • Use warm compresses at least twice a day

• Use OTC reading glasses until Rx is finalized 4-6 weeks after surgery• If any minimal pain use two Tylenol tablets for relief

• Severe pain should be reported to the doctor immediately• Report to the doctor ASAP if:

• Persistent pain- not relieved by Tylenol• Redness

Discharge • Unexpected loss of vision &/or field vision• Flashes or floaters

Post-op instructions

The DONTs:• Activity: Normal activity except heavy labor or sports can be resumed immediately

• No heavy lifting (anything over 5 pounds) or bending (below waistline) x 1 week• No driving the day of or after surgery • At 4 weeks all normal activities can resume

• Avoid hard rubbing or squeezing eye x 1 month• straining, squeezing or a blow to eye can result in disastrous complications

• Face wash: For the first few days, close your eyes when washing faceBathing:• Avoid any water splashing into the eye x 1 week

• Can bathe with head tilted backwards or keep eyes closed during shower• Games:

• Avoid strenuous activities like jogging, lifting weights, swimming, gardening, aerobics, contact sports x 2 weeks

• Normal daily activities including walking, reading and watching TV may be resumed immediately following the surgery

• Makeup: Avoid eye makeup x 2 weeks• Diet: No dietary restrictions

Driving: You should not begin driving until indicated by your doctor• Job: Can resume 2 days s/p surgery • Travel:

• Can travel 1 week after surgery • Keep eyes well lubricated during flight

• Avoid aspirin

F/U Schedule

1 Day

1 week

1 month

3-6 month

*Case Hx: status since surgery? pain? dry? discomfort? sleep? sick? vision?*VA (s) *SLE: Wound site (&sutures); K; AC; IOL condition & centration* IOPReview Postoperative instructions

*Case Hx: status since surgery? pain? dry? discomfort? vision? review of complaints & instructions*VA (s) + SLE + IOP *DFE: IOL centration & position; Posterior capsule; macula; peripheral retina*AB drops usually stopped after this visit

*Case Hx: status since surgery? dry? discomfort? vision? *VA (s) + Refraction/Keratometry + SLE + IOP*Rx released at this visit*Steroids & NSAIDs- almost done

Complete Eye Exam

Medication Schedule

Week 1 P.O.

Week 2P.O.

AntiBiotic QID x 1 weekNSAID QIDx 1 weekSteroid QIDx 1 week**ATs PRN

AntiBiotic DiscontinuedNSAID TIDx 1 weekSteroid TIDx 1 week**ATs PRN

NSAID BIDx 1 weekSteroid BIDx 1 week**ATs PRN

NSAID QDx 1 week then discontinuedSteroid QDx 1 week then discontinued**ATs PRN

3 Days Before

AntiBiotic QIDNSAID BID-QID**ATs PRN

Week 3P.O.

Week 4P.O.

Medication Schedule

Vigamox Zymar Besivance

Medication Schedule

Acular Acuvail Xibrom

Medication Schedule

PredForte