modern cataract surgery professor ejaz ansari, frcophth md
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v The Healthy Eye Light rays enter the eye through the cornea, pupil and lens. These light rays are focused directly onto the retina, the light-sensitive tissue lining the back of the eye. The retina converts light rays into impulses; sent through the optic nerve to your brain, where they are recognized as images.TRANSCRIPT
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Modern Cataract SurgeryProfessor Ejaz Ansari, FRCOphth MD
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Modern cataract surgery- benefits to your patients
Cataract- what is it, its symptoms and signs Indications for cataract surgery The procedure and results Recent innovations for your patients Video (if time!)
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The Healthy Eye Light rays enter the eye
through the cornea, pupil and lens.
These light rays are focused directly onto the retina, the light-sensitive tissue lining the back of the eye.
The retina converts light rays into impulses; sent through the optic nerve to your brain, where they are recognized as images.
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What is a cataract?
Clouding of the normally clear lens of the eye.
Healthy lens Lens with a cataract
• Can be compared to a window that is frosted or yellowed.
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What is a cataract?
A clear lens refracts light onto the retina and fine-tunes our focusing ability.
• A cloudy lens prevents light from focusing sharply on the retina.
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Symptoms of cataracts
Painless blurring of vision.
Glare or light sensitivity. Poor night vision and/or
difficulty driving at night.
Double vision in one eye.
Needing brighter light to read.
Fading or yellowing of colors.
Yellowing of colors
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When should cataract surgery be performed?
When cataracts cause enough vision loss to interfere with your daily activities:
Performing your job Driving safely Reading and watching TV in
comfort Taking medication
You and your ophthalmologist should decide together when surgery is appropriate.
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How is cataract surgery performed?
Ambulatory day case procedure (usually)
Local or topical anesthesia
Phacoemulsification (ultrasound)
Shield, no patch
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How is cataract surgery performed?
A small incision is made close to the edge of the cornea.
A tiny, high-frequency ultrasound instrument is inserted that breaks up center of the lens.
Broken-up cloudy lens material is removed through the incision.
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Advantages of Phaco(emulsification) For the surgeon For the patient- quicker visual rehabilitation, less
astigmatism, fewer visits post-op, fewer post-op complications (closed system surgery)
For the health economy
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What can I expect from cataract surgery?
Most cataract surgical procedures are performed without complications and result in immediate improvement in vision (0.1% chance of reduced vision).
You will apply eye drops for 4-6 weeks following surgery to reduce the possibility of infection and/or inflammation in the eye- enough dispensed!
You may need an eyeglass prescription to obtain your clearest vision following surgery.
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What can I expect from cataract surgery? Drive after 1 week (use one’s discretion) Care with washing hair and face for 4 weeks No gardening for 4 weeks Continue those glaucoma drops! See consultant after 2-3 weeks See optician after 6 weeks Not everyone is the same- glaucoma, ARMD,
diabetes
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Posterior capsulotomy
In a small number of cases, the natural capsule supporting IOL can become cloudy after cataract surgery.
Posterior Capsulotomy: laser surgery to open cloudy capsule and restore clear vision. Posterior Capsulotomy
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Phaco steps Incision Capsulorrhexis Hydrodissection Phaco Irrigation and aspiration
(for cortex) IOL insertion AC reformation and wound
closure
Cataract
PHOTO: M&Ms Chocolate UK Ltd.
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Steps- incision and capsule
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Hydrodissection and phaco
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Irrigation and aspiration; IOL insertion
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MICS v Standard
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Micro-incision cataract surgery MICS 1.8- 2.2mm incision (ct. 3mm) Even quicker visual rehabilitation Fewer post-op meds Fewer post-op visits Less astigmatism: @ 2 weeks post-op -0.33D; @6
weeks with 3mm incision -0.67D; (n=60)
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New intraocular lenses
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Is it laser? NO! It’s ultrasound, but.............. Laser cataract surgery (femto) is being used in
some centres Even with laser at the moment, phaco is required
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Conclusions Surgery is the only treatment for cataract Modern day case micro-incision cataract surgery
under topical anaesthesia- gold standard Post-operative drops for 4-6 weeks Range of innovative IOLs available Femtosecond cataract surgery being improved