HHS So, I’ll measure the white-to-white distance and calculate the power, and ask the OR to pre-order the appropriate lens so it’s available if needed.”, • Make sure pupil expansion tools will be available in the OR. “I do spend a little time explaining this to the patient, but I’m careful not to dissuade the patient from having cataract surgery,” says Dr. Zhang. “There may not be a benefit there. “It’s OK to close the eye up and come back in a few days or a month to fixate a lens in the eye. Iris hooks avoid this problem, and they can do a better job of controlling pupil size and shape, but they take longer to use.”. Dr. Zhang says she finds these helpful when managing a pseudoexfoliation patient. You don’t have to do it at the same time.”. Haripriya A, Ramulu PY, Schehlein EM, et al. Also, when I shine a bright light in the patient’s eye in the clinic, many patients become squeamish, so it’s harder to evaluate. So take your time, use the right tools, and if a problem is beyond your experience, refer to someone who’s accustomed to dealing with it.” REVIEW. I usually place it when I’ve removed most of the cortical material. • Watch for iridodonesis when the eye moves during the slit lamp exam. Gaining an understanding of the effects of cataract surgery on a range of health outcomes is important for maintaining the health and safety of … “I make sure we’ll have an iris expansion ring on hand, and iris hooks,” says Dr. Giaconi. Check the IOP; look at the optic nerve; do an OCT of the retinal nerve fiber layer. “In many cases of pseudoexfoliation, glaucoma or ocular hypertension are present,” Dr. Zhang points out. • Look for elevated IOP and optic nerve damage. “Because these lenses aren’t used that often today, our OR doesn’t stock all of the options. | According to Alcon, over 4 million U.S. cataract patients receive cataract surgery every year, and they expect this number to grow by up t16 percent over the next four years.. And cataract surgery has a high safety profile. In cataract surgery, the clouded eye lens is replaced with a clear plastic lens. Cataract surgery is common and usually uneventful as long as you’re in good health without any other major eye problems. In the procedure, a surgeon makes a small incision in the cornea of the eye, takes out the faulty lens, and replaces it with a prosthetic called an intraocular lens (IOL). “You don’t want to have to explain the impact of pseudoexfoliation to a skeptical patient after something has gone wrong. Contact your eye surgery department as soon as possible if you experience: increased pain and/or redness; increased stickiness; Double consecutive retrobulbar hemorrhage in a high-risk patient in treatment with aspirin and warfarin. Cataract surgery is used to restore cataract-related vision loss. This can even dislodge the lens. “Pseudoexfoliation isn’t a potential disaster, as long as surgeons know what they’re doing. “A CTR isn’t really designed to support that many clock hours. Current evidence suggests that warfarin therapy significantly improves prognosis in patients with atrial fibrillation with coexisting cerebrovascular disease, and those with non-tissue prosthetic heart valves. Colors are much better. Most of the complications from cataract surgery are minor and can be corrected. Pseudoexfoliation may be unilateral, so a difference between the eyes could indicate a problem.”, “The other part of this,” adds Dr. Devgan, “is that when you get to the OR and the patient lies down, gravity will pull the bag and iris back and the anterior chamber will become really deep. “I think most surgeons who’ve done a large volume of cataract surgeries will probably just stretch the pupil to open it up a little further, and then do the capsulorhexis underneath the iris, viewing through the pupil,” he says. “How soon I bring them back depends on their IOP on day one. Or, have your colleague who’s really good at it do it later. However, you’ll want to arrange a drive home once the procedure is complete. Teaching corner: Regional anaesthesia for ophthalmic surgery. “I often put my pseudoexfoliation patients on steroids and NSAIDs for a longer time than I would a routine cataract patient,” says Dr. Zhang. Dr. Giaconi notes that in terms of a mechanical device, both iris hooks and a pupil expander have pros and cons. Pseudoexfoliation patients need to be monitored carefully postop: • Be proactive about a potential postop pressure spike. Cataract surgery has a high success rate in improving your eyesight and should allow you to return to your normal activities, like driving. “Nevertheless, if there’s a lot of material on the anterior capsule, I like to use a tool to scrape the cells away,” she says. Sieber Pseudoexfoliation has long been known to be a concern when performing cataract surgery. In most instances this state represents an additive risk to the untreated disease for which warfarin is being prescribed. Select from premium Cataract Surgery of the highest quality. If you realize the anterior chamber is deeper when the patient is on the table, you know the patient has zonulopathy and you’ll need to proceed with caution.”, Another sign is that the anterior capsule wrinkles when pressed. Use of anticoagulation in elderly patients with atrial fibrillation who are at risk for falls. “When you’ve taken out the cataract and the cortex and you’re cleaning up the capsular bag, you may see some hazy lens cells left on the capsule,” says Dr. Devgan. Many surgeons choose to enlarge the iris with iris hooks, a device such as the. These can be subtle indications that may be missed on a cursory exam.”. “Surgeons are often surprised by vitreous in these patients,” she says. Listing a study does not mean it has been evaluated by the U.S. Federal Government. A typical procedure doesn’t take very long — only about 15 minutes. Reproduction in whole or in part without permission is prohibited. Prognosis for visual acuity with retrobulbar haemorrhage is generally good, given an experienced surgeon is present to rapidly decompress the eye. Cataract surgery complications are few, and cataract surgery is among the most common and most successful surgical procedures performed today.. 2007;33(7):1227-1234. “Right now I’m not aware of any prospective studies that go out 10 years. Pseudoexfoliation has long been known to be a concern when performing cataract surgery. Cataract surgery itself is painless. “In these eyes there’s a pretty good chance the lens will decenter postoperatively,” says Dr. Giaconi. 2001 Oct;29(5):553-4. 2000 Nov;85(5):708-11. doi: 10.1093/bja/85.5.708. “Also, compare the anterior chamber depth to that of the fellow eye. However, a recent study conducted at Aravind Eye Hospital in India looked at uncomplicated pseudoexfoliation cases—patients with no zonulopathy where the pupils dilated reasonably well. 2012 Nov;23(6):1782-4. doi: 10.1097/SCS.0b013e31826701f0. This minimizes the impact of any shrinkage.”, Dr. Giaconi points out a second reason to make a large capsulorhexis. “This is most prominently seen at the pupillary border. Huebert I, Heinicke N, Kook D, Boost KA, Miller CV, Mayer WJ, Haritoglou C, Kampik A, Gandorfer A, Hintschich C, Wolf A. J Cataract Refract Surg. So, if I find a lot of zonulopathy, I’d probably go ahead and put in an anterior chamber lens.”, • Use a phaco technique that won’t stress the zonules. That’s because the zonules are so loose that the lens moves forward and back.”. Perform the cataract surgery as you would any other case, but be alert for any sign of vitreous prolapse and zonular laxity. This site needs JavaScript to work properly. “So, noticing whether there’s an elevation in IOP or signs of optic nerve damage is important.”, • Consider performing gonioscopy. A cataract causes the lens to become cloudy, which eventually affects your vision.Cataract surgery is performed by an eye doctor (ophthalmologist) on an outpatient basis, which means you don't have to stay in the hospital after the surgery. • Check to see whether the other eye has had zonular issues in the past. Cataract surgery is very common and is generally a safe procedure. “I wouldn’t put a CTR in a pseudoexfoliation patient with 360-degree zonular weakness,” he says. Br J Anaesth. Typical Cataract Surgery […] Cataract surgery is a procedure to remove the lens of your eye and, in most cases, replace it with an artificial lens. Right now I ’ ve removed most of the bag in an already challenging case..... In many cases of pseudoexfoliation to a frequency of 0.4 % at 450 mg/day, the clouded eye is... Capsule and iris hooks are much easier to remove than an entire malyugin ring, or a option... It 's often carried out as day surgery under local anesthetic as an outpatient surgery or. 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