Cataracts
SURGICAL TREATMENT
A few facts about cataracts
• What are cataracts?
• Painless opacification of the lens
• How they form?
• Protein clumps or brown pigment deposit in the lens affecting transmission
• Why they happen?
• Aging: lens proteins denature over time
• Radiation: proteins coagulate from direct damage to DNA (e.g. lasers, UVB, X-rays)
• Corticosteroids (prednisone): topical or systemic causes indirect injury
• Diabetes: accumulation of sorbitol causes liquefactive damage to lens1
• Trauma
Classic presentation of cataracts
• Sxs
• Painless Common Types Location Symptoms
• Progressive loss of vision
• Bilateral (not uncommon) Myopia, improved
Nuclear Sclerotic Central lens vision in
• Blurry vision nearsighted
• Glare w/ night driving
Glare from
Nuclear
• Dx Cortical headlights while
periphery
driving
• Red reflex is absent (severe)
• See black instead of red
Posterior subscapular Posterior Difficulty seeing
• Retinal exam shows clouding of lens (younger patients) cortical layer in bright light
My patient history
HPI/HPC
• 90-year old male presenting with a left nuclear sclerotic cataract. He was referred for
surgical treatment due to deteriorating sight in his left eye. The patient previously
had an operation on his right eye due to cataracts earlier this year.
Relevant history
• Medical HX: glaucoma, handicapped (wheelchair), on apixaban (stopped a day prior)
• Allergies: shellfish
Diagnosis
• Axial length 19 mm in diameter
Surgery for Cataracts
PRE-OP, INTRA-OP, POST-OP
Pre-op assessment
BIOMETRY SPECIFIC REQUIREMENTS
• Need to decide strength of artificial lens • Contact lens wearer
that will replace patient’s lens • Hard contact lens wearer – removal 4 weeks
prior
• Biometry allows us to measure patient’s eye
• Soft contact lens wearer – removal 2 weeks
• Different lenses available for different needs prior
• Most common include multifocal lenses • Meds
(correct myopia/hyperopia), toric IOLs, and • Warfarin, blood thinners
trifocal lenses (correct glares and halos as
well) • ECG
• Blood test
Anesthesia
TOPICAL INTRACAMERAL
• Eye drops used conveniently for short • Injections into anterior chamber
surgeries
• Iris and ciliary body
• Limited to conjunctiva, cornea, and anterior
sclera • Usually lidocaine
• Iris and ciliary body not affected • Decreases IOP fluctuations
• Less cxs than orbital injections • Helps with pain
• Can reach retina and cause vision problems
• Viscoat Injection
• AKA intraocular viscoelastic injection
• Made up of sodium
hyaluronate/sodium chondroitin
sulfate
• Keeps corneal endothelium up and
running
• Protects the endothelium from being The Operation – Part 1
Dilate eye & administer topic anesthetics
damaged 1.
2. Clean patient’s eye w/ gauze
• Keeps the anterior chamber in 3. Drape head and body exposing eye
equilibrium 4. Make small incision in cornea
1. Viscoat insertion & intracameral anesthetics
• Divide and Conquer
• Phacoemulsification technique used to
easily remove and break up cataracts
• Make a cross with pen on the cloudy
lens
• Suction and break the cataracts
The Operation – Part 2
1. Make incision in the lens capsule
2. Phacoemulsification
1. Divide and conquer technique
3. Place absorbable lens on top of the posterior
capsule
4. Clean/wash eye
Complications
LENS CAPSULE OTHER COMMON CXS
• Breaking of posterior capsule that may have • Infection
been weakened
• Blurry vision or reduced vision
• Aqueous humor overflows
• Swelling of eye/cornea • Bruising
• Increased pressure
• Detached retina leads to permanent loss of
• Cataract lost in back of the eye vision (7 in 1000 people)
• Artificial lens may fall into posterior cavity
• May need specialized surgery to correct
Discharge
1. Discharged on same day
2. Tylenol for eye pain and headaches that may
occur after anesthetics wear off
3. Abx + eye drops to keep eye clean and free of
infection
4. Don’t rub eye & wear eye shield at nights for 2
weeks. Pts may have to keep eyes shut in the
shower to decrease inflammation
