CATARACT

SURGERY
GROUP 6
I. NAME OF CASE: CATARACT SURGERY
-Is a procedure to remove the lens of your eye and in most cases, replace it
with an artificial lens (Intraocular Lens or IOL).Cataract surgery involves
removing the clouded lens and replacing it with a clear artificial lens. The
artificial lens, called an intraocular lens, is positioned in the same place as
your natural lens. It remains a permanent part of your eye.

-Cataract surgery is generally done on an outpatient basis, which means you

won't need to stay in a hospital after the surgery. During cataract surgery, your
eye doctor uses a local anesthetic to numb the area around your eye, but you
usually stay awake during the procedure.
 -Cataract surgery is generally safe, but it carries a risk of infection and
bleeding. Cataract surgery increases the risk of retinal detachment.
-After the procedure, you'll have some discomfort for a few days. Healing
generally occurs within a few weeks.
Why is it done?
It is to treat cataracts – that causes blurry vision and increases the glare from
lights.
Visual Symptoms are:
Cloudy or blurry vision
Decreased night vision
Glare and halos
Sensitivity to light
Fading of colors
II. ANATOMY AND PHYSIOLOGY:

Lens focus light on the Retina, the images sent to the optic nerve to the visual
cortex in the brain allowing us to to see. As we get older the proteins within the
lens can begin to come together and form deposits, these cause the lens to
become cloudy and scatter the light passing into the lens.
PATHOPHYSIOLOGY:
Cataracts can develop in one or both eyes at any age as a result of a
variety of causes.
Risk Factors for Cataract
Formation:
A. Aging
B. Associated Ocular Conditions.
C. Lifestyle
D. Systemic Diseases
The three most common types of senile (age-related) cataracts are defined by their
location in the lens: nuclear, cortical, and posterior subcapsular.

A nuclear cataract is associated with myopia (nearsightedness), which worsens

when the cataract progresses – will severely blur vision.
A cortical cataract causes vision to worsen in bright light.
A posterior subcapsular cataract typically develops in younger people and, in some
cases, is associated with prolonged corticosteroid use, diabetes, and ocular trauma.
Near vision is diminished, and the eye is increasingly sensitive toglare from bright
light (e.g. sunlight, headlights).
III. LABORATORY TESTS:
To determine cataract, Eye Doctor will review the medical history and
symptoms, and perform an eye examination, including:
-A full ocular examination
-Biometry tests
-Corneal topography
-Optical coherence tomography (OCT)
-Blood sugar measurements in diabetic patients

Visual acuity test - A visual acuity test uses an eye chart to measure
how well you can read a series of letters. Your eyes are tested one at a
time, while the other eye is covered. Using a chart or a viewing device
with progressively smaller letters, your eye doctor determines if you
have 20/20 vision or if your vision shows signs of impairment.
Slit-lamp examination - A slit lamp allows your eye doctor to see the
structures at the front of your eye under magnification. The microscope
is called a slit lamp because it uses an intense line of light, a slit, to
illuminate your cornea, iris, lens, and the space between your iris and
cornea. The slit allows your doctor to view these structures in small
sections, which makes it easier to detect any tiny abnormalities.

Retinal exam - To prepare for a retinal exam, your eye doctor puts
drops in your eyes to open your pupils wide (dilate). This makes it easier
to examine the back of your eyes (retina). Using a slit lamp or a special
device called an ophthalmoscope; your eye doctor can examine your
lens for signs of a cataract.

Applanation tonometry - This test measures fluid pressure in your eye.

There are multiple different devices available to do this.
IV. PRE-OP MEDICATION USED:

fluoroquinolones
- The prophylactic use of povidone-iodine 5% solution and a perioperative
fluoroquinolone antibiotic help to decrease the risk of intraocular infection and are an
important part of what makes modern cataract surgery the safe and amazingly
successful procedure it has become.
Ketorolac
- For cataract surgery you will begin using the eye drops 1 day before surgery and
continue for up to 2 weeks afterward. For corneal refractive surgery the usual dosage is 4
times daily for up to 4 days after surgery. Do not use ketorolac ophthalmic while you are
wearing contact lenses.
- This medication is used to treat eye pain and swelling (inflammation) after cataract
surgery. Ketorolac belongs to a class of drugs known as nonsteroidal anti-inflammatory
drugs (NSAIDs). It works by blocking certain natural substances in your body to reduce
pain and swelling.
Valium pill
- In the preoperative area, the nursing staff will prepare your eye for surgery with a
combination of dilating, antiseptic, and anesthetic eye drops. You will usually be offered
a Valium pill to take by mouth to reduce your anxiety in the pre-op area. The nursing staff
will start an I.V.

Therapeutic effect

The fluoroquinolones are indicated for treatment of several bacterial infections,

including bacterial bronchitis, pneumonia, sinusitis, urinary tract infections, septicemia
and intraabdominal infections, joint and bone infections, soft tissue and skin infections,
typhoid fever, anthrax, bacterial gastroenteritis

Ketorolac is used to relieve moderately severe pain, usually after surgery. Ketorolac is in
a class of medications called NSAIDs. It works by stopping the body's production of a
substance that causes pain, fever, and inflammation.
V. ANESTHETIC AGENTS USED:

Cataract surgery is generally performed with a combination of

intravenous twilight sedation and local (topical) anaesthetic in the
form of numbing eye drops. The drops are very effective in blocking
pain signals from the eye to the brain.

- Twilight anesthesia also known as twilight sleep and allows an easy

awakening and a speedy recovery time for the patient. Anesthesia is used
to control pain by using medicines that reversibly block nerve conduction
near the site of administration, therefore, generating a loss of sensation at
the area administered.
What is intravenous sedation?
- Intravenous twilight sedation is a fast-acting combination of relaxing
medications delivered directly into your bloodstream via a cannula into a vein.
As opposed to general anaesthesia, patients under twilight sedation continue to
breathe on their own.
VI. Positioning of the patient to
the OR table:

- The foot pedals are placed parallel to the long axis of the operating table.
The patient's head is rotated toward the surgeon and/or in a chin-up
position. The surgeon sits side-saddle with his or her thighs parallel to the
long axis of the operating table and facing the head of the bed.
*AFTER THE SURGERY

The most suitable sleeping position after cataract surgery is lying

on the back. Doing so can help avoid severe post-surgery
complications, such as blindness.
 VII. DRAPING TECHNIQUE V

WHAT IS DRAPING DURING CATARACT SURGERY?

Draping allows access to the eye and complete

visualization while keeping a neat sterile field. Draping
the eye is important for cataract surgery it isolates the
eyelashes from the ocular surface. The eyelid margin and
eyelashes are often the source of bacteria in the rare
cases of endophthalmitis and the glands can create an
oily coating on the cornea which impedes the surgeon’s
view.
VIII. INSTRUMENTS USED
CASTROVIEJO
CALIPER
Castroviejo Calipers are used for
the precise measurement of the
structures of the tibial plateau and
in ophthalmic procedures
measures the eye including cornea
and pupils.
 COLIBRI FORCEPS CAPSULORHEXIS FORCEPS CAPSULOTOMY FORCEPS

These fine and smooth These fine sharp-tipped These forceps are use to create and
forceps have special 0.12 1x2 forceps are used to make a incision in the anterior capsule of
teeth. They are used for continuous curvilinear incision the lens during cataract surgery.
holding cornea. on the anterior capsule of the
lens.
 HYDRODISSECTION VISCOELASTIC CANNULAS DIAMOND KNIFE
A range of cannulas with tips For injecting viscoelastic to all The angled phaco knife is
designed to deliver fluids to meridians of the anterior chamber used this is a micro surgical
facilitate the separation of the and to coat intraocular lens. This knife used in making
range of cannulas has smooth sclerocorneal tunnels in
cortex from the nucleus and
rounded tips for the safe introduction small incision type of
capsule.
of viscoelastic. cataract surgery. Can be
used clear cornea blades
and trapezoid self-diving
blades.
 SIDE-PORT BLADE UNIVERSAL STRAIGHT SIDE- KNIFE FOR MICRO INCISION
PORT KNIFE COAXIAL SURGERY (MICS)
This is used in making a
sclerocorneal side port This is used in making a
sclerocorneal side port or a Designed to make micro incision.
or a secondary tunnel in
secondary tunnel in small
small incision cataract
incision cataract surgery.
surgery.
 NUCLEUS REMOVING FORCEPS PRECHOPPER SINSKY'S HOOK
This is an instrument used to force
Prechopper is a special cross-action This is an intraocular lens
out the lens in extracapsular type of
forceps for dividing a nucleus by the dialer. It has an angulated
cataract extraction. Designed to
phaco prechop technique. Nowadays round hook with a handle
remove fragments of the nucleus
Combo Prechoppers are the most used in inserting an
through a small incision. Ususally it
popular prechoppers, as they can be intraocular lens.
has two rows of delicate teeth on
used for all kinds of cataract.
jaws.
 IRRIGATION/ASPIRATION
HANDPIECES
These special handpieces can be used
for bimanual I/A (Irrigation handpiece
and Aspiration handpiece) and Coaxial
I/A (Irrigaton/Aspiration handpiece).
Irrigation/Aspiration handpieces are
used to maintain the intraocular
pressure and to remove the residual
cortex after phacoemulsification.
 FORMED IRRIGATING CYSTOTOME
Irrigating cystotomeis designed for capsulorhexis,
intercapsular/endocapsular and can-opener
capsulotomy techniques. Formed cystotome conforms
to the convexity of the lens providing easier access to
the anteriorcapsule. Reduces potential of corneal
touch. Formed sharp tipcystotome for creating an
opening into the anteriorcapsule, nucleus dislocating
or other intraocular applications. Capsulorhexis
cystotome has a special tip which provides more
control of the flap when performing continuous
curvilinear capsulotomies.
IX. SKIN PREPARATION TECHNIQUE OF THE OPERATIVE SITE:

For surgical site preparation in cataract surgery, a drop of 5%

povidone-iodine should first be instilled in the operative eye.
Eyelashes and eyelid margins are carefully scrubbed with cotton-
tipped applicators soaked in 10% povidone-iodine.
The periocular skin is then cleaned, starting from the eyelids and
moving outward in a circular motion using cotton balls, sponges,
or gauze soaked in 10% povidone-iodine.
The periocular skin is then cleaned, starting from the eyelids and
moving outward in a circular motion using cotton balls, sponges,
or gauze soaked in 10% povidone-iodine..
IX. SKIN PREPARATION TECHNIQUE OF THE OPERATIVE SITE:

The periocular skin is then cleaned, starting from the eyelids and
moving outward in a circular motion using cotton balls, sponges,
or gauze soaked in 10% povidone-iodine.
Given that duration may be important, the iodine should be
allowed to dry on the skin, or at least only the excess should be
blotted away rather than wiped off completely.
Once the surgical site has been prepared, the periocular skin, lid
margins, and eyelashes are carefully blotted to remove excess
iodine, thereby enhancing the adherence of the plastic drape.
 X. POST-OPERATIVE TEACHING TO THE PATIENT:

-Teach patient and family about proper hygiene and eye care techniques
to ensure that medications dressing, and surgical wound are not
contaminated during necessary eye care.
-Teach patient and family about signs and symptoms of infection and how
to report those to allow early recognition and treatment of possible
infection.
-Advice patient to follow ophthalmologist's orders related to administration
of any antibiotic or anti-inflammatory eye drops or medications.
-Instruct patient to comply with postoperative restrictions on head
positioning, to optimize to visual outcomes and prevent increased IOP.
-Advise the client to refrain from vigorous brushing of teeth and hair.
-Instruct patient to avoid doing any strenuous activities for the first few
days post-surgery.
 X. POST-OPERATIVE TEACHING TO THE PATIENT:

- Advise patient to avoid any rigorous exercise orheavy lifting.

- Advise patient to avoid driving until your eye doctor examines and say
it is safe to resume driving.
- Advise patient to stay away from dirt and dusty areas.
-Advise patient to avoid rubbing of eye.
- Advise patient to use protective eye shield, glasses or sunglasses
outdoors.
- Advise patient to aboid swimming or go to hot tubs for a couple of
weeks
-Advise patient to not use eye make-up 2 to 3 weeks post surgery
-Advise patient to visit doctor as per schedule on Day, Week1 and Week3.
THANK YOU!