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Advances in Cataract Surgery
Eric M. Smith, VMD |
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This downloadable video is for personal use only. Not to be resold or distributed without the express written permission of Waltham USA. Abridged from the complete procedure available on Waltham Forum® Video Vol. 6, No. 3. |
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The success of cataract surgery is dictated by proper patient selection, preoperative and postoperative medical management, and recent advances in surgical technique. Dr. Smith demonstrates lens extraction by phacoemulsification with intraocular lens implantation.
Outline
I.
Cataract Classification
A.
Location.
B.
Degree of maturation.
1.
Incipient—small opacity, vision not affected.
2.
Immature—affects vision, can visualize some tapetal reflection.
3.
Mature—cannot visualize any tapetal reflection.
4.
Hypermature—begins to liquify and lens shrinks.
II.
Etiology
A.
Hereditary.
B.
Metabolic, e.g. diabetes mellitus.
C.
Trauma.
1.
Penetrating injury.
2.
Nonpenetrating injury.
D.
Nutritional.
E.
Toxic.
III.
Selection of the Surgical Candidate
A.
Thorough physical examination.
1.
Systemic disease.
2.
Anesthetic risk.
3.
Temperament—requires cooperative surgical candidate.
B.
Concomitant ocular disease—can alter prognosis.
1.
Past or present uveitis—can decrease success rate from 85–95% to 39–52%.
2.
Lens resorption.
3.
Lens luxation or subluxation.
4.
Glaucoma.
5.
Retinal disease.
IV.
Preoperative Therapy
A.
Antiinflammatory.
1.
Steroids and NSAIDs.
2.
Topically and systemically.
B.
Mydriatics.
C.
Antibiotics.
V.
Cataract Surgery
A.
Intracapsular cataract extraction.
1.
Definition—160°180° incision along the dorsal limbus with the entire lens and lens capsule being revolved.
2.
Uses: luxated and subluxated lens.
B.
Extracapsular cataract extraction.
1.
Open sky.
2.
Phacoemulsification—fragmentation and removal of lens and replacement with prosthetic lens.
VI.
Postoperative Management
A.
Frequent reexamination.
B.
Complications.
1.
Uveitis.
2.
Glaucoma.
3.
Corneal edema.
4.
Retinal separation/tear.
5.
Lens capsule opacification.
6.
Self trauma.