DOCSLIB.ORG

FIVE PEARLS EVERY CATARACT SURGEON MUST KNOW ABOUT the RETINA an Understanding of These Issues Will Help to Ensure Success in Patients with Retinal Disease

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
FIVE PEARLS EVERY CATARACT SURGEON MUST KNOW ABOUT the RETINA an Understanding of These Issues Will Help to Ensure Success in Patients with Retinal Disease ABOUT THE RETINA COVER FOCUS COVER FIVE PEARLS EVERY CATARACT SURGEON MUST KNOW ABOUT THE RETINA An understanding of these issues will help to ensure success in patients with retinal disease. BY DENNIS P. HAN, MD; AND TEODORO EVANS, MD Cataract surgery is the most Recommended Before Cataract Surgery?). We strongly prefer common intraocular proce- laser rather than cryotherapy for prophylaxis. dure performed worldwide. The incidence of postoperative CME, also called Irvine-Gass Because cataract surgery is syndrome, seems to be low in uncomplicated cases, ranging usually performed in elderly from 0.2% to 2%.3-5 Recommendations vary significantly on patients, many of whom are at risk for retinal disease, it is WHEN IS PROPHYLACTIC LASER TREATMENT important that the surgeon RECOMMENDED BEFORE CATARACT SURGERY? be aware of implications for the retina. This article pres- ents the five pearls that every cataract surgeon must know Laser definitely recommended: about the retina. A thorough understanding of these • Symptomatic horseshoe tear pearls can make the difference between success and disap- • Acute traumatic retinal breaks pointment. Controversial, but the authors usually perform laser: PEARL KNOW WHAT RETINAL PROBLEMS • Symptomatic operculated tear # TO PREVENT AND HOW TO (operculum highly separated from retina may 1 PREVENT THEM allow observation) There are two major adverse events involv- • Lattice degeneration when the contralateral eye has had ing the retina that can occur after cataract retinal detachment* surgery: retinal detachment and cystoid macular edema (CME). • Asymptomatic horseshoe tear Retinal detachment is estimated to occur in about 0.7% of patients after cataract surgery, even in the era of phacoemulsi- Laser probably unnecessary but sometimes done: fication and extracapsular-type procedures.1 Few studies exist • Asymptomatic operculated tear regarding preoperative interventions to manage this risk. Most cataract surgeons try to avoid vitreous loss and attempt to mini- Laser not done: mize the need for a posterior capsulotomy, both of which are • Asymptomatic atrophic hole (round or oval, nonoperculated) events that increase risk of retinal detachment. • Lattice degeneration without history of retinal Is there a role for prophylactic retinal laser photocoagula- detachment in fellow eye tion? Although some studies strongly support the application • Age-related retinoschisis with or without outer retinal holes of retinal laser treatment in certain patients with retinal tears, no study has rigorously evaluated the outcomes of laser treat- * In patients with lattice degeneration and a history of retinal detach- ment in patients about to have cataract surgery.2 At minimum, ment in the other eye, laser photocoagulation is provided only if there it seems reasonable to apply general guidelines for prophy- is less than 6.00 D of myopia and fewer than 6 clock hours of involve- lactic treatment for such patients. The American Academy ment of lattice degeneration. Treatment to surround all lattice lesions, of Ophthalmology’s Preferred Practice Patterns provide such as opposed to just selected lesions, appears most effective.1,2 guidelines. We have considered these guidelines in creating our 1. Ophthalmology. 1986;93:1127-1136. own approach to the cataract patient with retinal breaks or lat- 2. Ophthalmology. 1989;96:72-79. tice degeneration (see When is Prophylactic Laser Treatment MAY 2015 | CATARACT & REFRACTIVE SURGERY TODAY EUROPE 43 SAMPLE REGIMEN FOR TOPICAL PROPHYLAXIS AGAINST POSTOPERATIVE CME* • Topical nonsteroidal antiinflammatory drug (eg, ketorolac four times daily, nepafenac twice daily, bromfenac once daily): Begin 1 week prior to surgery, stop for 1 week postoperative to permit corneal reepithelialization, then resume. • Topical prednisolone acetate 1% four times daily, then taper; if cystoid macular edema or CME appears, resume COVER FOCUS COVER four times daily until it resolves. Figure 1. A graphic representation of what can happen after • Continue 4 to 8 weeks after surgery, depending on risk cataract extraction (CE) in a patient with AMD progression. (eg, eyes with previous diabetic macular edema or with history of CME in fellow eye are treated longer). triangle. Understanding the concept of maximizing vision value can help with decision-making. * adapted from Oetting6 Obtaining a thorough history is important. Patients with rapid visual loss, a scotoma, or metamorphopsia should be sus- topical prophylaxis of CME in the routine cataract patient. pected of having something other than cataract. Always ask the However, if there are complications from surgery, such as vitre- patient to characterize his or her visual loss: “How would you ous presentation, a dropped nucleus, or endophthalmitis that describe your vision difficulty?” Do not just look at the visual has resolved, a role for CME prevention may exist. Additionally, acuity measurement on the chart. If the patient describes visual patients with a history of retinal vein occlusion or macular symptoms as, “like looking through a fog or a film,” it suggests epiretinal membranes have been noted to have a 32-fold and that cataract may be the actual problem, rather than a more fivefold increase in risk of CME, respectively. Randomized tri- focal retinal disturbance in the macula. als specific to these conditions have not been performed. The amount of visual improvement possible is usually judged However, Oetting suggested a sample regimen to reduce CME by the density of the cataract and the amount of underlying risk in such patients (see Sample Regimen for Topical Prophylaxis macular disease, both of which can usually be determined with Against Postoperative CME).6 direct and indirect slit-lamp biomicroscopy. In judging the visual In patients with preexisting diabetic retinopathy without impact of the cataractous lens, retroillumination of the lens is diabetic macular edema (DME), the rate of postoperative superior to viewing with direct illumination because the anteri- macular edema approaches 0%.7 It is not clear that topi- orly directed light scatter with the latter technique can confuse cal CME prophylaxis is justified in such cases. Patients who the examiner. undergo treatment with topical corticosteroid therapy should To judge the amount of optical aberration in the lens and be monitored for elevated IOP. cornea, a direct ophthalmoscope at its brightest light setting can be held 2.5 cm from the patient’s eye, focused on the lens THE PRESENCE OF AGE-RELATED and retroilluminating it with the fundus red reflex. The amount PEARL # MACULAR DEGENERATION of obscuration or disruption of the homogeneity of the red CAN LIMIT THE MAGNITUDE reflex should be consistent with visual acuity impairment. This 2 AND DURATION OF VISUAL examination technique can be superior to direct illumina- IMPROVEMENT AFTER CATARACT tion at slit-lamp examination. For example, not all 2+ nuclear SURGERY AND CAN EVEN PRECLUDE SUCH sclerotic cataracts are the same in causing visual loss, and the SURGERY retroillumination technique can help to make this distinction. To optimize outcomes, the ophthalmologist must deter- Additionally, using the direct ophthalmoscope, the examiner mine: (1) the degree of improvement expected from surgery, can distinguish lenticular from corneal aberrations by moving (2) the expected duration of improvement, and (3) the impact his or her head from side to side to determine the geometric that this improvement will have on the patient’s quality of life. plane of the abnormality using the parallax effect. Figure 1 helps visualize graphically what can happen after cata- It is controversial whether cataract surgery makes AMD ract surgery in a patient with age-related macular degeneration worse.8 If a cataract has reached a level of severity sufficient to (AMD) progression. The area of the triangle labeled Vision Value reduce visual function, such worsening is likely to be insignifi- takes into account the magnitude and duration of improvement. cant relative to the current state of the macula. It is thus impor- The impact on quality of life could be a third dimension of this tant to recognize lesions that are relevant to visual function in 44 CATARACT & REFRACTIVE SURGERY TODAY EUROPE | MAY 2015 COVER FOCUS COVER the present or will be in the near future. We have called these to expansion toward the fovea itself, it is advisable to inform a lesions the good, the bad, and the ugly. patient with RPE atrophy near the fovea that the benefit of sur- The good lesions are consistent with good postoperative gery may not last forever. visual acuity of lasting duration. They consist of small to inter- mediate drusen (< 125 µm) or eccentric pigmentary change PEARL KNOWING YOUR PATIENT’S or atrophy of the retinal pigment epithelium (RPE) distant # LIFESTYLE AND ACTIVITIES IS (> 1 disc diameter) from the macular center. Absence of visual IMPORTANT TO DETERMINE IF loss from AMD in either eye is also reassuring. Such patients 3 THE POTENTIAL MAGNITUDE can have years of excellent function. AND DURATION OF VISUAL The bad lesions cause moderate to severe visual loss that can IMPROVEMENT JUSTIFIES THE RISKS OF nearly immediately counter any beneficial effect from cataract CATARACT SURGERY surgery. They include neovascular pigment epithelial detachments The visual requirements of an active 60-year-old woman who and choroidal neovascular membranes. These lesions can mimic a travels, reads novels, and is the editor of the local gardening club rapidly worsening cataract, bring a patient to the surgeon’s atten- newsletter are much different from those of an 85-year-old man tion, and then lead to ineffective surgery. They are hard to detect with history of a hemispheric cerebrovascular accident whose preoperatively because there is no coloration change in the fun- main activity is watching football a couple of times a week. dus, and the subtle changes are obscured by the cataract itself. Take time to ask your patient how much he or she is impaired Patients with bad lesions who undergo cataract surgery may and what type of change in visual function it would take to make later say, “I had cataract surgery and it made me worse.” It is a difference in his or her life.
Load more

Recommended publications
  • Visual Outcomes of Combined Cataract Surgery and Minimally Invasive Glaucoma Surgery
    1422 REVIEW/UPDATE Visual outcomes of combined cataract surgery and minimally invasive glaucoma surgery Steven R. Sarkisian Jr, MD, Nathan Radcliffe, MD, Paul Harasymowycz, MD, Steven Vold, MD, Thomas Patrianakos, MD, Amy Zhang, MD, Leon Herndon, MD, Jacob Brubaker, MD, Marlene Moster, MD, Brian Francis, MD, for the ASCRS Glaucoma Clinical Committee Minimally invasive glaucoma surgery (MIGS) has become a reliable on visual outcomes based on the literature and the experience of standard of care for the treatment of glaucoma when combined the ASCRS Glaucoma Clinical Committee. with cataract surgery. This review describes the MIGS procedures J Cataract Refract Surg 2020; 46:1422–1432 Copyright © 2020 Published currently combined with and without cataract surgery with a focus by Wolters Kluwer on behalf of ASCRS and ESCRS inimally invasive (sometimes referred to as mi- and thereby lower IOP. The endoscope consists of a fiber- croinvasive) glaucoma surgery (MIGS) is a pro- optic camera, light source, and laser aiming beam with an Mcedure that lowers intraocular pressure (IOP) 832 nm diode laser. The endoscope probe is introduced into without significantly altering the tissue, allows for rapid the globe via a limbal corneal or pars plana incision. The visual recovery, is moderately effective, and can be com- anterior approach requires inflation of the ciliary sulcus with bined with cataract surgery in a safe and efficient manner.1,2 an ophthalmic viscosurgical device, whereas the posterior This is in contrast to more conventional glaucoma surgery approach uses a pars plana or anterior chamber irrigation (eg, trabeculectomy or large glaucoma drainage device port. Although the anterior approach can be used in a phakic implantation), which requires conjunctival and scleral eye, it is typically performed with cataract extraction as a incisions as well as suturing.
    [Show full text]
  • Ocular Surface Disease: Supplement April 2018 Accurately Diagnose & Effectively Treat Your Surgical Patients
    Ocular Surface Disease: Supplement April 2018 Accurately Diagnose & Effectively Treat Your Surgical Patients Supported by an unrestricted educational grant from Ocular Surface Disease: Accurately Diagnose & Effectively Treat Your Surgical Patients Prevalence of Ocular Surface Disease and Its Impact on Surgical Outcomes Accurate diagnosis of dry eye disease is critical before cataract or refractive surgery By Elisabeth M. Messmer, MD ry eye is a common disease, but it may remain EPIDEMIOLOGY OF DRY EYE SYNDROME undetected. If it is not treated before cataract or 1-4 refractive surgery, patients may have suboptimal visual AFTER CATARACT SURGERY outcomes from their procedures. D l Very limited data available, mostly small descriptive/ IMPACT ON CATARACT SURGERY non-randomised studies There are a number of triggering factors for dry eye (Figure 1). l 10-20% of patients: DED induced or worsened after Cataract surgery worsens or causes dry eye in approximately uncomplicated cataract surgery 10% to 20% of patients (Figure 2).1-4 l In all studies: Signs and symptoms of dry eye In a study of 136 patients with a mean age of 71 years who increase after surgery were having cataract surgery, 22% had a prior diagnosis of dry eye that was not treated.5 Thirty-one percent complained l In most studies: gradual improvement of signs and of stinging, burning or other symptoms of dry eye when asked symptoms of dry eye within 3 months about their symptoms, and 41% reported a foreign body l In some studies: signs and symptoms persist > 3 months sensation. When the patients were examined, 77% had corneal staining and 50% had central staining.
    [Show full text]
  • Strabismus, Amblyopia & Leukocoria
    Strabismus, Amblyopia & Leukocoria [ Color index: Important | Notes: F1, F2 | Extra ] EDITING FILE ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Objectives: ➢ Not given. Done by: Jwaher Alharbi, Farrah Mendoza. ​ ​ Revised by: Rawan Aldhuwayhi ​ Resources: Slides + Notes + 434 team. ​ ​ NOTE: F1& F2 doctors are different, the doctor who gave F2 said she is in the exam committee so focus on her notes Amblyopia ● Definition Decrease in visual acuity of one eye without the presence of an organic cause that explains that decrease ​ ​ in visual acuity. He never complaints of anything and his family never noticed any abnormalities ​ ● Incidence The most common cause of visual loss under 20 years of life (2-4% of the general population) ● How? Cortical ignorance of one eye. This will end up having a lazy eye ​ ● binocular vision It is achieved by the use of the two eyes together so that separate and slightly dissimilar images arising in each eye are appreciated as a single image by the process of fusion. It’s importance 1. Stereopsis 2. Larger field If there is no coordination between the two eyes the person will have double vision and confusion so as a compensatory mechanism for double vision the brain will cause suppression. The visual pathway is a plastic system that continues to develop during childhood until around 6-9 years of age. During this time, the wiring between the retina and visual cortex is still developing. Any visual problem during this critical period, such as a refractive error or strabismus can mess up this developmental wiring, resulting in permanent visual loss that can't be fixed by any corrective means when they are older Why fusion may fail ? 1.
    [Show full text]
  • CAUSES, COMPLICATIONS &TREATMENT of A“RED EYE”
    CAUSES, COMPLICATIONS & TREATMENT of a “RED EYE” 8 Most cases of “red eye” seen in general practice are likely to be conjunctivitis or a superficial corneal injury, however, red eye can also indicate a serious eye condition such as acute angle glaucoma, iritis, keratitis or scleritis. Features such as significant pain, photophobia, reduced visual acuity and a unilateral presentation are “red flags” that a sight-threatening condition may be present. In the absence of specialised eye examination equipment, such as a slit lamp, General Practitioners must rely on identifying these key features to know which patients require referral to an Ophthalmologist for further assessment. Is it conjunctivitis or is it something more Iritis is also known as anterior uveitis; posterior uveitis is serious? inflammation of the choroid (choroiditis). Complications include glaucoma, cataract and macular oedema. The most likely cause of a red eye in patients who present to 4. Scleritis is inflammation of the sclera. This is a very rare general practice is conjunctivitis. However, red eye can also be presentation, usually associated with autoimmune a feature of a more serious eye condition, in which a delay in disease, e.g. rheumatoid arthritis. treatment due to a missed diagnosis can result in permanent 5. Penetrating eye injury or embedded foreign body; red visual loss. In addition, the inappropriate use of antibacterial eye is not always a feature topical eye preparations contributes to antimicrobial 6. Acid or alkali burn to the eye resistance. The patient history will usually identify a penetrating eye injury Most general practice clinics will not have access to specialised or chemical burn to the eye, but further assessment may be equipment for eye examination, e.g.
    [Show full text]
  • Refractive Changes After Scleral Buckling Surgery
    Refractive changes after scleral buckling surgery Alterações refracionais após retinopexia com explante escleral João Jorge Nassaralla Junior1 ABSTRACT Belquiz Rodriguez do Amaral Nassaralla2 Purpose: A prospective study was conducted to compare the refractive changes after three different types of scleral buckling surgery. Methods: A total of 100 eyes of 100 patients were divided into three groups according to the type of performed buckling procedure: Group 1, encircling scleral buckling (42 patients); Group 2, encircling with vitrectomy (30 patients); Group 3, encircling with additional segmental buckling (28 patients). Refractive examinations were performed before and at 1, 3 and 6 months after surgery. Results: Changes in spherical equivalent and axial length were significant in all 3 groups. The amount of induced astigmatism was more significant in Group 3. No statistically significant difference was found in the amount of surgically induced changes between Groups 1 and 2, at any postoperative period. Conclusions: All three types of scleral buckling surgery were found to produce refractive changes. A correlation exists between additional segments and extent of refractive changes. Keywords: Retinal detachment/surgery; Scleral buckling/adverse effects; Refraction/ ocular; Biometry INTRODUCTION During the past several years, our Retina Service and others(1) have continued to use primarily solid implants with encircling bands. Only occa- sionally episcleral silicone rubber sponges are utilized. Changes in refrac- tion are frequent after retinal detachment surgery. The surgical technique used appears to influence these changes. Hyperopia(2) and hyperopic astig- matism may occur presumably by shortening the anteroposterior axis of the globe after scleral resections(1). Scleral buckling procedures employing an encircling band generally are expected to produce an increase in myopia and myopic astigmatism(1,3).
    [Show full text]
  • Contacts Vs. Iols for Congenital Cataract
    in Review News commentary and perspectives Contacts vs. IOLs for Congenital Cataract he verdict is in on the issue of optical correction in children who undergo unilateral cataract surgery before age 7 months: Aphakia, corrected with a contact lens, is a better option than an T CONTACT LENS PATIENT. Dr. Lambert examines a 6-year-old intraocular lens (IOL) for 55 others who received an aphakic girl in the IATS trial. This child was prescribed a most of these babies. IOL implant (median VA in contact lens in one eye at 1 month of age and could insert “Primary IOL implan- both groups, 0.90 logMAR her own contact lens by the age 4 years. tation should be reserved [20/159]). for those infants where, in More complications. pillary membranes occurred one normal eye. But the the opinion of the surgeon, However, a significantly 10 times more often in the thing about children is that the cost and handling of greater number of the pseu- pseudophakic eyes. they’re going to live for a a contact lens would be so dophakic eyes required one Scott R. Lambert, MD, very long time, and it is burdensome as to result in or more additional intra- a professor of ophthalmol- important for them to have significant periods of uncor- operative procedures over ogy at Emory University in the best possible visual acu- rected aphakia,” stated the the course of the study (41 Atlanta and the lead inves- ity in their problem eye,” investigators in the Infant patients compared with tigator in the trial, credited he said, particularly in case Aphakia Treatment Study.1 12 in the aphakic group; advocacy by the pediatric anything should happen to Comparable VA.
    [Show full text]
  • Treatment of Stable Keratoconus by Cataract Surgery with Toric IOL Implantation
    10.5005/jp-journals-10025-1024 JaimeCASE Levy REPORT et al Treatment of Stable Keratoconus by Cataract Surgery with Toric IOL Implantation Jaime Levy, Anry Pitchkhadze, Tova Lifshitz ABSTRACT implantation in the right eye. On presentation, uncorrected We present the case of a 73-year-old patient who underwent visual acuity (UCVA) was 6/60 OU. Refraction was –0.75 successful phacoemulsification and toric intraocular lens (IOL) –5.0 × 65° OD and –3.25 –4.0 × 98° OS. Nuclear sclerosis implantation to correct high stable astigmatism due to and posterior subcapsular cataract +2 was observed in the keratoconus and cataract. Preoperative refraction was –3.25 – left eye. The posterior segments were unremarkable. 4.0 × 98°. A toric IOL (Acrysof SN60T6) with a spherical power of 16.5 D and a cylinder power of 3.75 D at the IOL plane and Corneal topography performed with Orbscan (Bausch 2.57 D at the corneal plane was implanted and aligned at an and Lomb, Rochester, NY) showed central thinning of 457 axis of 0°. Uncorrected visual acuity improved from 6/60 to microns and positive islands of elevation typical for 6/10. Postoperative best corrected visual acuity was 6/6, 6 months after the operation. In conclusion, phacoemulsification keratoconus in the right eye (Fig. 1). In the left eye a less with toric IOL implantation can be performed in eyes with pronounced inferior cone was observed (Fig. 2), without keratoconus and cataract. any area of significant thinning near the limbus typical for Keywords: Intraocular lens, Toric IOL, Keratoconus, Cataract pellucid marginal degeneration.2 Keratometry (K)-values surgery.
    [Show full text]
  • Retinal Detachment with Subretinal and Vitreous Hemorrhages Causing Secondary Angle Closure Glaucoma Diagnosed with Ultrasound
    Henry Ford Health System Henry Ford Health System Scholarly Commons Emergency Medicine Articles Emergency Medicine 5-22-2020 Retinal detachment with subretinal and vitreous hemorrhages causing secondary angle closure glaucoma diagnosed with ultrasound Michael B. Holbrook Daniel Kaitis Lily Van Laere Jeffrey Van Laere Christopher R. Clark Follow this and additional works at: https://scholarlycommons.henryford.com/ emergencymedicine_articles YAJEM-159017; No of Pages 2 American Journal of Emergency Medicine xxx (xxxx) xxx Contents lists available at ScienceDirect American Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/ajem Retinal detachment with subretinal and vitreous hemorrhages causing secondary angle closure glaucoma diagnosed with ultrasound Michael B. Holbrook, MD, MBA a,⁎, Daniel Kaitis, MD b, Lily Van Laere, MD b, Jeffrey Van Laere, MD, MPH a, Chris Clark, MD a a Henry Ford Hospital, Department of Emergency Medicine, Detroit, MI, United States of America b Henry Ford Hospital, Department of Ophthalmology, Detroit, MI, United States of America A 90-year-old female with a past medical history of trigeminal neu- choroid/retina consistent with a retinal detachment. Her pain was con- ralgia and age-related macular degeneration (AMD) presented with a trolled with oral hydrocodone/acetaminophen. Ultimately her vision four-day history of a left-sided headache, nausea, and vomiting. Regard- was deemed unsalvageable given her age, length of symptoms, and ing her left eye, she reported intermittent flashes of light over the past lack of light perception. At time of discharge, her left eye's IOP was month and complete vision loss for four days. She denied a history of di- 49 mmHg.
    [Show full text]
  • Retinopathy of Prematurity: an Update Parveen Sen, Chetan Rao and Nishat Bansal
    Review article Retinopathy of Prematurity: An Update Parveen Sen, Chetan Rao and Nishat Bansal Sri Bhagwan Mahavir Introduction 1 ml of 10% phenylephrine (Drosyn) mixed in 3 ml Vitreoretinal Services, Retinopathy of prematurity (ROP) was originally of 1% tropicamide (after discarding 2 ml from 5 ml Sankara Nethralaya designated as retrolental fibroplasias by Terry in bottle) for pupillary dilatation. These combination 1952 who related it with premature birth.1 Term drops are used every 15 minutes for 3 times. 2 Correspondence to: ROP was coined by Heath in 1951. Punctum occlusion is mandatory after instilling the Parveen Sen, It is a disorder of development of retinal blood drops to reduce the systemic side effects of medica- Senior Consultant, vessels in premature babies. Normal retinal vascu- tion. Excess eye drops should also be wiped off to Sri Bhagwan Mahavir larization happens centrifugally from optic disc to prevent absorption through cheek skin. If the pupil Vitreoretinal Services, ora. Vascularization up to nasal ora is completed does not dilate in spite of proper use of medication, Sankara Nethralaya. by 8 months (36 weeks) and temporal ora by 10 presence of plus disease should be suspected. E-mail: [email protected] months (39–41 weeks).3 Repeated installation of topical drops should be The incidence of ROP is increasing in India avoided to prevent systemic problems. Sterile because of improved neonatal survival rate. Out of Alfonso speculum is used to retract the lids and wire 26 million annual live births in India, approxi- vectis for gentle depression. mately 2 million are <2000 g in weight and are at High-quality retinal images obtained using risk of developing ROP.3 In India the incidence of commercially available wide-angle fundus camera ROP is between 38 and 51.9% in low-birth-weight like the Retcam followed by Telescreening by a infants.3,4 trained ophthalmologist can also be done.
    [Show full text]
  • Incidence of Posterior Vitreous Detachment After Cataract Surgery
    ARTICLE Incidence of posterior vitreous detachment after cataract surgery Alireza Mirshahi, MD, FEBO, Fabian Hoehn, MD, FEBO, Katrin Lorenz, MD, Lars-Olof Hattenbach, MD PURPOSE: To report the incidence of posterior vitreous detachment (PVD) after uneventful state- of-the-art small-incision phacoemulsification with implantation of a posterior chamber intraocular lens (PC IOL). SETTING: Department of Ophthalmology, Ludwigshafen Hospital, Ludwigshafen, Germany. METHODS: This prospective study evaluated the vitreous status of eyes by biomicroscopic exam- ination, indirect binocular ophthalmoscopy, and B-scan ultrasonography before planned cataract surgery. Patients with the posterior vitreous attached were included for follow-up and examined 1 week, 1 month, and 1 year after uneventful phacoemulsification with PC IOL implantation. The preoperative prevalence and postoperative incidence of PVD were determined by ultrasonography. RESULTS: The study included 188 eyes of 188 patients (131 women, 57 men) with a mean age of 77.2 years. The mean spherical equivalent was À0.78 diopter (D) (range À8.75 to C6.25 D) and the mean axial length (AL), 23.22 mm (range 20.50 to 26.04 mm). Preoperatively, 130 eyes (69.1%) had PVD and 58 eyes (30.9%) had no PVD. Postoperatively, 12 eyes (20.7%) developed PVD at 1 week, 18 eyes (31%) at 1 month, and 4 eyes (6.9%) at 1 year. The vitreous body remained at- tached to the retina in 24 eyes (41.4%) 1 year after surgery. No preoperatively measured parameter (eg, age, refraction, AL, effective phacoemulsification time) was predictive of the occurrence of PVD after cataract surgery. CONCLUSION: The occurrence of PVD after modern cataract surgery was frequent in cases in which the posterior hyaloid was attached to the retinal surface preoperatively.
    [Show full text]
  • Florida Board of Medicine and Florida Board Of
    FLORIDA BOARD OF MEDICINE AND FLORIDA BOARD OF OSTEOPATHIC MEDICINE APPROVED INFORMED CONSENT FORM FOR CATARACT OPERATION WITH OR WITHOUT IMPLANTATION OF INTRAOCULAR LENS DOES THE PATIENT NEED OR WANT A TRANSLATOR, INTERPRETOR OR READER? YES _____ NO_____ TO THE PATIENT: You have the right, as a patient, to be informed about your cataract condition and the recommended surgical procedure to be used, so that you may make the decision whether or not to undergo the cataract surgery, after knowing the risks, possible complications, and alternatives involved. This disclosure is not meant to scare or alarm you; it is simply an effort to make you better informed so that you may give or withhold your consent to cataract surgery and should reflect the information provided by your eye surgeon. If you have any questions or do not understand the information, please discuss the procedure with your eye surgeon prior to signing. WHAT IS A CATARACT, AND HOW IS IT TREATED? The lens in the eye can become cloudy and hard, a condition known as a cataract. Cataracts can develop from normal aging, from an eye injury, various medical conditions or if you have taken certain medications such as steroids. Cataracts may cause blurred vision, dulled vision, sensitivity to light and glare, and/or ghost images. If the cataract changes vision so much that it interferes with your daily life, the cataract may need to be removed to try to improve your vision. Surgery is the only way to remove a cataract. You can decide to postpone surgery or not to have the cataract removed.
    [Show full text]
  • Cataract Surgery a Cataract Is Any Opacity Within the Lens of the Eye
    The Ohio State University Veterinary Medical Center Cataract Surgery A cataract is any opacity within the lens of the eye. The lens sits within the eye and helps to focus images onto the retina. Cataracts can be caused by genetics, diabetes, aging, and other diseases of the eye, such as retinal disease or inflammation. If cataracts are severe enough, visual deficits can be noted at home or in unfamiliar environments (e.g. bumping into things, missing treats or stairs). Diagrammatic cross section of the eye What do I need to do for my pet prior to cataract surgery? In order to ensure the best chance of vision after cataract surgery, the health of both eyes and the animal are evaluated. Vitreous This includes: Health of the Eye Lens Retina • Complete ophthalmic exam by an ophthalmologist, including Cornea tests to evaluate tear production and intraocular pressure • Electroretinogram (ERG) – this is an electrical test used to evaluate the health of the retina behind the lens, usually performed without general anesthesia • Ultrasound of the eye to evaluate the structural integrity of the lens, retina and fluid behind the lens (the vitreous) Health of the Animal • Physical exam, including listening to the heart and lungs • Basic blood and urine tests to evaluate the overall health of the animal Diabetic animals should receive additional diagnostics • Fructosamine and/or glucose curve should be performed by your referring veterinarian to evaluate for adequate diabetic Mature cataract in a dog with diabetes mellitus. control (occasional spot-checks at home are not adequate prior to surgery) • Urine culture collected sterilely directly from the bladder, to ensure there is no active urinary tract infection present These evaluations should be performed within one month of the planned surgery to ensure we have the most up-to-date picture of your pet’s health.
    [Show full text]