DOMINIC MCHUGH MD FRCS DOMINIC MCHUGH MD FRCS LONDON, UK LONDON, UK Cataract and Implant Cataract and Implant Surgery Surgery
Dec 22, 2015
DOMINIC MCHUGH MD DOMINIC MCHUGH MD FRCSFRCS
LONDON, UKLONDON, UK
Cataract and Implant Cataract and Implant SurgerySurgery
CataractCataractCausesCauses
• AgeAge
• Congenital Congenital
(genetic, metabolic)(genetic, metabolic)
• TraumaTrauma
• InfectionInfection
• InflammationInflammation
• SurgicalSurgical
• Drugs (eg steroids)Drugs (eg steroids)
CataractCataract
• May be induced by surgical May be induced by surgical procedure: lens touch; gas; oilprocedure: lens touch; gas; oil
Management of CataractManagement of Cataract
• ECCE (Extracapsular cataract ECCE (Extracapsular cataract extraction)extraction)
But longer wound healing timeBut longer wound healing time
Cataract SurgeryCataract Surgery
• Small incisional Phacoemulsification Small incisional Phacoemulsification surgery (Developed by Kelman, USA)surgery (Developed by Kelman, USA)
Before IOL implantation was Before IOL implantation was developeddeveloped
• Aphakic spectaclesAphakic spectacles
• Contact lensesContact lenses
Harold Ridley collaborated Harold Ridley collaborated with the Rayner company to with the Rayner company to
develop the IOLdevelop the IOL
John Pike, Rayner Company
Choice of IOLChoice of IOL
• Insertion through small incisionInsertion through small incision
• High biomcompatilbilityHigh biomcompatilbility
• Allows good retinal viewAllows good retinal view
• Stable centrationStable centration
• Low PCO (posterior capsular Low PCO (posterior capsular opacification) rateopacification) rate
IOL choiceIOL choiceWhy foldable/injectable?Why foldable/injectable?Minimise incision size to Minimise incision size to reduce healing time and reduce healing time and
astigmatismastigmatism×PMMA(rigid) : Non-foldable+large incisionPMMA(rigid) : Non-foldable+large incision
Acrylic: Injectable through 2.2-3.2 mm Acrylic: Injectable through 2.2-3.2 mm currently.currently.
Preparation for cataract Preparation for cataract surgerysurgery
Biometry: The calculation of Biometry: The calculation of required IOL power required IOL power
Keratometry (Keratometry (KK) (corneal ) (corneal curvature)curvature)
Axial length (Axial length (ALAL) of eye ) of eye (ultrasound)(ultrasound)
IOL power= IOL power= A constantA constant--2.5x2.5xALAL-0.9-0.9KK
Eg: Eg: 118118-2.5x -2.5x 24-24-0.9x0.9x4545=17.5=17.5 dioptres dioptres
IOL powerIOL power
Phacoemulsification: Phacoemulsification: surgical sequencesurgical sequence
• Corneal tunnelCorneal tunnel
• CCC (continuous curvilinear CCC (continuous curvilinear capsulorrhexiscapsulorrhexis
• HydrodissectionHydrodissection
• PhacoemulsificationPhacoemulsification
• Aspiration of cortical lens matterAspiration of cortical lens matter
• IOL insertionIOL insertion
Typical injectable IOLTypical injectable IOL
Superflex lens: 6.25mm x 12.50mm
C-Flex lens 5.75mm x 12.00 mm
Cataract surgeryCataract surgery
Postoperative managementPostoperative management
Eye pad overnightEye pad overnight
Antibiotic+steroid drops for up to one Antibiotic+steroid drops for up to one monthmonth
Change glasses at one monthChange glasses at one month
Complications of cataract Complications of cataract surgery (many!)surgery (many!)
• Posterior capsular rupture Posterior capsular rupture and vitreous lossand vitreous loss
• Dropped nucleusDropped nucleus
• IOL dislocationIOL dislocation
• EndophthalmitisEndophthalmitis
• Retinal detachmentRetinal detachment