Management of adult cataract I.ppt

Management of Adult Cataract

Prof. Naimatullah Khan Kundi

Head, Department of Ophthalmology

Khyber Teaching Hospital

Peshawar

Management of Adult Cataract

Medical Management

Indications for surgery

Pre-operative measurements

Pre-operative evaluation and information

Management of adult cataract Evaluation

1. Each individual’s situation may vary

2. Information and examination about the patient:

Does the lens opacity correspond to the degree of visual

impairment?

Does the patient’s reduced ability to function warrant

surgery?

Is the eye sufficiently healthy to expect improved visual

function?

Is the lens opacity 2ndry to a systemic or ocular

condition?

Cataract Medical Management

Some approaches may be temporarily effective until

cataract progression causes additional symptoms

Refraction

Illumination and spectacle add

Pupillary dilation

Optical aids

Cataract Medical Management

Refraction

Improvement of distant and near vision with glasses can

the functional visual impairment in many patients

Increased ambient illumination and increased spectacle add

are also helpful.

Cataract Medical Management

Pupillary dilation

Pupillary dilation may improve visual function (axial

cataracts allowing light to pass through peripheral portions

of the lens)

Optical aids

Some patients with limited visual function from cataract

may be assisted with optical aids when surgical

management is not appropriate

Hand held monoculars (2.5x, 4x)

High add spectacles

Magnifiers

Telescopic loups for reading and close work

Indications for Surgery

Patient’s desire

Visual requirements

Significant cataract

Monocular cataract

Complications

Diagnosis and management of other ocular diseases

Indications for Surgery

Patient’s desire for improved visual function

Visual requirements:

Many governmental agencies and industries have

minimum standards of visual function for such tasks

as:

Driving

Flying

Operating complex equipments

A patient whose BCVA does not meet these visual

requirements may need to consider surgery

Indications for Surgery

Significant cataract:

A patient with visually significant cataracts is a

candidate for surgery

Monocular cataract:

Common indications in these situations include:

Loss off stereopsis

peripheral vision

Bothersome glare

Symptomatic anisometropia

Indications for Surgery

Complications:

Phacolytic glaucoma

Phacomorphic glaucoma

Phacoantigenic uveitis

Anterior dislocated lens in to AC

Indications for Surgery

Diagnosis and management of other ocular diseases:

Dense cataract that obscures the view of the fundus

and impedes the diagnosis or management of other

ocular diseases:

Diabetic retinopathy

Retinal detachment

Glaucoma

Pre-operative measurements

1. Refraction

2. Biometry

3. Corneal Pachymetry

4. Specular Microscopy

5. B-Scan ultrasonography

Pre-operative measurements

Refraction

Careful refraction on both eyes

Useful in planning the IOL power necessary to obtain

the desired postoperative refraction

If fellow eye has a cataract, it may be preferable to

plan the implant power to achieve emmetropia

postoperatively

Pre-operative measurements

Refraction (cont’d)

If fellow eye has clear lens and a high refractive

error that requires spectacles correction, obtaining

a similar refractive result in the operated eye will

avoid problems with postoperative anisometropia

Contact lens wearing in the phakic eye can avoid

the problems

Pre-operative measurements

Biometry

Keratometry:

To determine corneal curvature and power

A-scan Ultrasonography:

To determine axial length of the eye

These are performed to calculate the appropriate

IOL implant power

Pre-operative measurements

Corneal Pachymetry

Measurement of corneal thickness

Useful in assessing the function of corneal

endothelium

When quantitative evaluation of corneal

endothelial cell density may be limited in

patients with significant corneal guttata

Pre-operative measurements

Corneal Pachymetry (cont’d)

Types:

1. Ultrasonic

2. Optical

Ultrasonic pachymeter more accurate and reliable

Central corneal thickness > 600µm may be

consistent with corneal edema and endothelial

dysfunction

Likelihood of postoperative clinical corneal

edema

Pre-operative measurements

Specular Microscopy

Determine the number of corneal endothelial

cells/mm2

Normal counts > 2400 cells/mm2

Cell count < 1000 cells/mm2 abnormal

Cataract surgery causes some loss of endothelial

cells

Pre-operative measurements

Specular Microscopy (cont’d)

If preoperative endothelial cells counts low,

risk of postoperative corneal decompensation

Endothelial cell morphology, including

enlargement and irregularity provides additional

information about the cornea to withstand stress

Pre-operative measurements

B-scan Ultrasonography

When retinal view impossible, US of posterior segment useful

This test can help determine the preoperative status of the

posterior segment with regard to the potential for:

1. Retinal Detachment

2. Vitreous Opacities

3. Posterior Pole Tumors

4. Posterior Staphyloma