CATARACT SURGERY
CATARACT SURGERY
- Treatment of choice i.e. surgical removal of cataractous lens.
INDICATIONS
1. Optical indications:
- To improve vision in a visually handicap patient.
- This is the most common indication.
2. Medical indications:
- Cataract needs to be removed urgently even if patient has good vision.
- Such good conditions are:
- Lens induced glaucoma or uveitis
- Phacoanaphylactic endophthalmitis
- Dislocated/subluxated lens
- Retinal detachment or diabetic retinopathy
3. Cosmetic indication:
- White pupil in mature cataract is unacceptable to some young patient &
- in order to obtain black pupil cataract extraction is indicated.
OPERATIVE TECHNIQUES
1. Extracapsular catarct extraction (ECCE)
- The nucleus, cortex & central part of the anterior capsule are removed.
- Leaving behind intact posterior capsule, peripheral part of anterior capsule & zonules.
- ECCE with posterior chamber lens implantation (ECCE with PCL) is the surgery of choice for almost all types of cataract.
- Absolute contraindication for ECCE is subluxation & dislocation of lens.
- Techniques for ECCE are:
- Conventional ECCE
- Manual small incision cataract surgery
- Phacoemulsion
2. Intracapsular cataract extraction (ICCE)
- Only indication is markedly subluxated or dislocated lens.
- Contraindicated in young patients (
3. Phacoemulsion
- Advancement in the method of doing ECCE.
- ECCE by phacoemulsification with foldable posterior chamber IOL is the procedure of choice for cataract.
- Steps in phacoemulsion include:
- Corneoscleral incision
- Continuous curvilinear capsulorrhexis
- Hydrodissection & hydrodelineation
- Emulsification & aspiration of nucleus & then cortex
- Foldable IOL implantation in posterior chamber.
- Recovery with phacoemulsification is fastest as incision is very small & no sutures are taken.
Exam Important
- Surgery of choice for congenital cataract is ECCE.
- In extra-capsular cataract surgery ECCE, Nucleus of the lens is excised
- Best way to prevent infection after cataract surgery is Antibiotics.
- Surgery of choice for congenital cataract is Posterior capsulectomy.
- Laser used to manage after cataract- Nd:YAG laser.
- In posterior capsular cataract, treatment is Nd-YAG Laser.
- Laser used in cutting out cataract capsule is Nd : YAG laser.
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