cataract and implant surgery
DESCRIPTION
Cataract and Implant SurgeryTRANSCRIPT
DOMINIC MCHUGH MD DOMINIC MCHUGH MD FRCSFRCS
LONDON, UKLONDON, UK
Cataract and Implant Cataract and Implant SurgerySurgery
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CataractCataractCausesCauses
• AgeAge
• Congenital Congenital
(genetic, metabolic)(genetic, metabolic)
• TraumaTrauma
• InfectionInfection
• InflammationInflammation
• SurgicalSurgical
• Drugs (eg steroids)Drugs (eg steroids)Brought to you by
CataractCataract
• May be induced by surgical May be induced by surgical procedure: lens touch; gas; oilprocedure: lens touch; gas; oil
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Cataract typesCataract types
Nuclear sclerosis Posterior subscapsular
Congenital (rubella) Trauma
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Management of CataractManagement of Cataract
• ECCE (Extracapsular cataract ECCE (Extracapsular cataract extraction)extraction)
But longer wound healing timeBut longer wound healing time
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Cataract SurgeryCataract Surgery
• Small incisional Phacoemulsification Small incisional Phacoemulsification surgery (Developed by Kelman, USA)surgery (Developed by Kelman, USA)
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Before IOL implantation was Before IOL implantation was developeddeveloped
• Aphakic spectaclesAphakic spectacles
• Contact lensesContact lenses
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Pioneer of intraocular lens Pioneer of intraocular lens implantimplant
Sir Harold Ridley FRS FRCSBrought to you by
Harold Ridley collaborated Harold Ridley collaborated with the Rayner company to with the Rayner company to
develop the IOLdevelop the IOL
John Pike, Rayner CompanyBrought to you by
1949-1950: First IOL 1949-1950: First IOL implantsimplants
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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
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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.
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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
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Phacoemulsification with IOL Phacoemulsification with IOL implantationimplantation
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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 insertionBrought to you by
Phaco parametersPhaco parameters
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Phaco+IOLPhaco+IOL surgery surgeryHydrodissectionHydrodissection
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Phaco+IOLPhaco+IOL surgery surgeryPhacoemulsificationPhacoemulsification
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Phaco+IOLPhaco+IOL surgery surgeryAspiration of cortexAspiration of cortex
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Phaco+IOLPhaco+IOL surgery surgeryFoldable IOL insertionFoldable IOL insertion
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Typical injectable IOLTypical injectable IOL
Superflex lens: 6.25mm x 12.50mm
C-Flex lens 5.75mm x 12.00 mm
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Cflex/Superflex injector
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Loading the Superflex IOLLoading the Superflex IOL
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Superflex insertionSuperflex insertion
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Superflex insertionSuperflex insertion
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Superflex insertionSuperflex insertion
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Insertion of injectable IOLInsertion of injectable IOL
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Endoscope view of SuperflexEndoscope view of Superflex
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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
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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 Brought to you by
Cataract surgery Cataract surgery complicationscomplications
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Cataract surgery: Cataract surgery: complicationscomplications
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