Dealing with the Dealing with the scariest complication scariest complication in cataract surgeryin cataract surgery

Ian FrancisIan Francis

SurfingSurfing : :

Leonardo era un Leonardo era un

pittore straordinariopittore straordinario

First : the most important word inFirst : the most important word in

the English language : the English language :

OntologicalOntological

: do you believe what you just saw ??: do you believe what you just saw ??

ONTOLOGICAL : ONTOLOGICAL :

“ “ The way things really are …”The way things really are …”

FOR EXAMPLE :FOR EXAMPLE :

1. Life1. Life 2. Your spouse2. Your spouse 3. Your children3. Your children 4. God4. God 5. Surfing5. Surfing 6. Medicine6. Medicine 7. Optometry7. Optometry 8. Ophthalmology8. Ophthalmology 9. Refractive surgery9. Refractive surgery 10. Neuro-ophthalmology …………10. Neuro-ophthalmology …………

All Ophthalmology and All Ophthalmology and

Optometry is Optometry is

Neuro-ophthalmologyNeuro-ophthalmology

Why ?? ….Why ?? ….

because much as anyone because much as anyone

may or may not like it :may or may not like it :

The eye bone is connected to The eye bone is connected to

1. the brain bone 1. the brain bone

2. the body bone2. the body bone

Dealing with theDealing with the

scariestscariest

complication incomplication in

cataract surgerycataract surgery

EndophthalmitisEndophthalmitis

: : E E

E :E :Only happens Only happens because because someone has someone has been operated !!been operated !!

Anthony PaneAnthony Pane : : Neuro-Neuro-ophthalmologist extraordinaireophthalmologist extraordinaire

Everyone in Medicine should read this….Everyone in Medicine should read this….

Med J Aust October 2008Med J Aust October 2008

“ “ Misdiagnosis of acute eye diseases byMisdiagnosis of acute eye diseases by

primary health care providers: incidence primary health care providers: incidence and implications “ ….and implications “ ….

1. Michael O. Statham1. Michael O. Statham : : RMORMO: : MB BS(Hons), MB BS(Hons), BAppSci(Optom)(Hons)BAppSci(Optom)(Hons)

2. Anamika Sharma 2. Anamika Sharma : : RegistrarRegistrar : : BmK BS(Hons), BMedSci(Hons) BmK BS(Hons), BMedSci(Hons)

3. Anthony R. Pane3. Anthony R. Pane : : VMOVMO : : MB BS(Hons), MMedSc, FRANZCO MB BS(Hons), MMedSc, FRANZCO

For E :For E :

It is of supreme importance not to It is of supreme importance not to

1. underdiagnose E1. underdiagnose E

2. misdiagnose E 2. misdiagnose E

3. treat E as of little consequence3. treat E as of little consequence

EE

1. Is either local or metastatic1. Is either local or metastatic

2. May requires lots of medical work to 2. May requires lots of medical work to confirmconfirm

3.3. May be life-threatening….May be life-threatening….

E : E : metastatic …metastatic …

patient referred urgently from the EHpatient referred urgently from the EH

Sinus venosusSinus venosus

Diagnosing E :Diagnosing E :

YOU MAY BE IN YOU MAY BE IN

THE BOX SEAT THE BOX SEAT

E :E :1. Vast majority have had cataract surgery1. Vast majority have had cataract surgery

2. Within a few days of the operation, things head south, 2. Within a few days of the operation, things head south, often rapidlyoften rapidly

3. Day 1: vision 6/4 or 6/12 vision3. Day 1: vision 6/4 or 6/12 vision

4. Vision on day 4 : HM or worse4. Vision on day 4 : HM or worse

5. Pain5. Pain

6. Loss of the red reflex6. Loss of the red reflex

7. Hypopyon7. Hypopyon

……examination requires finesse …examination requires finesse …

E :E :

Is getting the instructions for the Is getting the instructions for the postoperative drops correct postoperative drops correct really important ?……really important ?……

The story of a The story of a patient of minepatient of mine

with Ewith E

E story E story

Don : DOB 280726Don : DOB 280726

280704: R phaco Wednesday : uneventful280704: R phaco Wednesday : uneventful

290704 : Thursday : Day 1 pop : VAR : 6/4290704 : Thursday : Day 1 pop : VAR : 6/4

020804 : Monday 7.40pm : Day 5 pop : 020804 : Monday 7.40pm : Day 5 pop : VAR : PLVAR : PL

All stops pulled out by the VR team ……..All stops pulled out by the VR team ……..

E : VA last week was nplE : VA last week was npl

E : the other eye : 6/4E : the other eye : 6/4

Endophthalmitis Endophthalmitis following cataract following cataract surgery : the sucking corneal woundsurgery : the sucking corneal wound

Athena Roufas MBBS (Hons), MM (Ophthal Sci) Athena Roufas MBBS (Hons), MM (Ophthal Sci) Vivek B. Pandya MBBS (Hons), MM (Ophthal Sci) Vivek B. Pandya MBBS (Hons), MM (Ophthal Sci) Edwin C. Figueira MBBS, MSc, MS (Ophthal)Edwin C. Figueira MBBS, MSc, MS (Ophthal)Shahriar Amjadi B Sc (Hons), MBBS Shahriar Amjadi B Sc (Hons), MBBS Gaurav Bhardwaj BMedGaurav Bhardwaj BMedJosh Baker Josh Baker Katherine Masselos MPH, MB, BS (Hons)Katherine Masselos MPH, MB, BS (Hons)Fiona Stapleton PhDFiona Stapleton PhDSarosh Batliwalla BEc, MEc, MIntS, FIAASarosh Batliwalla BEc, MEc, MIntS, FIAAKatherine E. Francis BE (Hons)Katherine E. Francis BE (Hons)Rahul Dubey MBBS (Hons)Rahul Dubey MBBS (Hons)Jeanie Chui B Med Sci (Hons) MBBS PhDJeanie Chui B Med Sci (Hons) MBBS PhDIan. C. Francis FASOPRS, PhDIan. C. Francis FASOPRS, PhD

The sucking chest wound !!The sucking chest wound !!

Is E important ?Is E important ?

What is the world “accepted” rate of EWhat is the world “accepted” rate of E

It is said to be 0.1% : 1/1000It is said to be 0.1% : 1/1000

Is E important in Oz?Is E important in Oz?

NSW has a rate (1998-2004) NSW has a rate (1998-2004)

of 0.823%: >8/1000of 0.823%: >8/1000

Is this really true ??Is this really true ??

Risk factors for acute endophthalmitis after cataract surgery: a population-based study.

Hatch WV et alHatch WV et al

Ophthalmology. Ophthalmology.

March 2009 March 2009

116:425-30.116:425-30.

April 2009April 2009

April 2009April 2009

April 2009April 2009

Nick Mamalis Nick Mamalis Editor JCRSEditor JCRS Professor of OphthalmologyProfessor of Ophthalmology Nick.Mamalis@hsc.utah.edu  Nick.Mamalis@hsc.utah.edu   (John A.) Moran Eye Center :(John A.) Moran Eye Center :

0011 1 801 581 23520011 1 801 581 23520011 1 801 581 2121 (Emergency Switch : the 0011 1 801 581 2121 (Emergency Switch : the best number; they will contact his home)best number; they will contact his home)Office : 801 581 6586Office : 801 581 6586Pager : 801 339 0763Pager : 801 339 0763

11stst May 2009 May 2009

Emanuel Rosen FRCSEEmanuel Rosen FRCSE

Editor JCRS Editor JCRS

Manchester , England Manchester , England