Presentation on theme: "Dealing with the scariest complication in cataract surgery Dealing with the scariest complication in cataract surgery Ian Francis."— Presentation transcript:
Dealing with the scariest complication in cataract surgery Dealing with the scariest complication in cataract surgery Ian Francis
Leonardo era un pittore straordinario pittore straordinario
First : the most important word in the English language : Ontological : do you believe what you just saw ??
ONTOLOGICAL : “ The way things really are …” FOR EXAMPLE : FOR EXAMPLE : 1. Life 1. Life 2. Your spouse 2. Your spouse 3. Your children 3. Your children 4. God 4. God 5. Surfing 5. Surfing 6. Medicine 6. Medicine 7. Optometry 7. Optometry 8. Ophthalmology 8. Ophthalmology 9. Refractive surgery 9. Refractive surgery 10. Neuro-ophthalmology ………… 10. Neuro-ophthalmology …………
It’s ontological : All Ophthalmology and Optometry is Neuro-ophthalmology
All Ophthalmology and Optometry is Neuro-ophthalmology Why ?? …. because much as anyone may or may not like it : may or may not like it : The eye bone is connected to 1. the brain bone 1. the brain bone 2. the body bone 2. the body bone
Dealing with the scariest complication in cataract surgery
Endophthalmitis : E : E
E : Only happens because someone has been operated !!
Anthony Pane : Neuro- ophthalmologist extraordinaire Everyone in Medicine should read this….
Med J Aust October 2008 “ Misdiagnosis of acute eye diseases by “ Misdiagnosis of acute eye diseases by primary health care providers: incidence and implications “ …. primary health care providers: incidence and implications “ …. 1. Michael O. Statham : RMO : MB BS(Hons), BAppSci(Optom)(Hons) 2. Anamika Sharma : Registrar : BmK BS(Hons), BMedSci(Hons) 2. Anamika Sharma : Registrar : BmK BS(Hons), BMedSci(Hons) 3. Anthony R. Pane : VMO : MB BS(Hons), MMedSc, FRANZCO 3. Anthony R. Pane : VMO : MB BS(Hons), MMedSc, FRANZCO
For E : It is of supreme importance not to 1. underdiagnose E 2. misdiagnose E 3. treat E as of little consequence
E 1. Is either local or metastatic 2. May requires lots of medical work to confirm 3. May be life-threatening….
E : metastatic … patient referred urgently from the EH
Diagnosing E : YOU MAY BE IN THE BOX SEAT
E : 1. Vast majority have had cataract surgery 2. Within a few days of the operation, things head south, often rapidly often rapidly 3. Day 1: vision 6/4 or 6/12 vision 4. Vision on day 4 : HM or worse 5. Pain 6. Loss of the red reflex 7. Hypopyon
…examination requires finesse …
E : Is getting the instructions for the postoperative drops correct really important ?……
The story of a patient of mine with E with E
E story Don : DOB Don : DOB : R phaco Wednesday : uneventful : Thursday : Day 1 pop : VAR : 6/ : Monday 7.40pm : Day 5 pop : VAR : PL VAR : PL All stops pulled out by the VR team ……..
E : VA last week was npl
E : the other eye : 6/4
Endophthalmitis following cataract surgery : the sucking corneal wound Athena Roufas MBBS (Hons), MM (Ophthal Sci) Vivek B. Pandya MBBS (Hons), MM (Ophthal Sci) Edwin C. Figueira MBBS, MSc, MS (Ophthal) Shahriar Amjadi B Sc (Hons), MBBS Gaurav Bhardwaj BMed Josh Baker Katherine Masselos MPH, MB, BS (Hons) Fiona Stapleton PhD Sarosh Batliwalla BEc, MEc, MIntS, FIAA Katherine E. Francis BE (Hons) Rahul Dubey MBBS (Hons) Jeanie Chui B Med Sci (Hons) MBBS PhD Ian. C. Francis FASOPRS, PhD
The sucking chest wound !!
Is E important ? What is the world “accepted” rate of E It is said to be 0.1% : 1/1000
Is E important in Oz? NSW has a rate ( ) of 0.823%: >8/1000 Is this really true ??
Risk factors for acute endophthalmitis after cataract surgery: a population- based study. Risk factors for acute endophthalmitis after cataract surgery: a population- based study. Hatch WV et al Ophthalmology. March :
April 2009 April 2009
April 2009 Nick Mamalis Editor JCRS Professor of Ophthalmology (John A.) Moran Eye Center : (Emergency Switch : the best number; they will contact his home) Office : Pager :
1 st May 2009 Emanuel Rosen FRCSE Editor JCRS Manchester, England