1. cataract postoperative care
Liana Al-Labadi, O.D.

2. complications
Cataract surgery is the most commonly performed operation worldwide
Technological progress has enables major advances in this procedure
As with any surgery there are inherent risks, some of which are related to the increased complexity of the operation
Intraoperative complications
Postoperative complications

3. IntrA operative complications
ICCE
Was the main cataract surgery performed at the beginning of the 20th century
Method:
180 degree limbal incision was created
The lens & the capsule were removed together by breaking the zonular ligaments
No IOL was inserted- patients wore aphakic spectacles; or an ACIOL was inserted
Operative complications:
Vitreous loss
Haemorrhage
Chronic cystoid macular edema
High astigmatism

4. IntrA operative complications
ECCE
Involves a smaller limbal incision- less operative complcations
Operative complications:
Reduced risk of vitreous loss
Remaining undetected cortical material not removed
Results in server post operative inflammation & significant PCO (= posterior capsular opacification)

5. IntrA operative complications
PE (Phaco)
Method of choice
Incisions required are smaller
Procedure much safer
time of recovery, the stabilization of post-operative refraction & amount of induced astigmatism is less
However the technique itself is more complicated
Requires extensive training & manual dexterity \

6. IntrA operative complications
Tear/rupture of the posterior capsule
Can result in vitreo-retinal tractions & eventually RD
Increases risk of endophthalmitis
Nuclear fragments falling into vitreous--> severe inflammatory reaction
Increased risk if weak zonules
PXF, hypermature cataracts & CT disease
Dislocation of nucleus
Loss of lens fragments
Pupil constriction
Small non-dilating pupil can cause visibility issues
Use iris hooks or iris expanders
Useful in patients with floppy iris syndrome
Bleeding
Rare
Anterior capsule tear
Wound leak

7. Posterior Capsular Tear

8. The Routine Routine Postoperative Care: F/U visit schedule
Examination components
Medication Schedule
Early & late post-operative complications
Management of complications

9. Post-op instructions The norm- May remain for 6-8 weeks
Blurry, fluctuating, shimmering vision
Mild discomfort
Drops may sting
Drops may leave harmless white residue in the corner of the eye
Eye may feel scratchy or dry- provide patients with AT
Slight redness
Watering
Mild irritation
Glare
Slight drooping

10. Post-op instructions The DOs:
Wash hands before and after using eye drops
Wear your glasses during the day and wear the eye shield at night x 7 days
Unless doctor instructions specify otherwise
Wear sunglasses when out x 1 week during daylight
To protect the eyes from sunlight & injuries
Shake the drops and use as instructed
Only use clean tissues to wipe the eye
Make sure eyelids are always clean after surgery
Use warm compresses at least twice a day
Use OTC reading glasses until Rx is finalized 4-6 weeks after surgery
If any minimal pain use two Tylenol tablets for relief
Severe pain should be reported to the doctor immediately
Report to the doctor ASAP if:
Persistent pain- not relieved by Tylenol
Redness
Discharge
Unexpected loss of vision &/or field vision
Flashes or floaters

11. Post-op instructions The DONTs:
Activity: Normal activity except heavy labor or sports can be resumed immediately
No heavy lifting (anything over 5 pounds) or bending (below waistline) x 1 week
No driving the day of or after surgery
At 4 weeks all normal activities can resume
Avoid hard rubbing or squeezing eye x 1 month
straining, squeezing or a blow to eye can result in disastrous complications
Face wash: For the first few days, close your eyes when washing face
Bathing:
Avoid any water splashing into the eye x 1 week
Can bathe with head tilted backwards or keep eyes closed during shower
Games:
Avoid strenuous activities like jogging, lifting weights, swimming, gardening, aerobics, contact sports x 2 weeks
Normal daily activities including walking, reading and watching TV may be resumed immediately following the surgery
Makeup: Avoid eye makeup x 2 weeks
Diet: No dietary restrictions
Driving: You should not begin driving until indicated by your doctor
Job: Can resume 2 days s/p surgery
Travel:
Can travel 1 week after surgery
Keep eyes well lubricated during flight
Avoid aspirin

12. F/U Schedule 1 Day 1 week 1 month 3-6 month
*Case Hx: status since surgery? pain? dry? discomfort? sleep? sick? vision?
*VA (s)
*SLE: Wound site (&sutures); K; AC; IOL condition & centration
* IOP
Review Postoperative instructions
1 week
*Case Hx: status since surgery? pain? dry? discomfort? vision? review of complaints & instructions
*VA (s) + SLE + IOP
*DFE: IOL centration & position; Posterior capsule; macula; peripheral retina
*AB drops usually stopped after this visit
*Case Hx: status since surgery? dry? discomfort? vision?
*VA (s) + Refraction/Keratometry + SLE + IOP
*Rx released at this visit
*Steroids & NSAIDs- almost done
1 month
3-6 month
Complete Eye Exam

13. Medication Schedule Week 1 P.O. Week 2 P.O. Week 3 P.O. P.O.
3 Days Before
AntiBiotic QID
NSAID BID-QID
**ATs PRN
Week 1 P.O.
AntiBiotic QID x 1 week
NSAID QIDx 1 week
Steroid QIDx 1 week
**ATs PRN
Week 2
P.O.
AntiBiotic Discontinued
NSAID TIDx 1 week
Steroid TIDx 1 week
**ATs PRN
Week 3
P.O.
NSAID BIDx 1 week
Steroid BIDx 1 week
**ATs PRN
NSAID QDx 1 week then discontinued
Steroid QDx 1 week then discontinued
**ATs PRN
Week 4
P.O.

14. Medication Schedule
Vigamox
Zymar
Besivance

15. Medication Schedule
Acular
Acuvail
Xibrom

16. Medication Schedule
PredForte