Phacoemulsification With Intraocular Lens (IOL) Implantation

Phacoemulsification With Intraocular Lens (IOL) Implantation

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Modern extracapsular cataract extraction surgery involves removal of the lens fibers, which form the nucleus and cortex of the cataract, leaving the posterior epithelial capsule to hold the new artificial intraocular lens (IOL) and keep the vitreous humor away from the anterior chamber. Extracapsular techniques of cataract extraction surgery originally involved manual nuclear expression. Phacoemulsification is a mechanically assisted extracapsular technique of cataract extraction surgery. [1]

A cataract is illustrated in the image below.

Phacoemulsification is illustrated in the image below.

The most common indication for cataract surgery via phacoemulsification with intraocular lens implantation is the patient’s desire to improve vision.

If a patient’s best corrected visual acuity does not meet government agencies and industries minimum standards of visual function for tasks for driving, flying, or operating complex equipment, cataract surgery via phacoemulsification with intraocular lens implantation may need to be considered.

See the list below:

Reduced visual acuity (distant and near objects)

Daytime glare (sunshine)

Nighttime glare (street lights or car headlights)

Distortion of lines (wavy, fuzzy)

Monocular diplopia

Altered colors (white objects appear yellowish, bright colors appear bleached)

Not associated with pain, discharge, or redness of the eye

See the list below:

Reduced visual acuity measured on a Snellen chart or LogMar and near-vision chart

An abnormally irregular, dim, or absent red reflex is seen when the retina is viewed with an ophthalmoscope at arm’s length. Nuclear and posterior capsular cataracts cause a central black shadow across the red reflex. Cortical cataracts cause black spokelike shadows coming from the edge of the red reflex.

Reduced contrast sensitivity can be measured by the ophthalmologist using contrast sensitivity charts.

Very dense “mature” cataracts causing severely impaired vision cause a white pupil.

Shallowing of the anterior chamber and angles with very dense cataracts seen with slit lamp examination

After pupils have been dilated, slit lamp examination shows whether the cataract is cortical, nuclear, or posterior subcapsular and allows fundus examination.

Cataract in children is unusual but may be associated with a white pupil, inability to fix on a target (eg, a light) and the development of a squint.

Low endothelial cell count is a contraindication.

Toxic anterior segment syndrome (TASS) is fast becoming a problem for surgeons doing volume surgery in ambulatory surgical centers and hospitals. Its incidence may be avoided with the following:

Proper use and maintenance of surgical sterilization units

Meticulous care and sterilization of all surgical instruments

Avoidance of reusing cannulas

Washing out Betadine from the surgical field prior to beginning surgery

Minimizing the excessive use of intracameral injections (antibiotics, vital dyes, viscoelastics)

Bobrow JC, Blecher MH, Glasser DB, et al. Surgery for Cataract. Lens and Cataract. 2010-2011. Singapore: American Academy of Ophthalmology; 2010. Section 11: Chap 8.

Waheeb S. Topical anesthesia in phacoemulsification. Oman J Ophthalmol. 2010 Sep. 3(3):136-9. [Medline]. [Full Text].

Gupta SK, Kumar A, Agarwal S. Cataract surgery under topical anesthesia: Gender-based study of pain experience. Oman J Ophthalmol. 2010 Sep. 3(3):140-4. [Medline]. [Full Text].

Anderson NJ, Woods WD, Kim T, Rudnick DE, Edelhauser HF. Intracameral anesthesia: in vitro iris and corneal uptake and washout of 1% lidocaine hydrochloride. Arch Ophthalmol. 1999 Feb. 117(2):225-32. [Medline].

Chee SP, Chan NS, Yang Y, Ti SE. Femtosecond laser-assisted cataract surgery for the white cataract. Br J Ophthalmol. 2018 Jun 15. [Medline].

Yanoff M, Duker JS, eds. Small Incision and Femtosecond Laser Cataract Surgery. Ophthalmology. 4th ed. Elsevier; 2014. 371-77.

Arnold AC,. Basic Principles of Ophthalmic Surgery. USA: American Academy of Ophthalmology; 2006.

Kohnen T, Koch DD. Cataract and Refractive Surgery (Essentials in Ophthalmology). Germany: Springer; 2005.

Leaming DV. Practice styles and preferences of ASCRS members–2001 survey. J Cataract Refract Surg. 2002 Sep. 28(9):1681-8. [Medline].

Alio JL, Fine IH. Minimizing Incisions and Maximizing Outcomes in Cataract Surgery. Germany: Springer; 2010.

O’Brien JJ, Gonder J, Botz C, Chow KY, Arshinoff SA. Immediately sequential bilateral cataract surgery versus delayed sequential bilateral cataract surgery: potential hospital cost savings. Can J Ophthalmol. 2010 Dec. 45(6):596-601. [Medline].

Yanoff M, Duker JS. Ophthalmology. 1st ed. London: Mosby; 1999.

Olver J, Cassidy L. Ophthalmology at a Glance. London: Blackwell Science; 2005.

Seibel BS. Phacodynamics Mastering the Tools and Techniques of Phacoemulsification Surgery. 2nd Ed. 1995.

Manolette R Roque, MD, MBA, FPAO¬†Section Chief, Ocular Immunology and Uveitis, Department of Ophthalmology, Asian Hospital and Medical Center; Section Chief, Ocular Immunology and Uveitis, International Eye Institute, St Luke’s Medical Center Global City; Senior Eye Surgeon, The LASIK Surgery Clinic; Director, AMC Eye Center, Alabang Medical Center

Manolette R Roque, MD, MBA, FPAO is a member of the following medical societies: American Academy of Ophthalmic Executives, American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, American Society of Ophthalmic Administrators, American Uveitis Society, International Ocular Inflammation Society, Philippine Medical Association, Philippine Ocular Inflammation Society, Philippine Society of Cataract and Refractive Surgery

Disclosure: Nothing to disclose.

Barbara L Roque, MD, DPBO, FPAO¬†Senior Partner, Roque Eye Clinic; Chief of Service, Pediatric Ophthalmology and Strabismus Section, Department of Ophthalmology, Asian Hospital and Medical Center; Active Consultant Staff, International Eye Institute, St Luke’s Medical Center Global City

Barbara L Roque, MD, DPBO, FPAO is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, Philippine Academy of Ophthalmology, Philippine Society of Cataract and Refractive Surgery, Philippine Society of Pediatric Ophthalmology and Strabismus

Disclosure: Nothing to disclose.

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Phacoemulsification With Intraocular Lens (IOL) Implantation

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